Demand for mental health care has been rising through the coronavirus pandemic after months of job loss, climbing death rates and loneliness. Now, despite dwindling funds and technical difficulties, Montana mental health providers are using unusual strategies to reach isolated patients.
Michael Chavers has worked as CEO of Yellowstone Boys and Girls Ranch, which provides mental healthcare to children, for four years. When schools closed this fall, and children lost the familiar structures and support so many rely on, Chavers and his team began reaching out in unprecedented ways.
"It really has been through texting and the ability to reach out. Previously that was, well, kind of frowned upon prior to the pandemic because of the lack of security in the communication," Chavers said.
Chavers says relaxation of Medicaid requirements allowed therapists to work with kids by text when they didn’t feel safe or mentally well. And Chavers saw higher enrollment numbers than ever at YBGR this September.
"They would just engage in a game, over Zoom or something. Just anything to have that child feel like somebody cared about them and is willing to spend time with them," Chavers said.
Native American youth make up a quarter of YBGR clients. Jani McCall, a YBGR program developer, says Indigenous youth facing mental health problems were already at high risk before the pandemic started. McCall says the suicide rate for Montanans between 11 and 24 years old is eight per 100,000, but for Native Americans in Montana the suicide rate is over five times that.
"When kids leave residential treatment where they've had a very structured experience, where they've had wraparound services, really good education opportunities and all of that, then when they leave, they go back home often to an unstructured setting without the support they immediately need," McCall said.
In an attempt to bridge the gap, YBGR is developing contacts with licensed therapists near or within each tribal nation, who can offer care after a patient is discharged. The program started this fall, and efforts are slow going, but McCall has connected with professionals on the Blackfeet and Flathead reservations, and is waiting to hear from others across the state.
The state gave out nearly $9 million in grants for behavioral health care, but many mental and behavioral health providers, particularly in Montana’s more rural areas, didn’t apply or receive these funds. And while telehealth helps therapists reach isolated patients, Lenore Myers-Nault says it only works if those patients can actually access the service.
Myers-Nault is the Director of the White Sky Hope Center, which offers traditional Chippewa Cree mental and behavioral care at Rocky Boy Health Center (RBHC). Located on the Rocky Boy’s reservation, the clinic has struggled with a problem familiar to many Montana tribal nations.
"I think that's one of the hardest things is that people don't have the resources. Yeah, we could set it up on the service side, but what about the recipient side," Myers-Nault said.
She says some of their patients can’t afford electricity, so how could they afford phone or Wi-Fi services they need to connect to health providers? And she suspects there are even more people struggling who aren’t seeking help due to social stigma around mental health.
"They're suffering on their own in this time. We're already struggling systems and now we have this COVID, which we're not prepared for," Myers-Nault said.
This time has also been difficult for the providers themselves. Like other Montana healthcare facilities, many Rocky Boy Health Clinic workers contracted the coronavirus. Myers-Nault and her husband both worked from home after being diagnosed with COVID-19, which she says was only possible because they own personal computers.
Myers-Nault says even her own mental health, like many Chippewa Cree tribal members, has been impacted after losing family members, as well as the traditional ceremonies that allow survivors to celebrate, remember and grieve the dead.
"We still are tribal people and we have big families. And during this time we're not even able to have our ceremonies because of this COVID, especially our burial ceremonies. It completely changed it," Myers-Nault said.
She says when her uncle was buried, his immediate family couldn’t attend the funeral because they don’t own cars and couldn’t carpool with family for fear of spreading the virus.
"Usually we have a wake, bring the family together, we feed people that come in, then we bury that person. We try to bury him by the fourth day or at least have our feast. But we're not even able to do that. You know, to me, just burying five people? It’s overwhelming," Myers-Nault said.
Myers-Nault says many federal guidelines mandating mental healthcare don’t acknowledge the difficulties specific to rural areas facing high poverty levels like the Rocky Boy’s Reservation.
Myers-Nault says rural clinics like RBHC need to have more of a say in how federal and state funding is used for their community, in addition to just needing more funding, period, to make sure their patients can connect to critical mental and behavioral health care.
Mary Windecker, the executive director of the Behavioral Health Alliance of Montana, says Montana providers as a whole did well for the first six months, but as the pandemic drags on, funding is running out statewide.
"This epidemic has really shown a light on how bad our behavioral health system is, particularly in Montana. The providers aren't reimbursed enough to be able to provide widespread care. The 2017-18 budget cuts mean that a lot of programs closed in the rural areas. We've been rebuilding the program since then, but we were just getting started when COVID hit," Windecker said.
While most facilities are trying to keep up with client needs, they simply don’t have the resources for substantial change, like standing up technology and services to safely provide care to clients without internet. And Montana pays lower rates for behavioral health care than the four surrounding states, Windecker says, which forces workers to either move out of state or transition to less critical settings to make a living wage.
"We need to get behavioral health providers on a level playing field with hospitals and medical care. They need to be able to make enough money to pay people the going rate," Windecker said.
But, she thinks transformational change is possible. She says there are models for funding for behavioral healthcare that other states have used, so Montana wouldn’t need to remake the wheel. But Windecker says that change is something Montana’s legislature needs to prioritize.
"There are serious solutions to this brokenness. It's not all just doom and gloom. We can actually make transformative change and fix it," Windecker said.