Nowhere in America is the mental health safety net thinner than in sparsely populated areas like Beaverhead County in southwestern Montana, where fewer than 10,000 residents are spread across 5,572 square miles. A $75 million state revenue shortfall has led to budget, spending, and Medicaid reimbursement cuts that greatly reduce Beaverhead County resident access to outpatient therapy and case management. The primary Missoula-based regional provider of such services can no longer staff to deliver them in Beaverhead County.
In plotting a viable way forward, the county’s Mental Health Local Advisory Council (MHLAC) sought out Dennis Mohatt, WICHE’s vice president of behavioral health and a nationally recognized expert on rural healthcare. With his assistance, MHLAC earlier this year conducted a survey, focus groups, and interviews to assess community needs and priorities. In May, Mohatt traveled to Dillon, the county seat, to help the group sort through their findings and establish a strategic plan.
WICHE Mental Health Program personnel have played this role in dozens of rural areas over the years and are increasingly invited to provide insights in key forums. Mohatt hosted a National Institutes of Mental Health webinar on rural mental health in late May, and WICHE’s Hannah Koch spoke at a June journalism workshop on behavioral health issues in rural communities. These speaking platforms broadcast urgent health needs, as well as WICHE’s ability to partner with communities that may lack deep behavioral health system experience or know-how.
“Planning, needs assessment, analysis—that’s our bread and butter,” Mohatt says. “We also provide training and support in suicide prevention, veteran behavioral health, mental health first aid, and motivational interviewing. You can find such training elsewhere, but you’re unlikely to find it with our rural knowledge and expertise.”
Mohatt said he was encouraged by the Beaverhead County group’s openness to creating a stronger, more flexible mental health safety net, anchored by a robust primary care system, a federally supported Critical Access Hospital, and a federally qualified Community Health Center.
At its May meeting, the MHLAC decided its top priority would be to reach out to every county resident who had lost case-management services and connect them with an in-county primary care provider. “In my opinion, for a community that size, focusing limited resources on building up the capacity and quality of an integrated primary care/behavioral health system is a good use of resources,” Mohatt says, noting also that it would better position the county to attract federal government and other funding. “[Integrated care] is the wave of the future in healthcare.”
Among other Beaverhead County plan elements Mohatt views as promising: a multi-faceted public awareness and information campaign, and a new peer-run drop-in center in Dillon to replace a discontinued conventional Adult Day Treatment program. “Most people in day treatment/partial hospitalization programs will tell you it’s the peer support they come for. Center it around a healthy lunch, and you’ve made a big dent in the isolation people are feeling,” Mohatt says.
Recapping his Dillon visit, Mohatt praises the “high level of interest, responsiveness, and pragmatism” of Beaverhead County stakeholders, adding “I urge them to build on it.”