People suffering from mental illness, whether it is thoughts of suicide, paranoia or other debilitating and dangerous issues, face an increased uphill battle in Madison County because of the limited local services available to help them, their families and friends. Services are available but spread out in regional communities like Dillon, Butte and Bozeman. That distance adds to the cost of help both financially and with an added time commitment.
The Madison County Health Department released a county health assessment in October 2011, which was aimed to help guide future health efforts in the county. The main idea behind the survey was to give the county an idea of the overall health of the county’s population and what needs exist in terms of health care services.
Some problems the health assessment pointed out were the lack of mental health services and problems that may be related to binge drinking and suicide. The health assessment showed that Madison County’s binge drinking rate was 19 percent, which was higher than the state average of 17 percent in 2011. The county also had a higher suicide rate than the rest of Montana—23.2 per 100,000 people as opposed to Montana’s rate of 20.3 people per 100,000. At the time of the survey, Montana had the highest suicide rate in the nation.
It is not just these issues that affect Madison County residents. The county’s elderly population has needs of its own.
“We work with residents who are in need of mental health services but the services have not been available. More and more has been done with telemedicine,” said Darcel Cook, Madison Valley Manor Administrator.
She said the Ruby Valley Hospital now has tele-psychiatry services available, which consists of a room with a television, webcam and other equipment set up for patients so they can get mental health services from a variety of mental health professionals. Cook said there is currently a grant awarded to several states, including Montana, which helped to put this service in place. The Madison Valley Medical Center is considering a similar service in Ennis.
“We would definitely use the service if it were next door. We also have St. Pete’s in Helena that is a short-term inpatient psychiatric hospital and they do have senior beds,” Cook said. She added that the problem with that is most families do not want their loved ones far from home and it is unfair that they have to be uprooted to get care, especially as dementia is becoming more and more prevalent and one of the biggest reasons people end up in nursing homes. Another issue is that their beds are usually full. Even in Bozeman there are waiting lists that can be months long, according to Cook. She said it is also very difficult for some of the residents to make that trip; even going to Sheridan would be a hardship for most.
Law enforcement in Madison County often receives calls about people in possible need of mental health treatment—threatening suicide, acting strangely or showing other potentially harmful actions. Ennis Police Chief Scott Newell said officers must be sure to treat these people not as criminals, but address the situation as a medical need. Once law enforcement has determined if the person is a danger to themselves or others, they more often than not have to call in the Crisis Response Team (CRT) or another entity to evaluate them. The Crisis Response Team out of Gallatin County serves Gallatin, Park and Madison counties. The CRT, which consists of a number of mental health professionals, has seen a rise in the number of patient evaluations it does. The number rose by almost 700 between the last two fiscal years. They can recommend either voluntary or emergency detention arrangements. The evaluations are often done at the Bozeman hospital or the Hope House in Bozeman, according to Newell. He added that sometimes area hospitals will not evaluate someone who poses a danger to its staff and other facilities are often full or have a long waiting period.
A determination of mental illness by the CRT or another qualified body does not mean the person will necessarily get help. Newell said law enforcement has to contact the county attorney’s office and the matter is brought before the District Court. A judge then has to see the patient, who needs legal counsel, in court within 24 hours of the evaluation. The patient can deny the allegations and request not to be committed. It is up to the judge to decide what happens from that point on.
Privacy and the stigma around mental health issues continue to be issues that keep people from seeking help. All court proceedings mentioned above are closed to the public, but according to Newell and Christine Durham, Madison County Public Health Registered Nurse, in the small county and its small communities, word of someone simply asking about mental health services can imply there is an issue and people begin to talk.
Area schools must balance these issues—stigma and privacy—as well as educating students about warning signs and ways to prevent problems. Some schools, like Sheridan, have a full-time school counselor. There, Dr. Laurie Bartoletti has a focus on college and career, along with mental health issues. Some of the classes she teaches are the K-8 daily classes on friendship, personal safety, career, bullying and leadership.
“In addition we house Alta Care, a counseling and behavior assistant service,” Sheridan Superintendent Kim Harding said. “The counselor and behavior management specialist work almost daily with students to support them with mental health and academic issues.”
Staff at Ennis schools recently completed suicide prevention training in part with a safety and security assessment by the Montana Safe Schools Center. Ennis Superintendent John Overstreet said the training was well attended by the staff.
Durham said the combined limited resources and stigma attached to needing them only add to issues facing a person with mental illness.
“Even though there is a large need in Madison County, the county’s population is not high enough to sustain a full-time practice,” Durham said. She added that at a recent Madison County Board of Public Health meeting, a group of people from surrounding counties discussed the need and desire for a multi-county partnership related to mental health services. That committee is still in the process of being formed, but will look for public input in the future.