Access to mental health services, something already hard to get for some Montanans, took a step backward this year because of state budgeting issues.
In the wake of the budget cuts, 10 offices closed and over 100 behavioral health care workers lost their jobs, according to one count by the Behavioral Health Alliance of Montana, which represents more than 30 providers.
Now Governor Steve Bullock says the state is in a position to put some money back into those programs, but not enough to restore them completely.
His administration’s health department says it will work toward redesigning the system that helps people with mental health needs live independently and will do so with public input.
Mary Windecker is executive director of the Behavioral Health Alliance of Montana. She says she’s optimistic the state-provider relationship is improving after a tense year and a half.
Corin Cates-Carney: Mary Windecker, thanks for taking the time with Montana Public Radio.
Mary Windecker: Thanks, Corin.
CCC: Now that money is available and being put back to some of these services, what does that mean for the providers and clients of behavioral health services in Montana?
MW: Well, we serve adult and children mental health and also tribal and behavioral health providers so there wasn't an aspect of any provider that is part of our alliance that was not impacted by the budget cuts. So we really are looking at how the state is reallocating that money. We're thrilled that the governor and DPHHS have made the decision to put that money back into the system. And now we're really just looking at how we can craft, with the state as a partner, sustainable, evidence-based, outcome-based programs so we don't find ourselves in this situation again in a year or two.
CCC: And even before these programs were cut, what was the state of these kinds of services in Montana?
MW: Well, we haven't had a sustainable behavioral health system in a long time. Money that was taken from the institutions and given to behavioral health in the community in the 70s' has just steadily been whittled away. And I think that, largely, it's because people don't understand how behavioral health is reimbursed. And also, there were no outcomes being tracked so people were possibly receiving case management longer than they needed to or they weren't receiving the right kind of case management or they weren't improving. There was no way to show whether we were doing a good job as providers.
Montana spends a lot of money on behavioral health. So it's not that there's not enough money in the system, it's how it's being spent. So that's something that the state has come to us and said, 'we want the providers input on how we recreate this program so it's sustainable and you can show that you're doing good as providers with the clients.'
CCC: For people who aren't in the industry, what is case management?
MW: Case management is really helping people live independently in their communities. So the case managers typically will help them with housing vouchers, help them with insurance paperwork, help them get on Medicaid if that's a concern, make sure that they're seeing their physician, make sure they're seeing their therapist, make sure that they're taking their medications. And when that system went away, these people had nowhere to turn. It really is the equivalent of getting rid of primary care in the medical community and only treating people in the emergency departments.
CCC: If this is such a vital service for such a vulnerable population of people why is there this big gap?
MW: I think it was a lack of understanding. I think anytime you have people who don't really understand the intricacies of medical care, behavioral health care - when we threw the baby out with the bathwater and now we're left to rebuild the system. But I think we can rebuild it in a sustainable, really cost-effective way so that these people aren't left without a safety net.
CCC: As the mental and behavioral health system was disrupted over the past year and a half with these budget cuts, has a new relationship between the providers and the state formed because of all of this?
MW: I'm optimistic on that. I think that it was a rude awakening for both sides and everybody involved didn't really understand how valuable these organizations were. You know, we saw it really impact law enforcement, emergency rooms and hospitals, community health centers. Everybody was just hit. These people had nowhere to go.
And so, I think that in many ways it was a good education for the state to understand that this really is a valuable service. And on the providers side, I think it really lit a fire under the providers to want to be a part of the solution instead of just continuing on with the system we had.
CCC: And as the system is rebuilt, your organization, the Behavioral Health Alliance of Montana, what's its role in all that?
MW: Well the state has asked us to be the provider voice, so we have two task force that I've organized with our providers - one for children, one for adults - and those providers will be working with the state to really craft a new system for case management.
CCC: Can you give us a picture for how this new system differs from what's currently in place?
MW: Well in the past, we've sort of been given marching orders and what the reimbursement will be without really a negotiation on what makes sense.
CCC: And when you say reimbursement rate that's Medicaid reimbursement rate?
MW: Correct, that's Medicaid reimbursement rate for case management or any other service in the behavioral health system. And it's largely 90 percent Medicaid. And so, how that reimbursement was set didn't always make sense. So I think it's really educating the state and listening to what their concerns are so that we put together a system that works for both sides so that we don't find ourselves in this situation again.
CCC: This Thursday the state health department is taking public comment on the budget restorations outlined by Governor Bullock. After a year of a lot of uncertainty within the healthcare provider industry, are there clear expectations now and is there a road map for what you can expect to see out of the state?
MW: No. There's just nothing clear about healthcare delivery. It never is, and we're used to that. We're just very appreciative and that's what we'll be saying at the session coming up is how pleased we are that the state is willing to make us a part of the solution. We're ready to get to work. We want to really turn the corner on these cuts and put them behind us and really come up with something new and innovative for the state of Montana and the clients that the providers serve.
CCC: The public comment that will be taken on Thursday about these budget restorations - do you see them as needing some changing before they're made official?
MW: Well there's a lot of things that haven't been decided yet. So I think that any time the state and DPHHS and the legislature is listening to the providers and the clients on the ground, there's a saying, 'do nothing about me without me.' And I think that's a very, very important to remember in healthcare that we're not imposing a system on people. We're listening to people and finding out what really suits their needs in moving forward with their lives.
CCC: Mary Windecker is the executive director of the Behavioral Health Alliance of Montana. Mary, thanks for taking the time.
The Department of Public Health and Human Services is taking public comment on the administration's plan for their $30 million budget restoration this Thursday, Sept. 27 at 10 a.m. The public hearing will be held at the DPHHS office in Helena.
