The county attorney specializing in cases involving people with mental illness is worried about the effect of state cuts for case management, particularly on Missoula's homeless population.
In its annual report issued earlier this month, the Missoula County Attorney’s Office reported that of the 240 involuntary commitment petitions it filed in 2017, more than a third involved homeless people.
The report, prepared by County Attorney Kirsten Pabst, said the office was very concerned about the impact of recently enacted cuts to services for the mentally ill on the vulnerable population.
As part of budget cuts enacted during last year’s regular and special sessions of the Montana Legislature, the Department of Health and Human Services funding for case management was cut by nearly $1 million a year, and reimbursement rates for service providers fell as well.
In December, Western Montana Mental Health Center — the largest agency providing case management services in the area — laid off case managers and other employees as part of budget cuts.
Jordan Kilby is the attorney in the civil division of the county attorney’s office who handles involuntary commitment cases. She said that while people can be taken into custody if they pose an immediate danger to themselves or others due to a mental disorder, half the petitions she files are for people whose mental disorder simply means they can't provide for their own basic needs.
“In Montana in the winter, one of those basic needs is housing. Staying in the community with a mental disorder, it’s not easy. People can have issues with delusion, paranoia. And if someone is out without a coat or shoes in the winter, they are going to get picked up and a referral will likely come to our office,” Kilby said.
After filing an involuntary commitment petition, Kilby can suspend the court process for up to 14 days to see if a person taken into custody can be brought back to a healthy baseline where they can care for themselves.
“Some people just need time in the (Neurobehavioral Medicine Inpatient Unit) at St. Patrick’s hospital or a couple days in crisis housing. What I like to see is that between when a person is picked up and the end of the suspended time, they can resolve,” Kilby said.
But the chance of that happening when someone isn’t working with a professional case manager is low. Kilby said it’s always a good sign when she finds out there is a case manager working with a homeless person.
“Case managers are really, really important. They make sure a person is taking meds, filling out housing vouchers, getting to their appointments. If we have to file on someone, I can call up a case manager and say, ‘What’s the plan for this person?’” she said.
With cuts to case management, Kilby is worried about what the most vulnerable in Missoula will do when they either lose contact with someone who is keeping them in the loop with medical and other services, or when remaining managers are so loaded down with clients that their ability to help any particular person is limited.
If a person's issue remains after she files her petition, the result can be involuntary commitment in the state hospital in Warm Springs for treatment.
Kilby said she doesn’t see how a higher likelihood of people being sent to Warm Springs — where room and board alone without any treatment or medication is $565 a day — will save money.
“I am afraid of what’s going to happen because of this reduction,” she said.
Heather Reeves said Kilby’s concern is warranted.
“That’s a very real fear. Case management organizations aren’t gone, it’s just that because (Western Montana Mental Health Center) was so large, the hits to them are profound,” she said.
Reeves is the manager of PATH, a federal grant program that works to find housing for homeless people with severe disabling mental illness. While the two people in her office can provide limited assistance similar to that of a case manager, she said the plan has always been to move a client on to a full-time professional as quickly as possible.
“Our job is to stabilize and hand them off to long-term care. Now we can’t be assured that we can do that,” Reeves said.
While state cuts may have made the budget look better, Reeves said shrinking the amount of help available doesn’t change the need.
“That’s what we were really upset about. This cut has so many snowballs and tendrils that it’s going to affect. ER visits, state hospital visits, private industries that are going to be hit with what the state hasn’t funded,” she said.
“When you are cutting essential services, I just can’t see how they didn’t have a plan for what is supposed to happen.”