After almost a year of pondering a solution to the mental health service crisis in Lewis and Clark County, a group of concerned citizens has come to the realization that they have carried the issue as far as they can.

Volunteer members of the Helena Mental Health Local Advisory Council (LAC) agreed at their February meeting that they have done their part to raise awareness about what needs to happen to repair the breakdown in services.

Now, it's time for someone with the necessary professional and financial backing to take up the cause -- to build a crisis facility in Helena.

"We could go on meeting every month, rehashing it ... but we feel like we're ready to move it onto the next step," said Dan Anderson, chairman of the LAC.

The backdrop

The mental health crisis in Helena -- and across the state -- was several years in the making, but came to a head in this community in 2002.

At that time, St. Peter's Hospital closed its mental health division after losing two of the three psychiatrists who manned the short-term, acute-care facility. On average, the unit provided assistance to about 400 patients a year.

Now, hospital officials are quick to point out that the hospital continues to provide assistance to the mentally ill, just not in the same form as it once did.

"St. Peter's emergency department staff and physicians and Helena's primary care doctors have always been on the front line assisting the community's mentally ill with their acute care needs and will continue to do so," said Peggy Stebbins, spokeswoman for the facility.

Nonetheless, the closure left the community without such services, so officials were forced to direct mentally ill patients to crisis units in other communities, the Lewis and Clark County Detention Center or to Warm Springs State Hospital.

Those diversions have applied pressure in areas ranging from law enforcement to medicine.

According to statistics provided by officials with the Montana Department of Public Health and Human Services, 57 percent of the total admissions to Warm Springs in FY2004 were court-ordered or emergency detentions.

Eighty-two percent of the admissions originated from Lewis and Clark, Deer Lodge, Gallatin, Park, Missoula and Silver Bow counties.

Only 22 percent of the admissions resulted in an individual being treated at Warm Springs, while 78 percent returned to their communities.

"Since these individuals remained at Warm Springs for treatment only 22 percent of the time, one assumption would be that the individual only needed some short term crisis care," members of the Helena advisory council wrote in an overview of the mental health service problems.

Anderson said that fact underscores the need for a crisis center in this community.

Prior to being shuttled to Warm Springs, the majority of mentally ill men and women in crisis come into contact with local mental health service providers and even law enforcement.

Representatives of Golden Triangle Community Mental Health Service receive about 700 crisis calls a year.

At the same time, law enforcement officials in Lewis and Clark County estimate they receive about three mental-health related calls a day -- more than 1,000 a year.

The framework

The LAC brought together representatives from law enforcement, mental health services, the judicial system, families of the mentally ill and more to get a firm grasp on the challenges facing the community, and perhaps, to frame out a solution to the problem.

No one on the LAC was willing to sit back and simply theorize about how to meet the needs of mentally ill men and women in crisis, according to Mignon Waterman, LAC member and former Montana state senator.

"I've just decided that most of this is going to happen on a local level," she said.

Waterman worked to secure a $7,000 grant through DPHHS last year to send local representatives from the Helena Police Department, the Lewis and Clark County Sheriff's Office, St. Peter's Hospital, Golden Triangle and the National Alliance for the Mentally Ill (NAMI) to receive specialized training in Memphis, Tenn.

In the 1980s, Memphis found itself in a similar predicament to the one in Helena and the Memphis Police Department developed the Crisis Intervention Team (CIT) program to help address the problem.

The program, now in operation in Memphis, partners law enforcement officials with representatives of NAMI, mental health providers and consumers to respond to crisis events related to mental illness and suicide issues.

Earlier this year, the LAC received a $6,000 grant from Eli Lilly, a pharmaceutical company, to send five volunteers back to Memphis for 40 hours of additional training that will provide them with the background to train other law enforcement officers on how to handle crisis situations involving mentally ill men and women.

"We feel really good about the first part of this," said Anderson, adding that the LAC believes this problem has a two-pronged solution.

The future

The second prong of the solution is providing the law enforcement officials trained in handling mentally ill people in crisis with a place to take them.

For members of the LAC, finding someone to run such a facility and pay for its construction is the rub.

"We've described in a good amount of detail, for a lay group, what we're looking for," Anderson said.

Ron Alles, administrator for Lewis and Clark County, said this week that the commissioners appreciate the work of the LAC, and they'll do what they can to facilitate the process -- within reason.

"We certainly need to be at the table," Alles said. "I don't know if we need to be at the head of the table, but maybe we have to be to start off."

Stebbins said hospital administrators have been involved in the LAC discussions throughout the past few months and intend to continue to stay abreast of those efforts.

"St. Peter's is supportive of the Local Advisory Committee and appreciates how the group is developing creative ways to deal with the lack of mental health systems in Montana," she said.

Both Alles and Stebbins emphasize that crisis care for the mentally ill is a statewide issue and state government needs to be part of the solution.

Alles said several communities in Montana need such facilities and tax dollars will be the basis for developing crisis centers. However, he doesn't know what form those tax dollars will ultimately take.

Joyce DeCunzo, administrator for the Addictive and Mental Disorders Division (AMDD) of DPHHS, says that no new money for such endeavors is likely to surface as a result of the current legislative session.

"However, many legislators are interested in this topic and I think that's really positive," she said. "We hope to develop a plan for the next legislature that could result in new money to further develop a full crisis response system."

Noting that it is important for the community to capitalize on whatever financial opportunities materialize, Alles said the county commissioners intend to contact several different parties -- including mental health providers and St. Peter's Hospital -- to sit down for a frank discussion about what they can contribute.

"It's up to the county to bring the discussion forward," he said. "But the county doesn't have the silver bullet that we're going to need to make this thing work."

DeCunzo said the best-case scenario for all Montanans affected by mental illness would be for AMDD to develop a system that treats patients at the lowest level possible.

So, if proper services are available within the community, people should be treated at that level rather than in the state hospital. Then, beds would be available at that higher level for the people who need that degree of treatment.

DeCunzo said local crisis centers more than likely will play a role in that goal, but it will probably take several years to fully develop the comprehensive system that AMDD envisions.

"Our initial hope is to maximize the use of current systems by enhancing them, as opposed to starting over with new systems," she said. For example, some communities may be able to contract for one or two inpatient hospital beds to be used on an as-needed basis.

"We're looking at the whole picture ... not just the end result," DeCunzo said, adding she believes AMDD's proposed long-range direction seems to be in sync with that of the LAC.

Anderson said this type of discussion is all that members of the LAC can ask of officials.

"It's one of those things where you think, 'If there's a will to get things done, there's a way,' " he said.

By the numbers

400 - The St. Peter's psychiatric unit, when it was open, had about 400 admissions per year.

700 - Golden Triangle gets about 700 crisis calls per year.

62 - Lewis and Clark County admitted 62 people to Montana State Hospital in FY2004.

3 - Law enforcement in Lewis and Clark County gets about three mental health-related calls per day.