911 Operator: What’s your emergency?
Caller: My daughter. She has multiple cuts on her arms, legs and stomach. She’s having thoughts of suicide and says that she has a plan in mind. She needs help right now - what can I do?
911 Operator: You’ll need to take her to the Billings Clinic Emergency Department.
A growing mental health crisis
Emergency Department (ED) visits for adults and children in psychiatric crisis have steadily increased across the US, reaching levels that many have called unsustainable. According to the federal Agency for Healthcare Research and Quality, the rate of ED visits for psychiatric emergencies has jumped more than 50% since 2013. Nationally, 1 in 8 visits to an ED is related to mental health or substance abuse. On an average day in Montana, 8-11 patients seek mental health services at the Billings Clinic Emergency Department. The highest single- day count in recent memory was 24. Overall, Billings Clinic has experienced a 20% increase in youth and adults seeking mental health care since 2018.
Once in the ED at Billings Clinic, patients in crisis receive two separate evaluations. First, they receive a medical evaluation to determine if a medical illness or injury may be causing or exacerbating the psychiatric problem. Once that is complete, an individualized psychiatric assessment is performed by a mental health professional. Because two unique assessments are required, length of stay in the ED can be more than twice as long for patients with mental health issues compared to patients with medical conditions only.
Billings Clinic: The region’s single resource
Billings Clinic opened the region’s first inpatient psychiatric center in 1987 and moved into the current Psychiatry Center the following year, increasing capacity to 44 beds. Since then, in 2003 the Billings Clinic Psychiatry Center has added a 24 patient ‘partial hospitalization’ program for youth requiring intensive outpatient treatment. A ‘Bridge Clinic’ was established in 2010 to support patient success when ‘bridging’ from inpatient care back to the community. In the past year, 2,023 individuals received inpatient psychiatric care at Billings Clinic.
The Billings Clinic Behavioral Health Center provides outpatient access to psychiatrists, therapists, and specialists in addictions, substance use, and other areas. In the past year alone, the Center completed 22,017 patient appointments. This includes opening behavioral health services at Billings Clinic Bozeman to help serve the growing need in Gallatin County. In total, Billings Clinic now employs over 200 physicians, nurses, and other staff in mental and behavioral health services.
Leader in innovation
Finding better ways to meet the unique mental and behavioral health care needs of the region has led Billings Clinic to innovate, resulting in well-deserved regional and national recognition. Some of the most highly acclaimed initiatives include:
• Montana Psychiatry Residency Program, training psychiatrists at Billings Clinic and in this region, while helping to meet the ongoing workforce short age and improve access.
• Research, including Triple Chronotherapy for rapid treatment of depression in youth and adolescents, and previous evaluation of Equine Therapy for treatment of PTSD, anxiety, and depression.
• Care Redesign, including the Psychiatric Stabilization Unit (PSU) and embedded mental health resources in the ED to reduce treatment delay for patients experiencing psychiatric emergency.
• Integrated Behavioral Health, placing resources into Primary Care settings to improve access to care for patients and Project ECHO to support care providers in rural locations.
The road ahead
There are many challenges in providing mental health care – a growing shortage of trained mental health professionals, more people than ever seeking care, and limited community resources. But the need for these services is profound. Providing mental health care must be a core component of health care accessible in every community. Billings Clinic is committed to being both a leader in care and a part of the solution to this growing crisis.
Despite the increasing need for mental health care, no hospital system in the region except Billings Clinic has stepped up to provide acute inpatient mental health services. As a result, in the past year Billings Clinic received patient transfers and direct admissions from nearly every county in Montana and more than half of the counties in Wyoming, plus Idaho and both North and South Dakota. Many patients have been turned away from needed care because inpatient beds at Billings Clinic are at capacity. This is a truly unacceptable burden for patients and families. Single-handedly providing access to inpatient mental and behavioral health care for the entire region is costly. Since 2013, Billings Clinic has subsidized over $26 million in costs to provide mental and behavioral health care for the region, including an $8 million loss in the last year alone. There is an urgent regional need for more and better access to mental health resources, a need that currently Billings Clinic alone is striving to meet. Our community looks forward to the day when new yard signs and banners in the medical corridor point the way to expanded mental and behavioral health services, because then all will know progress is being made for residents of this region.
If you or someone you know is in crisis and needs help, call the Montana Suicide Prevention and Mental Health Crisis Lifeline at 988 or by texting “MT” to 741741 for free 24/7 help. If it is an emergency, call 911 immediately.
