When L tells the story of her mom’s cycle of mental health crises and homelessness, she brings a stack of papers and notes documenting how hard it is to help.
She's spent more than a year trying to navigate the state’s mental health system, searching for anyone who can help her mom stabilize.
Her mom Ellen is in her 60s and has been homeless for eight years. She struggles with schizoaffective disorder, a mixture of schizophrenia and bipolar. Ellen also has anosognosia, which means she doesn’t understand that she has a mental health condition and because of that refuses to get treatment.
This story uses L’s first initial and Ellen’s middle name to protect their privacy and Ellen’s ability to get housing. That’s also why Ellen won’t be quoted in this story.
In late 2023, L uprooted her life in Colorado to move back home to Missoula, Montana and help her mom regain mental health services and find a place to live.
She found Ellen was unmedicated and too unstable to live with her. L is an only child and has trauma from growing up with her mom’s illness.
“And it’s pretty painful on cold nights to have to not let somebody in because it will deteriorate your whole mental health and stability,” L said as she pet her dogs on the couch at her Missoula home.
Ellen was mostly stable and had housing until 2017. State budget cuts to Medicaid that year led to the end of her case management, which helped her with everything from housing to health care.
Ellen was mostly stable and had housing until 2017. State budget cuts to Medicaid that year led to the end of her case management, which helped her with everything from housing to health care. Ellen’s rental sold around that time and without a case manager to help her, she stopped taking her medications and fell into homelessness.
Ellen spiraled on the streets. She got trespassing violations when she tried to find safe places to sleep. She went to jail, was sent to a shelter, the ER or the state psychiatric hospital.
It became a familiar cycle. Montanans like Ellen often never get the long-term help they need. But major spending on the state’s mental health system may offer some hope. Gov. Greg Gianforte and lawmakers will decide during the 2025 Legislature how to spend most of a $300 million appropriation to reform everything from the state psychiatric hospital to community services.
Montanans like Ellen often never get the long-term help they need. But major spending on the state’s mental health system may offer some hope.
When L first arrived back in Montana, she quickly saw the gaps in services for people like her mom. In the search for help, she met Theresa Williams. Williams leads Missoula County’s crisis intervention team, which takes on tough cases like Ellen’s.
“We’re talking years and years and years of this particular individual falling through the cracks of our community,” Williams said.
Ellen needed housing to have any hope for long-term mental stability.
L and Williams coordinated with mental health providers, county officials, the local hospital, law enforcement and more. They had some success. Ellen regained case management services. But she still refused medications and often got kicked out of the homeless shelter.
L and Williams decided that Ellen needed to go to the state hospital where staff can involuntarily give her medication.
“We were kind of hoping this intervention at the state hospital would help with stabilization, but really, it was still a band-aid,” Williams explained.
It was a band-aid because there was still no clear path to housing that could break the crisis cycle.
A task force of state policymakers say they’ve developed a package of potential solutions.
“I have hope that we turned the corner. At least we recognize all throughout the state that those people dealing with serious mental illness need treatment, they need community support, those families need support,” said Republican Sen. John Esp, who sat on the Behavioral Health System for Future Generations Commission.
It made recommendations for how to spend the $300 million to improve Montana’s mental health safety net.
Some money is already flowing to help communities reopen crisis facilities, group homes and stabilize mobile crisis teams among other near-term fixes.
Some money is already flowing to help communities reopen crisis facilities, group homes and stabilize mobile crisis teams among other near-term fixes.
Other reforms the commission and Gov. Gianforte want to make need approval from state lawmakers because they will require long-term funding.
So far, legislators are supporting the creation of a “step-down facility” that will treat Montana State Hospital patients who aren’t ready to be discharged back to the community. Sen. Esp says he will have a bill that would create a second facility in the eastern portion of the state.
Lawmakers also gave initial approval for 24/7 mobile crisis teams and stabilization care and the state’s participation in a federal program that will give local mental health clinics more funding.
Those reforms could help people like Ellen, but housing still might be a barrier to long-term stability.
”These people do get out of a hospital setting, get out of a step-down facility and they go back into a homeless situation here in Missoula, Billings or somewhere else in the state and then the cycle repeats itself because there isn’t a long-term plan,” said Missoula County Attorney Matt Jennings.
”These people do get out of a hospital setting, get out of a step-down facility and they go back into a homeless situation here in Missoula, Billings or somewhere else in the state and then the cycle repeats itself because there isn’t a long-term plan,” said Missoula County Attorney Matt Jennings.
The state has set aside nearly $16 million to open around 400 beds in residential facilities like group homes. However, not every bed will be for adults with severe mental illness.
Jennings says congregate settings like group homes also don’t work for everyone.
There are 100 people like Ellen in Missoula County alone, according to Jennings. He says the state will need to find more ways to house those with severe mental illnesses.
Sen. Esp understands that frustration and says he and other lawmakers will continue to push recommendations they made in future legislative sessions, calling this first round a “foundation.”
L hasn’t been following the proposed reforms closely but says they do give her hope her mom will receive more support next time she is in crisis.
She says the system is in shambles. L hoped Ellen would stabilize after she got to the state hospital, but staff gave her the wrong medication, further destabilizing her as she returned to homelessness.
L, Theresa Williams and local service providers worked for months to convince Ellen to take medication that does work. Luckily, she agreed.
“My mom does have some sort of a life back,” L said.
Ellen has been able to stay in the homeless shelter more often. That’s allowed her to avoid run-ins with law enforcement and has stayed out of ERs. But permanent housing remains elusive, and L knows her mom could go downhill again without a place to live.
Ellen has been able to stay in the homeless shelter more often. That’s allowed her to avoid run-ins with law enforcement and has stayed out of ERs. But permanent housing remains elusive, and L knows her mom could go downhill again without a place to live.
Ellen has agreed to get on waiting lists for group homes and assisted living. L hopes a bed opens and her mom agrees to take it.
For L, this experience has eroded her own mental health. She’s moving out of state.
“I will always help her moving forward, but I also have to put myself first, too because I don’t have anyone else doing that,” L said, wiping tears from her eyes.
