Bright spots in a dark struggle

The year 2021 was a big one for Emilie Sayler. That’s when Sayler’s studies at the University of Montana and work at the Ruby Valley Hospital placed her at the center of two major crises. 

First, there was the pandemic. 

“While working at the hospital, I had the opportunity to coordinate vaccine clinics during the COVID-19 rollout,” she recalled in a recent phone interview. “We, at one point, had a waitlist of about 1,000 people looking to get their COVID vaccines. It was a fascinating experience to be studying for my master’s in public health from the University of Montana while working in it.”

In the spring of 2021, an opportunity presented itself: the position of Public Health Director for Madison County. Sayler applied.

“I was just fascinated by the work,” she said.

But then came another kind of plague, one that revealed Madison County residents to be tragically vulnerable to suicide.  

“From January 2021 through August 2022, we had an 18-month period when we lost eight residents,” said Sayler. “At that time, our estimated population by census was just over 8,000, so we had a suicide rate of one per 1,000 or 100 per 100,000, which is incredibly high. I think at the time, it was about four times the national average.”

In response, the county created a fully funded position within public health for a behavioral health therapist to serve the community. Despite this effort, a suitable candidate still eludes the county. 

“We’ve had that position posted for almost two years now,” Sayler said. “We’ve been really close to filling it a couple of times, but we just haven’t been able to secure a licensed worker who is willing to come in and fulfill those duties.”

Sayler appears to maintain her resolve by working alongside others across Southwest Montana. This teamwork, according to recent news from the Montana Department of Public Health and Human Services, could pay off for Madison County residents in need of better options for accessing behavioral healthcare. 

Madison County was part of a grant application in collaboration with Silver Bow County and other surrounding counties. The grant aims to fund a regional crisis coordinator who would handle crisis care needs, resource mapping, and other critical outreach specific to each patient. 

“That information would be incredibly valuable for us to know what resources we need to develop locally, prioritize what the needs are, and see what’s feasible based on what’s actually happening,” said Sayler.

The current round of grant funding was announced recently by Gov. Greg Gianforte, who described it as a $15.8 million investment in one-time grants to increase bed capacity for community-based residential providers offering behavioral healthcare or developmental disability services to Montanans.

As recommended by the Behavioral Health System for Future Generations (BHSFG) Commission, the investment represents the next allocation of $300 million in funding secured by the governor last year to reform and improve Montana’s behavioral health and developmental disabilities services systems.

“Timely access to more residential services at the local level is critical and plays a major role in preventing the need for more intensive services down the road,” Gov. Gianforte said in a press release. “I thank the commission for advancing another recommendation that will help to transform the delivery of behavioral healthcare in Montana.”

Department of Public Health and Human Services (DPHHS) Director Charlie Brereton said the goal of the grant program is to stabilize or increase residential services across Montana and to build sustainable capacity, while also ensuring more Montanans can be served in clinically appropriate settings closer to home.

“This funding represents yet another key milestone to ensuring providers at the local level have the resources they need to serve Montanans appropriately,” Brereton said. “We know the current lack of residential services capacity in our state leads to inefficient treatment, challenges for patients discharging from inpatient settings, and missed opportunities to keep Montanans closer to home. We are eager to help solve this long-standing issue and will continue to advance projects like these with the needs of future generations in mind.”

Possible uses of the grant funds include helping purchase or construct new facilities, upgrading and maintaining existing facilities, and hiring and training staff to increase bed capacity.

Brereton stressed that residential treatment settings are an essential part of the behavioral health and developmental disabilities continuum of care by helping to prevent more intensive service needs, while also providing a step-down care option for individuals leaving inpatient settings.

In the coming weeks, DPHHS will work toward finalizing contracts with eligible providers which applied for the funding and received an award. DPHHS will publicly announce award recipients once all contracts are effectuated. 

So Sayler waits, along with others addressing Madison County behavioral health needs.

“We’re really working hard collectively to try to access more care,” Sayler explained. “But we face so many obstacles in our remoteness and isolation that it’s just an ongoing battle for us.”

But there has been some progress. 

“At the time the (Madison County Mental Health Local Advisory Committee) was formed, there were two practicing licensed behavioral health professionals in the county,” remembered Sayler. “Now, we have so many more—we’ve got them in both hospitals, we’ve got private practices popping up, we have access to telemedicine, and our schools are prioritizing it. Some of our schools are hiring therapists to work within the schools.”

Also, there’s training to recognize signs of suicide and other mental health crises. 

“We can train teenagers, we can train adults to recognize signs and symptoms of suicide and know how to refer a person for help when that happens,” she said, highlighting Question, Persuade, Refer (QPR), a peer-reviewed program offered by various entities across the state.

This growing awareness also might be reflected in the results of Ruby Valley Medical Center’s 2022 Community Health Needs Assessment, which identified alcohol and drug use and mental health as the community’s top healthcare concerns. 

Currently, when someone in Madison County goes into a behavioral health crisis, the solution is often a long road trip to Idaho Falls, the closest place to find available inpatient care. That’s why recent news of plans by Bozeman Health to expand its inpatient capacity is welcomed in Madison County. 

Debra McNeill, the RVMC’s spokesperson, explained in an email to The Madisonian, “I think the Adult Inpatient Behavioral Health Unit (AIBHU) at Bozeman Health will be good news for all of Southwest Montana. It doesn't appear that there are any other inpatient behavioral care services in Southwest Montana, except Warm Springs State Hospital.”

The new AIBHU at Bozeman Health, scheduled to open in 2025, could become a new landing place for Madison County residents in crisis. 

“Bozeman Health is committed to whole-person wellness and recognizes the need for continued support of the regional behavioral healthcare continuum,” said Dr. Kathryn Bertany, CEO of Bozeman Health, in a press release. “We are committed to bringing inpatient behavioral health services to Deaconess Regional Medical Center in Bozeman to support patients who need acute inpatient care in order to stay close to home and thus close to their local support systems as this will facilitate optimal outcomes.”

McNeill with RVMC highlights the critical need for such facilities. 

“Madison County residents have been burdened by both the stigma against reaching out for mental healthcare and, until recently, a severe shortage of mental healthcare professionals,” she said. 

The sentiment is echoed by Jim Hajny, executive director of Montana’s Peer Network. 

“We’re a statewide recovery organization, and we work all over the state in mental health recovery and substance use recovery,” he said. “Montana lost 50% of its crisis beds during COVID. The state of Montana did not recognize that that was an essential service.”

Hajny added, “When someone’s in crisis, there’s something about face-to-face that helps. There’s something about sitting in a room together, connecting on a whole different level.”

Madison County Public Health Director Sayler offered an optimistic view of what’s currently playing out when it comes to accessing behavioral healthcare locally. 

“We’re making strides,” Sayler asserted. “Everyone knows there’s a need. Everyone has ideas on how we can meet that need, and everyone’s willing to collaborate and come up with ideas on how to fund it. So that’s really great. We’re really progressing. We’re really making strides.”