by William Skink

One might think, having worked at a homeless shelter for 7 years, that I would be excited to see a bill prohibiting Warm Springs from discharging people to the streets and homeless shelters.

But I’m not because the bill is significantly flawed, which makes sense considering who sponsored it. From the link:

Rep. Ellie Hill Smith, D-Missoula, said her bill would end the practice of dumping homeless patients, and force health officials to include housing arrangements in their discharge plans from Montana’s only state-run psychiatric hospital in Warm Springs.

“When Warm Springs discharges them, they are often still in their hospital clothes and they are given seven days of medication,” Hill Smith said. “It is, frankly, morally reprehensible and it’s fiscally unsound.”

First, there is already discharge planning happening at Warm Springs. I’m not a fan of how that facility is run, but the problems are primarily from inadequate staffing and training, which ultimately means money. The problems were recently so bad, the facility risked losing Federal money:

Montana State Hospital, the state’s publicly run psychiatric facility, was set to lose its federal agreement in February because of what’s called an “immediate jeopardy,” a situation where the hospital’s noncompliance with federal regulations was considered serious enough to risk death or serious injury to a resident.

After a legal notice was published in The Montana Standard on Thursday announcing the termination of the agreement between the Warm Springs hospital and the federal Centers for Medicare and Medicaid set for Feb. 8, the agency sent the paper a notice of retraction, saying that the situation that put residents at significant risk had been “abated.”

The second major problem with this bill is pretty straight forward: if there are no appropriate housing arrangements for a discharge, what is Warm Springs supposed to do? And what is this bill going to do to address the shortage of transitional housing and other community-based placements? There aren’t any good answers to those questions, and, as it turns out, there isn’t even data available regarding how many of the returning patients to Warm Springs are homeless:

Not having a stable home environment increases their chances of being readmitted to the hospital, Smith said. Hill Smith, an attorney who previously ran a Missoula homeless shelter, said 386 of the 768 people who were admitted in the hospital last year were returning patients. It was not clear how many of those returning patients were homeless.

I wonder if Rep. Hill even talked to anyone at the shelter she once ran about this issue. I doubt it. If I had been consulted, I would have described how the shelter got a request from Warm Springs to discharge a mentally ill woman, and the Pov said no. So what happened? Warm Springs got her set up with case management from the worst (in my opinion) mental health provider, then discharged her to a motel room. Within a few days the woman stopped taking her meds and got kicked out of the motel, then showed up at the shelter.

Does this bill also prohibit discharges to motel rooms? Because if it doesn’t, that’s the kind of thing Warm Springs will do.

Finally, there’s the money. The fiscal note makes one six figure claim, and Rep. Hill makes a counter claim that I think is ridiculous:

Health department officials said in a fiscal note accompanying the bill that the state would be forced to pay for temporary housing costs upfront while hospital officials await a determination of whether the patients are eligible for federal aid.

The cost to the state would run more than $150,000 a year, according to the agency’s estimate. Hill disputed that, saying the costs would be lower if hospital officials begin patients’ discharge plans when they are admitted.

The bill also requires health officials not to delay a person’s discharge from the hospital in order to comply, and to provide patients who are headed to temporary housing with information on how to find permanent housing.

How in the hell is immediate discharge planning supposed to lower the cost of paying for transitional housing? That makes absolutely no sense to me. Here’s another question: where is the money for more staff time to engage in discharge planning supposed to come from? Warm Springs can barely provide enough staffing to keep patients from dying and nearly lost federal funding because of it.

I also don’t get what is going to happen when this bill “requires health officials not to delay a person’s discharge from the hospital in order to comply”. If no facility will take a discharging patient, Warm Springs can’t delay the discharge, but they also are prohibited from discharging people with no appropriate place to go. It’s a classic damned if you do, damned if you don’t scenario.

In summary, when one looks beyond the feel-good headlines of this bill, it starts looking crazier than the people who end up in Montana’s lone psychiatric hospital. It’s almost as bad as Rep. Hill’s “revenge porn bill”, which was interestingly dressed down at Moogirl a few days ago by Mary Moe.

What’s happening with mental health and homelessness in Montana is a serious problem. Unfortunately this bill doesn’t offer a serious response. If passed into law, it will actually create more problems when the funding to do what needs to be done doesn’t materialize.