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Panel of Billings mental health experts, law enforcement, children services weigh budget cuts

BILLINGS — Experts in Yellowstone County’s mental health sector issued a warning at a Tuesday night public forum: Proposed budget cuts within the Montana Department of Health and Human Services will threaten public safety.

Representatives from law enforcement, mental health agencies, local hospitals, senior services and children’s health programs met at the United Way in Billings to discuss the impacts of the budget cuts and potential solutions.

DPHHS submitted its proposed cuts to the governor’s office last week.

While the impacts on each state agency are different, they all agreed that the common result is a decline in public safety.

“These cuts will be felt in different ways but they all result in the reduction or elimination of services for those most in need and will have ripple effects throughout the community,” said Barbara Schneeman, vice president of RiverStone Health.

Schneeman said the cuts would have a direct fiscal impact of over $2 million and would impact more than 8,300 patients.

The cuts would eliminate the Kids First program in Yellowstone County, reduce operational support for communicable disease support, reduce vaccines for uninsured or under-insured adults, eliminate the Medicaid Passport to Health program, eliminate target case management for children and youth with special health care needs, eliminate the Medicaid health improvement program and Medicaid hospice services, according to Schneeman.

Representatives for Billings Clinic and St. Vincent Healthcare also prophesied a ripple effect.

“Billings Clinic in partnership with many agencies in Yellowstone County has created a network of safety to keep people in their communities, and losing some of this funding will be more of a burden and potentially put people out on the streets,” said Dr. Michael Temporal, family physician and director of population health for Billings Clinic.

Barbara Mettler, the executive director of South Central Montana Regional Mental Health Center, said her organization is already experiencing cuts and can’t withstand much more loss.

“Unlike some folks, we’ve already shut down our targeted case management team,” said Mettler. “When we closed the program we had approximately 230 people we were providing services to. So it’s not lack of need, it’s a lack of available resources.”

Yellowstone County is one of 11 counties in the 25,000 square miles served by the Mental Health Center.

According to Mettler, 60 percent of the center’s budget is Medicaid reimbursements.

Over the past eight years, the number of employees at the center has decreased from 165 to 160 employees.

“My biggest concern, biggest fear, is that if this continues, at some point we’ll have to close our doors and turn out 2,500 people on the streets with no mental health services,” said Mettler.

Billings Police Chief Rich St. John said that leaving mentally ill patients without treatment or consistent counseling is a recipe for disaster.

“We’re going to have to deal with all the people that have co-occurring addiction and mental health issues,” said St. John. “I tell people over and over again that we are law enforcement officers, we fight crime and evil. We are not social workers, but we routinely get pushed into social work.”

Jan Beggar, the chief operating officer of Alternatives Inc., agreed with St. John.

“Our biggest concern is public safety,” said Beggar. “(If these cuts are made) we’re letting clients who should be in treatment programs, incarcerated, into the community, but with no services at the mental health center, no room at the county jails.”

Beggar said there are 400 clients in jails across Montana awaiting placement in a program already and noted that any cuts would lead to swelling jail populations.

There are 1,600 people in programs through Alternatives Inc., according to Beggar.

Amy Fladmo, the director of Center for Children and Families, said her program’s Second Chance Homes for drug and alcohol-addicted mothers is at risk.

“The average length of time a child is in foster care is three and a half years,” said Fladmo. “With Second Chance homes we can narrow that down to approximately six to 12 months, which is a cost savings of $16,000 per child.”

Fladmo said the CCF’s child forensic interviewing program would also lose funding, which could harm the conviction rate of child sex offenders.

Children with mental and physical disabilities could lose programs through the Yellowstone Boys and Girls Ranch and Early Childhood Intervention.

CEO Mike Chavers said the 300 youth and families currently served at the ranch could lose their programming.

Additionally, about 35 positions at the Ranch would be eliminated through $1.2 million in salary reductions.

“Today in Montana, we have the highest number of kids sent out of state that we’ve ever had,” said Chavers. “If it’s $350 each day for us, it’s one and a half times for kids out of state.”

ECI Executive Director David Munson said the cuts are essentially setting the state up for larger costs down the road.

“Pay pennies now or many dollars later,” said Munson. “It’s about $7,900 per child per year in special education. If we can reduce those costs in our city, our district… they don’t need service later on.”

Munson noted that Montana would be the only state without ECI if the program were defunded.

“If you have a child or grandchild with a disability, you’d have to say ‘I need to move to Idaho or North Dakota or South Dakota or Wyoming or Guam or Puerto Rico so my child can get services,’” said Munson. “It’s mind-numbing that that is even on the block.”

The elderly citizens in Yellowstone County are also faced with cuts to programming through St. John’s and Big Sky Senior Services.

“We have a certain segment of our population that for any number of reasons runs out of resources while they’re with us and we have those who come to our doors without any at all,” said the Rev. Tom Schlotterback, vice president of Mission Advancement. “Historically, for 53 years, we’ve opened the gate and said you are welcome here. We will never close our doors, but we might have to start closing the gate for some of these people.”

Schlotterback said St. John’s absorbed $700,000 in losses in 2006. A decade later, St. John’s took a loss of $2.1 million.

“That gap will continue to increase unless funds increase and at least keep somewhat at pace,” said Schlotterback.

Denise Armstrong, the director of Big Sky Senior Services, said  many seniors need assistance.

“Our seniors, the ones we serve, are living at the poverty level,” said Armstrong. “We help them manage their money through a payee program because many of them have been exploited by their family members. There’s a lot of people 80 plus years old with no family members, no one in their lives and they need help.”

According to Armstrong, proposed cuts would result in a decrease of 700 employee work hours, 1,350 fewer meals served to seniors at meal sites, 674 fewer meals delivered to seniors, and 213 fewer rides for seniors to visit a doctor and the grocery.

The panel discussed a number of possible solutions, including a tobacco tax, local option tax and decreasing Montana’s reserve fund.

Montana law requires the ending fund balance to contain at least $143 million, but one proposed solution was to see if legislators could decrease the minimum and use some funds to make up for budget shortfalls.

Other solutions considered were increasing taxes on the wealthy and implementing program participating fees.

The proposed cuts were sent to Gov. Steve Bullock’s desk last week for review.

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