Karen Patty typically spends the first hour of her workday reviewing police calls from the day before to see if she needs to follow up on any of them. After that she typically gets a call to provide on-scene care for people in a mental health crisis.
She’s one of two crisis therapists contracted through the Western Montana Mental Health Center-Gallatin to respond to calls with Belgrade and Bozeman police departments, and the Gallatin County Sheriff’s Office.
She said in 2019, the first year of the program, the number of calls she responded to spiked in the spring but calmed down during the summer. That didn’t happen this year.
“It’s definitely on a very sharp trajectory up each month,” Patty said.
The crisis response therapists aren’t alone in that observation. Mental health officials across Gallatin County said they’ve also seen a rise in needs for services amid the coronavirus pandemic and after the recent wildfire that burned more than two dozen homes.
Help Center 211, which serves 13 counties, has seen its workload increase by 50% compared to last year. An official from Western Montana Mental Health Center said the facility has seen an increase in detention bed use of about 10 days per month since April. Bozeman Health’s behavioral health urgent care has treated more than 200 patients since March.
The opening of the behavioral health urgent care center is one example of new responses to mental health needs during the pandemic. Several organizations are also working together to improve resources in the area.
It’s the sort of work that many wanted to see even before the pandemic, and that they want to see continue.
“That needs to happen — not just when it’s a crisis,” said Matt Kelley, Gallatin County health officer.
Mandy St. Aubyn, development and communications coordinator for Help Center 211, said the call center typically sees people calling about suicide, depression and anger or fear. She said the majority of the calls have been about suicide, depression and worries surrounding COVID-19.
The help center was also tapped as an information hotline after the Bridger Foothills fire. She said there’s been an increase in calls in people looking for basic services like food, shelter and financial security since.
Help Center 211 serves 13 counties including Park, Madison, Broadwater, Jefferson and Gallatin. When a call comes in, St. Aubyn said, a counselor works to connect the caller to the right resources.
So far this year, the hotline has received 7,266 calls. From mid-March to September, 67% of those callers were female, 52% were male and 1% identified as non-binary.
Most of the callers, 45%, are between the ages of 25 and 44, and people 45 to 64 accounted for 40% of the help center’s calls during that period. People between 15 and 24 were 10% of the calls, and people 65 and older made up 5%.
She said the pandemic has helped people realize that everyone has mental health needs, and that “it’s not just a subset of a population.”
“They may be struggling more with their mental health, but they might also be recognizing that it’s OK to reach out and ask for help,” St. Aubyn said.
Michael Foust, director of the Western Montana Mental Health Center, said we’re likely seeing the “tip of the iceberg” of what mental health issues are coming.
“I don’t want to paint a grim picture,” Foust said. “It’s the realism of a pandemic. It’s just what happens in a pandemic or any kind of disaster.”
Federal unemployment benefits have run out. Alcohol sales, in a state that Foust said is already deemed the “booziest,” have increased. Kids are going back to school where reports of abuse and neglect are typically made.
“I still think we have a long ways to go,” he said.
Foust believes the county is headed in the right direction and that “it could have been a lot worse.” And, he said, resources have been able to keep up with demand — the food bank is still doling out food, residents continue to donate to relief accounts and nonprofits are still providing for those in need.
He said the pandemic is an opportunity to look at the services the county has and reflect on what it could do better. And work on reaching people early in mental health crises started long before the pandemic arrived in Gallatin County.
A number of organizations formed the Gallatin County crisis redesign committee to review and improve services. The committee includes Bozeman Health, the Gallatin County Sheriff’s Office, Western Montana Mental Health Services, Community Health Partners and the Gallatin City-County Health Department.
Maureen Womack, Bozeman Health’s system director of behavioral health, said the group had ideas percolating about how to improve services before the pandemic. Womack, the co-chair of the committee, said coronavirus placed a sense of urgency on rolling out those ideas to give people better access to mental health care.
Since March, in addition to its behavioral health urgent care, Bozeman Health has placed a behavioral health crisis interventionist in the emergency department and launched a tele-psychiatry program for patients in Bozeman and Big Sky.
“Necessity is the mother of invention,” Womack said. “When we were looking at the effects of the pandemic, we wanted to make sure that people who had a behavioral health crisis … did not have to co mingle with people that had physical conditions that may be infectious.”
For Patty, the spike in calls started in June. She saw an increase in threats of suicide and involuntary commitments to psychiatric care.
Patty tries to keep people in their home, surround them with their own support system and get them connected to outpatient services — it’s cheaper and better for the person that way, she said. If that can’t happen, Patty said, therapists will petition the county attorney’s office to involuntarily commit someone.
Patty said there are three thresholds when therapists decide to involuntarily commit someone. People are either actively suicidal or actively homicidal or unable to meet their basic needs due to a mental health diagnosis.
In the past, she said, a majority of involuntary commitments happened because a person was actively suicidal. Patty said that has shifted to more people being committed because they’re unable to meet their own needs due to a mental health diagnosis.
Because of the coronavirus pandemic, Patty said, there’s a significant absence of coping skills that people typically engage in. That includes checking in with a health care provider, being around friends and other things that offer support and comfort to someone in crisis.
“As their support network falls apart, their acuity starts rising, and we need to do something different,” Patty said.