Bozeman Health prepares to help psychiatric patients ‘on the journey that they’re on’

BOZEMAN — The paint was still drying on the walls of Bozeman Health’s new psychiatric wing in early September. As she walked past colorful murals and busy contractors, Nicole Madden pointed out one of her favorite design details: the hinges on the doors of patient rooms.

Like many parts of the 14-bed adult wing, spanning 9,100 square feet on the ground floor of the main hospital campus, the door hinges are specially constructed to protect people in the throes of mental health crises — while also respecting their privacy and dignity.

“If somebody closes their door and then slides one of these big heavy chairs behind it, tries to barricade, we can actually unlock the hinges,” said Madden, the health system’s director of psychiatric services, demonstrating the dual swing mechanism during a recent tour. The purpose, she said, is to “allow for that autonomy and privacy as much as possible, but in a way that staff can still control the environment and maintain safety for everybody.”

All around the unit, other examples show how Bozeman Health, the largest health system in Gallatin County, has tried to meet a longstanding community need: setting up a modern, medically equipped psychiatric unit where Montanans in serious mental health episodes can receive care for days or weeks at a time. 

Increasing mental health services has repeatedly been one of the top issues raised in polls and surveys about community health needs in Gallatin County. Bozeman, the county’s largest city, has long been the only major Montana municipality without an inpatient psychiatric unit. Community mental health advocates for years pressured Bozeman Health to prioritize developing psychiatric beds above other, more lucrative services, citing the city’s booming population, proximity to rural communities and growing census of university students. 

Even when the hospital began embracing the concept of a psychiatric unit on its campus, fundraising and construction posed a significant hurdle. Each one of the dual-swing doors for patient rooms, for example, cost about $6,500, plus another $800 for installation. The total construction budget for the unit exceeded $6.5 million, according to the hospital’s figures.

Madden said that the expenses are worth it, and that the need in and around Bozeman for the unit is obvious. In 2024, the health system completed 1,359 mental health crisis evaluations, more than half of which were for suicidal ideation or action. Montana has for years had one of the highest suicide rates in the country; deaths are more common among men than women and largely driven by access to firearms. 

Gallatin County is not among the counties in Montana with the highest suicide rates. But supporters of the inpatient unit have long said that the lack of dedicated psychiatric beds in Bozeman also hurts the surrounding region. Without them, patients suffering psychosis, manic episodes and severe depression are funneled elsewhere, straining resources at private hospitals in Helena, Missoula and Billings.

Historically, the Bozeman shortage has also meant that some local patients under involuntary mental health commitments have been transferred to the Montana State Hospital in Warm Springs, the state-run psychiatric facility more than 100 miles away. 

Sen. John Esp, R-Big Timber, said having a new unit in Bozeman will help keep local residents’ care rooted closer to home.

“That’s what it takes. You have to have a warm handoff,” Esp said. “You can do that much easier if you’re in the same locality. It’s hard for anybody to have a warm handoff from Warm Springs to Rapelje or Warm Springs to Ennis. But it’ll be much easier from Bozeman to Ennis.”

Even with the shorter distance, future patients of the Bozeman Health unit may also have to contend with widespread stigma about seeking mental health services before they walk in the door. Madden said the facility’s design was intended to be warm and welcoming — a contrast from the sterile, harsh images some people may have of psychiatric institutions. 

“It’s really hard for people in our state to ask for help, and so I think we have set a tone that is deeply respectful and very welcoming,” Madden said. “And so when people come through our doors, I want them to feel supported by our staff. I want them to feel welcome to come in, be themselves, and work with our team to help them get going on the journey that they’re on.”

Madden doesn’t expect many of the patients coming through to generate revenue for the hospital. Montanans struggling with mental health issues are often covered by the state’s Medicaid program, which reimburses for some but not all of the cost of care. Others may be uninsured entirely. Madden said the hospital, unlike some other types of health care facilities, won’t set aside beds based on insurance type.

On the whole, she continued, the hospital’s goal is to have income from the psychiatric wing break even with its costs. She estimated the unit may have an annual operating budget of $5 million to $6 million — expenses that include supporting a staff of more than 30 professionals, ranging from psychiatrists to social workers, peer support specialists to registered nurses. 

Health care systems in Montana often struggle to meet staffing needs, a problem made even more challenging during the pandemic. But Bozeman Health points to its recent track record of building up a team of behavioral health professionals, many of whom will start to work in the new adult unit when it’s open. 

Those staff members, who were running patient care simulations and continuing to develop detailed policies in early September, are slated to begin treating patients within weeks. Madden said she hopes that Montanans who begin to fill the unit later this month will eventually leave with enough support to thrive outside the hospital’s walls.

“A place to go next, a plan for how they’re going to be successful in the community, and not feel like they ever need to come back. They’re welcome here, but we want people to feel so prepared when they leave this place,” Madden said. “That they have the tools that they need to be successful.”