Guest column: Quality mental health care faces barriers

(The following is a letter to the chief executive officers of three major health care organizations in Havre from Amber Spring, chair of the Hill County Mental Health Local Advisory Council.)

To: Bullhook Community Health Center, Cindy Smith, CEO

Center for Mental Health, Sydney Blair, CEO

Northern Montana Health Care, David Henry, CEO

From: Amber Spring, Hill County Mental Health Local Advisory Council (LAC), Chair

Montana has consistently ranked in the top five for suicide rates in the nation for the past 30 years.

Mental health providers and those working in suicide prevention continually state that suicide is preventable and depression is treatable.

However, in Hill County, there appears to be barriers to receiving mental services and this must be addressed.

I write to you today as the chair of the Hill County Mental Health Local Advisory Council. In Montana, LACs are coalitions of community members interested in assessing, advocating, planning and strengthening public mental health services in their communities. Locally, the Hill County LAC strives to examine and identify gaps in child and adult services and collaborate with local stakeholders — like you — to improve mental health services in the community.

At the present time, Hill County and the extended Hi-Line area have two licensed psychiatric providers, Suzanne Lockwood with the Center for Mental Health — C4MH — and Jennifer Durward with Northern Montana Health Care — NMH — both of whom are considerably difficult to get into. For instance, if you would like to be seen at the C4MH, you are required to first visit a therapist in their office for an evaluation, even if you have been in therapy with an outside provider. Currently, none of the therapists in the Havre office are licensed, so if you have private insurance, this visit will not be paid. The C4MH Havre office will refer a person to visit a licensed therapist in their Great Falls office, who will then refer the person back to Ms. Lockwood.

At Northern Montana Health Care, you must first be seen by your primary provider to have bloodwork and an assessment done, before you can are allowed to be scheduled with Ms. Durward.

Both providers are scheduled out about four weeks, so adding the additional weeks of following their offices’ protocols by visiting additional providers, it could be upwards of six to eight weeks before you are even seen by a psychiatric provider.

It is completely understandable with the caseload that both of these women hold that they need “gatekeepers.” And it makes complete sense that both of them want to be sure that the patients being referred are appropriate for their practice.

Ms. Lockwood only sees patients 18 and older and Ms. Durward sees clients 13 and older. Hill County, and the extended Hi-Line area do not have a psychiatric provider to prescribe to children under the age of 13. We have a shortage of psychiatric providers, yet neither agency is looking to hire one.

Imagine that you are a person battling depression, struggling just to get out of bed in the morning, with low energy, low motivation, feeling that you and the world would be better without you. Would you be willing or able to jump through all of these hoops to be evaluated for medication?

Maybe you would be willing to see your primary provider for medication. Would they be willing to prescribe it? Another issue that is being voiced by residents of Hill County is that primary providers are often not comfortable with prescribing psychiatric medications.

The LAC recognizes that none of the mental health issues being faced by Hill County are unique. However, we do not want to sit idly by and see the quality of care continue to decline.

I am writing you today to ask that we, as providers, consumers and community members, utilize our strengths and resources to better collaborate in addressing the mental health concerns of those in and around Hill County.

Below are some of the issues we would like to see addressed:

• Increase timely access to mental health services. How can we as providers and as a community decrease the time it takes for a person to get into a psychiatric or mental health provider?

• Increase collaboration with mental health providers to build treatment teams. How can we create a system of care for clients that spreads across agencies and individual providers?

• How do we work with each other instead of against each other?

• Improve usage of the PHQ-9 in primary care settings to assess for depression and make appropriate referrals.

• Improve psychiatric education and medication education for primary providers.

• Finally, a primary goal of the LAC is to decrease mental health stigma. Foreseeably, addressing the above bullet points will increase a person’s ability to ask for help.

I would invite any provider, consumer or community member to our monthly meetings in the Jon Tester Conference Room at the Bullhook Community Health Center.

If you would like to be added to our email distribution list, contact me at [email protected].

(Amber Spring is chair of the Hill County Mental Health Local Advisory  Council.)