With demand soaring for services from the stress of the recession, the Montana mental health budget faces a potential $1 million shortfall.

State officials, given an imperative by the governor to cut costs, have sharply reduced case management services provided through the Mental Health Service Plan as of January. Clients now receive just one and and a half hours of case management per month, cut back from eight hours.

Even more drastic, a notice went out in December of plans to close day treatment at centers across the state as of June 30. That includes the therapy-oriented adult center operated in the Flathead by Western Montana Mental Health Center.

Shirley Howell, director of adult day treatment, said the concept doesn’t make good economic sense, even without considering the human toll on the clients.

“It would be devastating to folks,” she said.

Howell points out that the Adult Day Treatment Center provides crisis intervention through daily outpatient groups where staff monitor symptoms and do crisis intervention, keeping some from progressing to the emergency room, Pathways Treatment Center and Montana State Hospital.

She said the costs of mental health services don’t go away — just move into more costly venues for taxpayers.

“It’s like squeezing a balloon,” she said. “The expense just bulges out somewhere else.”

The maximum billing for day treatment is just under $38 per day, no matter how many hours a client spends attending individual and group activities, where they learn to manage emotions and build relationships to minimize isolation. The center also provides vocational and volunteer opportunities in the community.

Day treatment bills out at less than half the daily cost of a patient admitted to Pathways where an average stay runs between $7,000 and $13,000. Doctor billings at Pathways range between $200 to $800 per day plus emergency room doctor billings of $200 to $800.

Montana State Hospital pencils out as the most costly with a stay in the highly-monitored Spratt Unit costing $635 per day down to $579 for other units. Patients remain hospitalized up to 90 days by court order.

For five ambulance transports last year to the state hospital, Flathead County Sheriff Office paid $12,954.50 for an average of $2,590.90 each. The county footed a bill of $268,539.88 for mental health services among Pathways, Kalispell Regional Medical Center and psychiatrists’ fees.

Flathead County Attorney’s Office time works out to about $300 per case.

Howell expects these costs to multiply if even a small percentage of the 40 to 50 clients end up in crisis without the intervention provided at the Adult Day Treatment Center. 

“Not all will end up at the ER, but a few will,” she said. “It seems to me that $37.89 is a pittance compared to those potential costs. And that doesn’t count their quality of life.”

Unlike some day programs where patients drink coffee and sleep, the Flathead Valley program maintains a strong therapeutic thrust with licensed clinicians treating individuals and leading groups in illness and stress management and recovery. They also have groups for diabetic cooking, walking and other exercise.

“We look at people from a holistic perspective,” Howell said. “State examiners have told the staff that Flathead County has the best program in the state. It really is a wonderful program.”

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.