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Cuts & Consequences

Montana budget cuts hitting case workers, clients

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MISSOULA - Mental health case managers play a critical role in communities across the state, but because of state budget reductions, many have lost their jobs. The consequences of these targeted case management budget cuts are proving to be devastating.

Gov. Steve Bullock’s state budget cuts in 2017 effectively dismantled the community based mental health care system in Montana. The cuts eliminated almost $6 million that funded targeted case management for adults living with severe disabling mental illness.

Case managers worked to support this population so that these people were able to live in their homes and communities. Dozens of case management professionals were laid off statewide and clients were left hanging with less appropriate options for their care.

Western Montana Mental Health Center (WMMHC) laid off 16 case managers in Missoula at the end of 2017 because of funding losses.

Those case managers predicted what would happen next. In December, former WMMHC caseworker Lisa Leon told MTN News she was already receiving calls from clients, panicked about losing their support system.

“I had a client who -- because of this news -- did attempt to kill himself. [He] wasn’t successful, but that’s just the beginning,” Leon said in December. “You know, I don’t know how many more, I’ve got people going into crisis people calling me up freaking out…I don’t know what to tell them.”

Almost immediately, some of the clients on their caseloads began to fall apart without case management support and ended up being put into mental health treatment by the court system.

“If you take away someone’s crutches, they are going to fall. Case management is their crutches. These people fell…and it’s costing the state,” Leon said. “Why are involuntary commitments up? It’s because there aren’t case managers there to field the call when somebody is going into crisis,” Leon added. “And then police get called and somebody is put into an involuntary position.”

Agencies and organizations are absorbing the consequences. The Missoula County Attorney’s Office is filing an increasing number of petitions for involuntary commitments in 2018 due to the elimination of case managers.

“If a person with a serious mental illness is not able to meet their basic needs of housing, clothing, health, safety -- or they are an imminent threat to themselves or others, they are suicidal, or homicidal -- and that gets reported, then our office will file a petition to put them into inpatient treatment involuntarily if they are not willing to go,” explained Missoula County Deputy County Attorney Jordan Kilby.

Kilby says police officers or family members will bring them into an emergency room for an evaluation if they have committed a crime or they are unable to maintain their homes or showing other symptoms of a mental illness.

Compared to the same four-month time frame in 2015, 2016, and 2017, there are already almost 20 more cases than usual. There were 74 cases in 2015, 69 in 2016 and in 2017 there were 78 cases. Just this year so far, there are 98 petitions for involuntary commitment filed by the Missoula County Attorney’s Office.

Not only are the number of these commitments increasing, but Kilby says people are coming across their caseload in worse condition than usual. It’s called decompensating, where people living with these severe types of mental illness stop taking care of themselves and become a danger to themselves or others.

“Over the past three months, I have just felt like people had decompensated to a point where they couldn’t function in the community or in the community beds, so we were having to send more people to the state hospital,” Kilby said. “Where, before, people hadn’t decompensated quite that much by the time they came into our system.”

WMMHC staff members say the state is going to be dealing with increased costs associated with more people in need of higher levels of care.

“Putting people into a higher level -- into a high level of care -- either the Montana State hospital system or the detention facility is much more expensive,” said WMMHC’s Mary Windecker.

“So, it’s going to cost the state much more in the long run than people living individually in their communities. It’s better care for them, it’s less expensive for the state – so, it’s really not a proactive way of looking at mental health treatment,” Windecker concluded.

The Western Montana Mental Healthcare Center has reworked some of their programs to help support people who lost their case managers or are in need of care.

RELATED: Health service cuts menace Missoula Co. agencies, commissioners

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