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Program Aims To Address Montana’s Mental Health Care Worker Shortages

An illustration of silhouettes of two peoples' heads overlapping at the back and facing opposite directions, evoking mental health issues.

Montana’s mental and behavioral health care system is experiencing a generational crisis.

“It’s on the verge of collapse,” says Mary Windecker of the Behavioral Health Alliance of Montana.

On Windecker’s long list of concerns is a workforce shortage among behavioral health care providers. A new program is now laying a foundation in eastern Montana in hopes of remedying that.

Montana’s shortage of mental and behavioral health care providers is particularly acute in the state’s rural north central and eastern communities. Nurse practitioner Stacy Stellflug says this is because providers don’t stay for the long term.

“Oftentimes what happens is we get health care providers that come to the Wild West to serve their time and they'll do their two, three or four years, get their loans paid off, and then they move on to different settings, unfortunately.”

Stellflug is an assistant professor at the MSU College of Nursing in Billings. She’s leading a new program to train and financially support mental health care students who will eventually serve in 38 of Montana’s most rural counties, often isolated from care. She says these places either have no local specialists, or are struggling with high turnover rates among health care providers.

“That leaves those communities with someone new to start all over again and try to get some sort of camaraderie or rapport built with that provider so they feel comfortable enough to share things that maybe they wouldn’t normally share,” Stellflug says.

That’s particularly true in north-central and eastern Montana. Under the best of circumstances, a resident experiencing a mental or behavioral health crisis might have to drive hundreds of miles to seek care. Even then, Stellflug says the nearest hospital may not have enough adequately trained staff.

Behavioral Health Alliance of Montana’s Mary Windecker says the state’s mental and behavioral health care system has teetered on the edge of collapse for decades.

“But the pandemic really pushed us over that edge,” she says.

Windecker says a combination of factors including spikes in overdoses and mental health care referrals, as well as below cost-of-service Medicaid reimbursement rates, are among several challenges facing providers. Windecker says those struggles are felt by urban and rural counties alike.

They’re also dealing with the same workforce shortage adversely impacting other segments of the U.S economy.

“How can somebody live in Missoula, make 13 bucks an hour and find a place to live with rents going up?” Windecker asks.

The fledgling Montana Behavioral Health Workforce Education and Training–Eastern and North Central Montana — or BHWET-East — is designed to address that shortage of providers in Montana’s north and eastern frontiers.

The program provides training and financial support for students working to become psychiatric mental health nurse practitioners, counselors, or psychiatrists. It’s a network of collaborators, including MSU Billings, Montana State University’s College of Nursing, Billings Clinic and Montana’s Office of Rural Health and Area Health Education Center.

The work is supported by a four-year, almost $2-million federal grant from the U.S. Health Resources and Services Administration.

The grant funding started July 1 and will fund the training program for over four years. Two mental health nurse practitioner students are already enrolled with 16 more close behind.

There’s no requirement that the students will stay in rural Montana once they graduate, but Stellflug thinks most will. She says the program administrators are particularly interested in Montana applicants.

“They get that you will be in a fishbowl and that you will be stopped in the grocery store and asked about a refill on a medication. They’re the ones that really appreciate what it means to live and work in a rural area where resources are sometimes limited and access is often a challenge.”

Stellflug teaches several Native American students who she says intend to eventually treat patients on their home reservations. She adds anyone aspiring to provide mental or behavioral health care in Montana must learn about the cultural aspects of the state’s Native communities.

“We can’t just give education on the reservation and expect people to know or have any appreciation of what each individual tribe has gone through and the historic challenges that they face and continue to face on a daily basis.”

Stellflug hopes the new training program will result in more mental and behavioral health care providers choosing to stay in historically under-served rural north-central and eastern Montana.

Edward O'Brien is Montana Public Radio's Associate News Director.