Eliza Wiley
Trees line a road at Montana State Hospital in Warm Springs, between Anaconda and Deer Lodge.
An unknown number of non-criminal patients at Montana’s overcrowded state mental institution are stuck in limbo awaiting transfer to less restrictive facilities.
The law says mental health patients must be held in the least restrictive setting possible. But even after Montana State Hospital civil patients have stabilized enough that mental-health staff clear them for transfer to less institutional treatment centers in or nearer their home communities, some patients report being delayed at the Warm Springs campus for months at a time.
The stakes are high during those waiting periods. Patients who might do well in a community mental health center have to cope not only with their own mental health issues while delayed at MSH but with those of all the other involuntarily committed patients around them. Every passing day means additional treatment and the chance to get healthier, as two patients attested in a recent interview, but they are also aware of the looming possibility that something could happen to jeopardize their chance to transfer when the time comes.
“Being in the B unit, it’s very hard,” said a 42-year-old patient named Laura who has faced transfer delays for at least a couple of months. “There is never a place you get to go where you get away from people. It’s very noisy. It’s crowded. There’s never a place where you get to be alone. There’s just no solitude. There’s no getting away from it. There’s yelling. It seems like there’s some crisis going on or about to happen all the time.”
“There’s a lot of drama that goes on like people freaking out or yelling or manic or something,” said a 20-year-old patient from Billings named Jessica who has been at MSH for over a year and awaiting transfer for several months.
“The units are pretty overcrowded,” Jessica added. “My roommate is supposed to have a single room. We have to put an extra bed in there to fit more people in.”
Jessica reported knowing at least two other patients in her unit experiencing transfer delays.
For her part, Jessica has been doing well and has had extra privileges because of her good behavior over the past few months. This was confirmed by Jeff Pflug, an MSH program manager present for the interview. However, Jessica reported acting out and yelling once because she was frustrated about the transfer delays.
“It was a minor thing, not a severe thing that would keep me from discharging,” Jessica said. “I just took one of the meds to calm me down and I was fine after that … but I see other people getting transferred and getting placements and it frustrates me. It feels like my hard work is going to waste.”
“I’ve got more and more to lose, so I’ve gotten quieter and more out of the way,” she said.
It isn’t just patients who are concerned about the transfer delays. In September 2013, a social worker and program manager named Janette Reget sent an email to NAMI Montana’s executive director, Matt Kuntz, and then forwarded it to Gov. Steve Bullock. In it, Reget advocated for Medicaid xxpansion, which she argued would help get more patients on the program—a prerequisite for some of the state’s community group homes. She also framed the transfer-delay situation as a civil rights issue.
“Patients’ rights are being violated, because they have to remain in the highest level of care when they are ready for a lower level of care,” Reget wrote. “I think it’s only a matter of time before we see a lawsuit.”
MSH administrators declined interview requests for this story and insisted on filtering all responses through Department of Public Health and Human Services spokesman Jon Ebelt.
Ebelt said MSH does not track such transfer delays in reports and does not know the full extent of the issue. He wrote that staff would not “guess” how many people had been in that situation but said it is “not common.”
Eliza Wiley
The main entrance to Montana State Hospital.
He said the average length of stay for all involuntarily committed patients was 79 days in fiscal year 2014, down from 94 days in 2013 and a high of 118 days in 2011. When pressed about the upper range of patient delays, he equivocated.
“MSH aims to ensure patients are placed in a situation that will allow them to thrive, and sometimes establishing that match takes longer than we would like, but we feel that ensuring patients are placed in supportive environments should always take priority,” Ebelt wrote in a recent email.
“One key challenge is finding a provider that can meet the needs of a patient, that also has appropriate beds and capacity,” he wrote in another email. “For example, sometimes a facility that will meet a patient’s needs only has beds assigned for clients of the other gender. Other challenges include matching patient community preference with availability in that community.”
In other words, there are a lot of moving parts. MSH can’t just send a patient who is ready for transfer to the facility of his or her choice because there are several reasons why those facilities might not be able—or want—to take them. Since such patients were involuntarily committed, MSH has a legal obligation to continue treating them at MSH if no other appropriate location is available.
However, over the course of the email conversations, it became clear that MSH administration had no interest in finding out the full extent of the civil transfer delays— or at least not in investigating the matter itself.
After Ebelt indicated that the only way to get the information would be to look for records in individual patient charts, this reporter filed a public-records request seeking carefully redacted pages from patient files that contained the relevant information.
MSH denied that request, calling it “impractical” and “unreasonable.” When pressed on the issue, Ebelt offered two options.
Since MSH wouldn’t do the work, the first included paying a HIPAA-certified contractor to review patient files. Ebelt said he expected that to cost “tens of thousands of dollars.”
The other option was sending a copy of a letter to all MSH civil patients, about 120 people, requesting permission to review their individual files for information about transfer delays. That letter has been submitted. Ebelt said it “may take some time.”
However, it is unlikely all patients will respond and, even if they did, there would be no way to know if the results were anomalous or representative of a larger pattern.
Several mental health-related bills are currently in process at the state Legislature. Politicians on both sides of the aisle are talking about how best to fix Montana’s “mental health crisis,” but it is easy to see ideological thumbprints all over their plans.
For instance, the Democratic governor’s plan favors state-based over community-based solutions. His proposed budget would allocate about $12.5 million to infrastructure and staffing for Warm Springs and a new dementia ward at the state nursing home in Lewistown but only about $7 million to help bolster community mental health centers.
The plan isn’t good enough for staff at Disability Rights Montana, the state’s main legal advocacy group for people with disabilities including mental illness.
DRM attorney Beth Brenneman submitted a letter in a January 15 committee hearing that read, in part, that it “supports the Governor’s mental health plan insofar as it increases funds to community-based services. However, we believe that its proposal to expand institutional beds at both Montana State Hospital and the Mental Health Nursing Care Center proposes a violation of federal law, as our state mental health system already over relies upon institutional placements in violation of the Americans with Disabilities Act.”
The letter went on to argue that other states have been sued and lost over similar plans to increase state-run mental health facilities when community-based services were lacking.
“Should Montana decide to invest further in these institutional beds at the cost of community services, litigation will likely be inevitable,” wrote Brenneman.
DRM is currently suing the state for alleged violations against mentally ill prisoners, in part because of practices regarding forensic (or criminal) patients at MSH.
DRM staff did not respond to calls and emails requesting comment for this story.
Over on the Republican side of the aisle, Rep. Ron Ehli, of Hamilton, has come out as a vocal critic of the governor’s plan, arguing that a bigger share of any money should go to community mental health centers. Ehli is sponsoring a few bills that would redirect money to such centers.
However, it is important to note that these are the same centers currently turning away MSH patients and, in some cases, not even responding to MSH requests for transfer—and nothing in Ehli’s bills would specifically compel community-based facilities to take more transfers from Warm Springs.
Meanwhile, an unknown number of involuntarily committed patients who have been cleared for transfer have been stuck in an overcrowded state-run mental institution, trying not to freak out while they wait to get out.
This story has been republished under a Creative Commons license with mtvigilante.org, a project of the nonprofit Big Sky Investigative Reporting. You can see the original story here.
