State commission promises rebuild of the mental health system

A group of lawmakers, health department staff and service providers have launched a years-long effort, conceived during the 2023 Legislature, to “rebuild” Montana’s snarled and fragmented system for serving people with developmental disabilities, mental health and addiction needs.

The Behavioral Health Systems for Future Generations Commission, the brainchild of the Gianforte administration and Republican lawmakers, pulls together $300 million for potential capital development, boosting community services, and fixing other system shortfalls in the coming years. Gov. Gianforte has touted the effort as a “historic investment” to repair the Montana State Hospital in Warm Springs, strengthen local and community-based services, and much more.

During their inaugural meeting Thursday, members generally agreed that the commission’s directive is as daunting and important as it sounds.

“We’re all excited to take the first step toward implementing and formulating our collective vision for a system that will care for our families and friends with these life-changing problems,” said Sen. John Esp, R-Big Timber, one of four Republican lawmakers on the commission.

Led by Rep. Bob Keenan, R-Bigfork, and the governor’s health department director Charlie Brereton, the commission is also made up of two Democrats and two Montana behavioral health and developmental disabilities experts. 

Over the course of their roughly six-hour meeting Thursday, most appointees, guests and public commenters agreed on a basic premise: The state is deeply inadequate when it comes to caring for vulnerable groups. 

On any given day, would-be-residents sit on stubborn waitlists for understaffed group homes; a discharged state hospital patient leaves the federally uncertified facility only to arrive at a local homeless shelter; tens of thousands of Montanans live with a substance use disorder, most of whom have never received treatment; suicide rates are persistently, tragically high.

But finding solutions, participants said, will take months of creative thinking and building support among stakeholders, the governor’s administration and lawmakers. 

“As you’re building this out, remember: It’s going to be a long, hard fight for this stuff,” said Matt Kuntz, president of the NAMI Montana mental health advocacy group and one of several public commenters who spoke to the committee. 

According to the commission’s founding piece of legislation, House Bill 872, the group is tasked with developing by July 2024 a report with recommendations, which they will eventually present to Gianforte. The governor can revise the recommendations and propose new initiatives subject to the review of the commission and other legislative oversight committees. If a legislator does not approve of a proposal or designated funding, they can tap the existing process for polling lawmakers to convene a special legislative session.

The commission focused much of its meeting debating a set of seven priorities developed by Brereton and state health department staff to guide its work. The topics include developing an evidence-based, sustainable crisis response system that spans the entire state, finding “clinically appropriate” settings for Montanans with different diagnoses and needs, expanding mental health and addiction services for adults and children, and boosting capacity of development disability providers. 

The group is also accepting “requests for information” until August 11, later than the original July 31 deadline, from patients, family members, advocates and providers about ways to improve behavioral health and developmental disabilities services in Montana. 

Brereton also made clear that the commission’s work would be informed by a not-yet-awarded contract with a third-party consultant. That contract, according to a background packet provided by department spokesperson Jon Ebelt Thursday, is meant to “support the department in designing and implementing a cohesive behavioral health system and developmental disability service strategy that meets the needs of Montana with excellence.” 

Brereton said the state has closed the contract for further bids and intends to pick a consultant in the next two to four weeks. He did not disclose how much money the state had offered; Ebelt deferred later questions about the value of the contract to the Department of Administration, citing the ongoing selection.

The Gianforte administration has already received input from consultants in its ongoing handling of the state hospital crisis and strains on other state-run facilities, as well as how to fix the lagging reimbursement rates for health care providers who accept Medicaid patients. It is not clear if those groups, Alvarez & Marsal LLC and Guidehouse, Inc., submitted bids for the new contract.

Commission members stressed their interest in engaging a wide variety of experts and people with experience in these health care systems during the months ahead. The effort of evaluating the current system and designing a better one, the group said, will likely take many hands on deck.

“I’m willing to listen to innovative thinking on how we can do things better, how we can get more bang for our buck, how we can move the bar up and forward,” said Esp. “We are committed to making this work. The Legislature as a whole is committed to making this work.”

“Or else,” Keenan added.

The group is scheduled to meet again in September.