The emergency room at Bozeman Health Deaconess Hospital is seeing an influx of people seeking psychiatric care.
The hospital has seen an increase over the past four to six months — whether people are checking in voluntarily or being admitted by law enforcement — said Diane Patterson, the health system’s chief nursing officer.
“We’re seeing more patients and it’s been a bit overwhelming,” she said.
For several months, the hospital has treated an average of about 80 to 120 behavioral patients per month in the emergency room.
March saw 114 of these patients in the emergency room. For comparison: in October there were 28 patients.
That pressure is largely due to Gallatin County cutting ties with one of the area’s top mental health providers, the Western Montana Mental Health Center.
Since the WMMHC is no longer under contract to provide psychiatric services – specifically its voluntary and involuntary psychiatric inpatient beds – the hospital is taking on the workload.
This comes as local officials and Bozeman Health work to establish new mental health services. Many of these services are at least a year out. Meanwhile, the hospital struggles with a shortage of inpatient psychiatric beds, resources, and dependence on a troubled Montana State Hospital.
Meanwhile, as more conduct disorder patients progress through the emergency department, the hospital has worked to increase the number of mental health providers and strengthen training for other mental health care workers. The emergency room hired a psychiatrist, a crisis intervention specialist and a psychiatrist, she said. The hospital has also conducted additional training for other emergency room staff.
Officials say it’s working for now but won’t be sustainable for much longer.
Gallatin County has a complicated mental health care infrastructure. Several nonprofits and organizations are filling critical gaps in the behavioral health care continuum.
If you don’t work fully, the system struggles to fill in all the gaps.
Under particular scrutiny were Hope House, an adult crisis stabilization center, and the nationwide provider that had inpatient psychiatric beds.
The county said WMMHC had “multiple times” breached its contract to provide mental health services at Hope House.
The mental health services provided by WMMHC, including counseling and outpatient care, were funded in part through a contract with the county.
In 2020 and 2021, Hope House faced the closure of its secure emergency room, often resulting in law enforcement transferring patients to another WMMHC facility or to the state psychiatric hospital.
When Gallatin County ended its contract with WMMHC, the preliminary plan was to bring patients with conduct disorders to the hospital’s emergency room.
Now, almost five months later, there has been no formal resolution on the matter. But solutions could be on the horizon. Those who spoke to the Chronicle said it felt mental health services were on the brink of change.
“We knew this was going to be a chaotic transition period,” County Commissioner Zach Brown said. “It is, but we are mobilizing for a better situation with more reliable partners and a more modern service model that really involves our healthcare system closely. I’m optimistic.”
Since February, law enforcement has been bringing people in mental health crises to the emergency room at Bozeman Health Deaconess Hospital.
When patients require a higher level of care, law enforcement takes them to the Warm Springs State Hospital. So far, it’s worked, said Gallatin County Sheriff Dan Springer.
“It works for the time being, but it’s not an answer forever,” he said.
Still, a key part of the interim plan — to move patients who need a higher level of care to the state hospital — has been muddled.
The state hospital has faced a number of problems in recent months, including severe understaffing, four patient deaths attributed to unsafe conditions and one patient who assaulted another patient. The hospital also lost federal funding after an inspection.
Bozeman Health chief nursing officer Diane Patterson said the decision to move patients from Bozeman Health to Warm Springs will be made on a case-by-case basis.
Instead, they have attempted to transfer patients to other hospitals across the state and will transfer patients out of the state if necessary.
Despite problems at the state hospital, Springer said there were no problems getting patients there.
But he fears burning out ER staff if this becomes a more permanent solution.
Patterson said the hospital has been trying to stay ahead of burnout, increasing emergency room staffing and working to dedicate emergency rooms to people in mental health crises.
The hospital only started building these rooms a few weeks ago, Patterson said.
They should be ready in the fall.
Brown believes the county is in almost a better position than others.
“Other communities aren’t in that position, and that’s almost an odd advantage,” he said. “We can design something from scratch.”
Ideally, Brown said, the county would end its near-total dependency on the state hospital by building enough services to care for local people.
Advocates have long said there are other gaps in the continuum of care — including youth mental health services.
Continuum of Care is an integrated system of care for a patient over time, with a range of health services covering different levels of care intensity, ranging from education and preventive services to caring for the most vulnerable people with acute mental health crises.
Acute crisis care is one of the largest identified gaps, Patterson said.
The psychiatric division is still in the draft stage, said Denise Juneau, Bozeman Health’s chief government and community affairs officer.
Bozeman Health is trying to fill other gaps, including the gap left by the county last time it ended its contract with Hope House. But that was a few years ago.
Bozeman Health, the largest health care provider in the county, is working with an Arizona company to stabilize the crisis — a void left when the county severed ties with WHMMC and Hope House.
Connections Health Solutions, which provides behavioral health crisis care in Tucson and Phoenix, Arizona, would operate the Crisis Stabilization Center in partnership with Bozeman Health.
The Crisis Stabilization Center would be an open door and landing pad for a variety of behavioral health issues and acute crises, and a destination for law enforcement to accommodate people in crisis — instead of the emergency room or detention center, Patterson said.
“It’s really meant to be a place to go,” she said, adding that it would be a place for people to go, regardless of the nature of the crisis or poisoning.
“That’s really what the community has been asking for,” Patterson said.
Both Springer and Brown were excited about the services offered by Connection.
“Our hope is that they will more than fill in the gaps — than Hope House could achieve,” Springer said.
Bozeman Health and Connections has a location at Spanish Peaks Plaza at 120 N. 19th Ave. in mind, but the ink hasn’t dried yet, Juneau said. The 19th Avenue location and partnership is still under negotiation.
A deal is also being made with WMMHC for land near the Deaconess Hospital. The Gallatin Mental Health Center, located near the hospital, was built on land donated by the hospital.
In late 2021, Bozeman Health made an offer to purchase the WMMHC property. In November, WMMHC declined the offer.
WHMMC executive director Levi Anderson then told the Chronicle that accepting the offer would mean a “several million dollar loss” for WMMMC.
This spring, Bozeman Health made another offer. According to Bozeman Health, WHMMC has accepted. Anderson did not respond to a request for comment.
Juneau declined to say how much Bozeman Health offered, saying the purchase is ongoing.
Patterson said Bozeman Health isn’t sure how it will use that campus — whether they’ll continue services already offered there or add new services — or what updates will be needed.
“Everything needs to be checked,” she says.
A clause attached to ownership of the property requires WMMHC to use the facilities to provide psychiatric care. If not, ownership reverts to Bozeman Health, according to District Attorney Marty Lambert.
Lambert said the county would want a similar arrangement for the property to ensure it continues to be used for mental health care.
As the county and hospital remain on a “hold,” Brown said the area is poised to provide better services.
“The ultimate goal is to have as many services here in our community that we reduce our reliance on the state hospital, for example,” Brown said. “That was the plan before the state hospital started to deteriorate, and it underscores that direction.”