Lawmakers push legislation to address Montana's mental health crisis

When Brandi King finished a 14-month deployment with the United States Army, she returned home to Montana’s Fort Belknap Indian Reservation to heal.

King carried with her the trauma she experienced during combat in Mosul, Iraq. She began to feel anxious, hypervigilant and she couldn’t sleep at night. In rural Montana, mental healthcare resources can be scarce. King wasn’t able to see a counselor or support specialist, and her post-traumatic stress progressed.

She became suicidal and attempted to take her own life more than once.

Family and friends were supportive and wanted to help, but like anyone suffering from an illness, King needed more.

“People like myself end up in the emergency room, crying out for help,” King said.

It’s been more than a decade since King returned home, and the now 38-year-old is representing the interests of the Fort Belknap Reservation at the Montana Legislature. As a member of the Fort Belknap Indian Community Council, she’s uniquely aware of her community’s needs.

King recently told her story to a room full of lawmakers and audience members in a Senate committee hearing at the Montana Capitol. She was speaking in support of Senate Bill 30, which would give Medicaid expansion reimbursements to specialists certified in peer support. In an interview afterward, she said she felt a responsibility to share her experience.

“This is just one story in 10,000,” King said.

Data from the Centers for Disease Control show Montana leads the nation in death by suicide per capita, with 28.9 suicides per 100,000 people.

This ranking has spurred lawmakers to try to improve mental healthcare for Montanans, and a number of legislators on both sides of the aisle have introduced bills in that effort. Ideas range from providing grant money to schools for suicide prevention to allowing psychologists to prescribe certain medications.

Peer Support

Sen. Jen Gross, D-Billings, is carrying SB 30, the bill that would add certified peer support specialists to the list of professionals who can be reimbursed through Medicaid expansion for healthcare services.

The Substance Abuse and Mental Health Services Administration defines a peer support specialist as someone who uses personal experience with mental illness and/or addiction combined with formal training to promote recovery and resilience in behavioral health. The idea is for someone to draw from his or her personal struggle and triumphant to help others do the same.

In an interview, Gross said it’s important to emphasize that peer support is an evidence-based practice. She said specialists fill a gap in resources at a lower cost, and argued this is why they should qualify for reimbursement.

“Certified peer support specialist are really critical to the infrastructure of mental healthcare in the state,” Gross said.

Jason McNees works as a peer support specialist for the Helena Indian Alliance and spoke in support of the bill. He said in the past year, he’s retained 85 percent of his clients who sign up for support services. The training for peer support specialist is similar to that of a licensed counselor, McNees said, and it’s meant to supplement other treatment.

“We’re very successful in the service we provide,” McNees said.

Representatives from Billings Clinic, Montana Centers for Independent Living and the Rocky Mountain Tribal Leader Council also spoke in support at the hearing. No one spoke in opposition.

Matt Kuntz, executive director of Montana’s chapter of the National Alliance on Mental Illness (NAMI), said in an interview that having a shared experience between peers has proven to be really valuable in mental health care.

“[Peer support] has matured to the point that it’s time to make it real,” Kuntz said.

Two other bills introduced in the Legislature would make mental health support a part of a child’s education.

Youth Suicide Prevention

Shodair Children’s Hospital in Helena has seen a 19 percent increase in admissions for inpatient mental healthcare since 2017. Carly Sell, a registered nurse for the psychiatric care provider, said that mental illness among children is more common than people realize.

“We probably all know those kids but we don’t know they’re struggling,” Sell said.

Sell is also the program director for the hospital’s Grasslands Acute Program, one of four units that admits patients, divided by age. In total, the acute units admitted about 1,100 kids in 2018. Sell said at least 75 percent in acute units are admitted with some form of suicidal ideation.

Rep. Mary Ann Dunwell, D-Helena, has introduced two bills aimed at preventing youth suicide, and Sell spoke in support of both.

The first, House Bill 186, states that Montana’s youth suicide rate is “intolerably high” at twice the rate of the national average. The bill would create a student mental health screening pilot program. It would be funded by grants awarded through the Montana Office of Public Instruction. It asks for an appropriation of $1 million from the Legislature’s general fund.

It’s a bipartisan effort between Dunwell and co-sponsor, Rep. Joel Krautter, R-Sidney. He spoke as a proponent during the bill’s hearing and said it’s an issue that has affected his eastern Montana district.

“As we battle this epidemic, we must give our community partners support so we can turn this around,” Krautter said.

Communities would be able to choose what screening programs work best for their distinct populations, as long as the programs are research-based.

The bill is moving on to the full House for debate after it passed out of committee on a 19-0 vote.

Its companion bill, House Bill 187, would revise laws already in place addressing youth suicide prevention. The Montana Department of Health and Human Services has a suicide prevention officer who directs prevention programming across the state.

Dunwell’s second bill would have this office evaluate and award grants for suicide prevention activities, and it would appropriate $1.3 million from the state’s general fund for those grants. The bill’s language would require grants be prioritized for research-based practices. An example of one such program is Youth Aware of Mental Health (YAM). The program is used globally to encourage young people to think about and discuss mental health issues.

Montana State University Extension is promoting the program in the state and 17 Extension agents are certified to teach YAM in rural schools, like Shelby, Miles City and Ronan.

Colleen Murphy spoke in support of the bill as a clinical social worker in Boulder’s elementary school. She said the youngest child who has expressed suicidal thoughts in her office was in third grade.

“The more mental health preparation that we have, the better,” Murphy said.

This bill was tabled during executive action in committee, meaning it will be on hold until committee members decide if they want to debate it on the House floor or not.

Psychologists and prescription medications

A mental healthcare-related bill still waiting for a committee hearing is Senate Bill 106. Sen. Jason Small, a Republican from Busby on the Northern Cheyenne Indian Reservation, is carrying the legislation that would allow clinical psychologists to prescribe medications.

In an interview, Small said this would be “extremely beneficial” to reservations, and rural Montana in general.

Psychologists can prescribe prescription medications in five states, including Idaho and New Mexico.

Dr. Earl Sutherland is a clinical psychologist at Bighorn Valley Health Center in Hardin and was instrumental in drafting the bill. He said he can’t ever seem to hire enough people at the rural health center.

“We have a critical shortage of mental health providers and services,” Sutherland said.

The bill includes 12 pages of restrictions and requirements for psychologists to prescribe medication, like a masters’ degree in clinical pharmacology and strict record-keeping mandates. It also specifies psychologists would only be able to prescribe “drugs or medicine customarily used in the diagnosis and treatment of mental or emotional disorders.”

Sutherland said he would tell legislators considering this bill:

“Please give us the opportunity to help our patients.”

However, this type of practice also draws controversy. Kuntz said NAMI Montana would not be taking an official position on the issue because it’s torn. On one hand, it could help rural Montanans, Kuntz said. But he’s worried it could have adverse effects.

“[Therapeutic] psychologists are an asset themselves. They are incredibly important in Montana, and if we incentivize them to leave that practice, then who will provide it?” Kuntz said.

Small will present SB 106 to the Senate Business, Labor and Economic Affairs Committee on Feb. 1 at 8:30 a.m.

Individual communities are attempting to solve healthcare problems on their own while they wait for state resources.

In King’s hometown, a new program called Fort Belknap Integrated Behavioral Health, within the tribal health department, is trying to close resource gaps.

At one point, the reservation had one person handling all calls and referrals related to suicide. Now, with the formation of the new program, Fort Belknap will gain a clinical psychologist, a licensed counselor and four mental health advocates.

However, that’s just the beginning to what King hopes for mental healthcare development in Montana.

“That lack of resources is why I feel so strongly about advocating for support,” she said, “Especially to help the younger generations.”

Shaylee Ragar is a reporter with the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, the Montana Broadcasters Association and the Greater Montana Foundation. Shaylee can be reached at [email protected].