Access to care key to preventing suicide


Montana had the highest suicide rate in the nation in 2014, according to the American Foundation for Suicide Prevention. Montana’s Suicide Review Team revealed that only 40 percent of these suicides had an identified mental health disorder, but it is likely that many of these cases had undiagnosed or untreated mental illness according to the National Alliance on Mental Illness.

Some 39,000 adults and 10,000 children in Montana live with a serious mental illness, according to the U.S. Public Health Service. This is out of about 1 million residents, which leads to a prevalence rate of 4.9 percent. According to The Substance Abuse and Mental Health Services Administration, this is slightly higher than the national average of 4.2 percent.

According to the U.S. Department of Health and Human Services, a “serious mental illness” is described as “A mental, behavioral, or emotional disorder (excluding developmental and substance abuse disorders) that is diagnosable currently or within the past year, of sufficient duration to meet diagnostic criteria specified within the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders, resulting in serious functional impairment, and which substantially interferes with or limits one or more major life activities.” This differs from people who, say, have had periods of brief depression or anxiety, or have mild depression and anxiety.

Joannie Patterson-Croskey, a local licensed clinical social worker, says that there may be a few reasons for why these rates are so high in Montana. Among them are seasonal affective disorder which occurs due to the decreased amount and length of sunlight in winter time, isolation, high alcoholism rates which can increase depression, and the stigma attached to mental illness and lack of resources and education on the subject.

These disorders have serious consequences, especially when left untreated. Many students with a serious mental illness will drop out of school. According to the U.S. Department of Education, in 2006-2007, 61 percent of students in Montana with serious mental illnesses dropped out of high school because they were not able to get the services they needed.

Another survey issued by National Alliance on Mental Illness in 2012 stated that 64 percent of college students who had dropped out and responded to their survey said that they did so because of a mental health related reason.

According to the Spring 2015 American College Health Association’s National College Health Assessment, 25.2 percent of college students reported being diagnosed or treated by a professional for a mental illness, while 48.7 percent reported symptoms of a mental illness.

Many people with serious mental illnesses also end up in the criminal justice system. In 2008, there were approximately 900 inmates with a serious mental illness in Montana, according to the U.S. Department of Justice.

The National Alliance on Mental Health released a report card “grading” states on their mental health care in 2009. Montana received a “D,” mainly for its overall shortage of mental health care providers, as well as an abundance of stigma and lack of outpatient housing options.

Funding for mental healthcare in the state constitutes only 3.1 percent of the budget, according to a study done by the NASMHPD Research Institute. The National Alliance on Mental Illness states that there has been a general trend across the U.S. of cutting funding for mental health services.

According to the American Hospital Association’s 2009 survey, there is an average of 10.8 psychiatric inpatient beds per 1,000 adults with serious mental illness. Montana was at the bottommost quartile of this range, with fewer than eight beds per 100 patients. A study funded by the Arlington, VA: Treatment Advocacy Center in 2008 suggested a minimum of 9.3 beds per 1,000 people with a serious mental illness, but that is only in tandem with effective community-based services and assisted outpatient treatment programs, which Montana lacks.

Patterson-Croskey says that when she moved from Ohio to Bozeman, she was shocked at the lack of resources for mental health. She says that even smaller Montana towns like Livingston and Dillon had a mental health center, whereas Bozeman did not. In October of 1990 though, she helped to establish the Gallatin Mental Health Center.

She says that another problem at the time that still lingers somewhat today was the lack of education and experience amongst the few professionals who were here. People who had brief psychotic episodes were always just automatically diagnosed with Schizophrenia, for example. There was only one psychiatric room in the hospital, but few people had the expertise to adequately run it.

While it may seem that mental healthcare in Montana is grim, many reforms are being made.

The 2013 legislature appropriated funds for the creation of a universal suicide screening tool for all county jails and detention facilities, integrating Mental Health First Aid into the core curriculum at the Montana Law Enforcement Academy. All officers and detention officers receive 8 hours of Mental Health First Aid with 4 hours of Question, Persuade, and Refer, according to AFSP.

Patterson agrees that things have greatly improved since she first started in Bozeman. She says that our understanding of the human brain has grown, and we now have a better appreciation for the complexity of mental health (e.g., diagnoses are more carefully made).

However, she says that there are still aspects of the system that could be improved. The fact that someone can start a private practice with very limited education and experience is something that is concerning to her. Also, because of increasing insurance rates, people in poverty are becoming less and less able to access the care they need. While the Affordable Care Act has helped many people, she says that it hasn’t done enough to address this problem.

Funding for the Mental Health Center has also always been limited. Because of this, they are not able to address children with mental illness very well, although recently that is beginning to change.

It is important for people to first be aware of mental illness and to remove the stigma attached to it. The American Association of Suicidology states that talking about suicide with teens can actually be beneficial. Educating the public and encouraging those who deal with mental illness will be a key aspect in addressing this problem in Montana.

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