by Travis Mateer

When you talk to people about the mental health crisis visible on the streets of America, you’ll often hear about the fabled de-institutionalization that occurred during the Reagan years, but it’s really not that simple. Despite how costly and problematic institutionalized care is, I’d like the BIPARTISAN supporters of House Bill 29 (PDF) to explain what the community alternatives are.

I get why there’s bipartisan support for ending involuntary committals to Montana’s State Hospital for people with conditions like Alzheimers, but local options for appropriate skilled nursing facilities are declining, so what the hell is going to happen if a bill like this passes? From the link (emphasis mine):

State lawmakers from both parties have shown support for a plan to stop the practice of committing people with Alzheimer’s disease, other types of dementia, or traumatic brain injuries without their consent to the troubled Montana State Hospital and instead direct them to treatment in their communities.

To highlight how insane this is, a Daily Montanan article from last August describes the state-wide decline in nursing care beds. From the link:

In the past six months, Montana has lost approximately 10 percent of its nursing home beds throughout the state as seven nursing homes have announced they are closing because they can’t continue to sustain a loss of more than $100 per day on each resident.

The problem, which has been most pronounced in rural communities, is creeping into some of the state’s largest cities. Bozeman has seen its largest nursing home provider close, leaving just one facility with a maximum capacity of 69 beds to serve the community, which is experiencing explosive growth, averaging 3 percent per year, or adding nearly 3,000 people annually.

I’m viscerally aware of this deplorable situation for Montana’s aging population with cognitive issues, having worked at Missoula Aging Services for three years in their call center, and before that, seven years at the homeless shelter where I saw plenty of people with dementia conditions and brain injuries show up after being kicked out of local nursing homes.

Since Montana, as a state, is acutely terrible at protecting aging adults with cognitive issues, I am actually quite happy another terrible bill that sounds well-intentioned, but would be a disaster, got tabled before wasting more legislative time than necessary.

For new legislators who took their sads to Twitter over this mean move by Republicans, let me explain something: Red Flag laws just aren’t going to fly in Montana. From the link:

House Bill 202, sponsored by Rep. Ed Stafman, D-Bozeman, is a “red flag” bill — a policy that allows for a court to order that an individual surrender their firearms if a family member, partner or law enforcement agency can make the case that the person presents a danger to themselves or others.

The bill would establish “extreme risk orders of protection” allowing a district court to prohibit a person from purchasing or possessing a firearm during the duration of the order. The language, Stafman said, is modeled after the federal Bipartisan Safer Communities Act, a gun safety and mental health services law Congress passed in 2022. The BSCA, among other provisions, includes grants to help states implement extreme risk protection order programs as long as strict due process rights are followed.

Before Ed Stafman gives MORE power to law enforcement (like Mineral County Sheriff, Ryan Funke) let’s maybe take a look at how their current capabilities are being exercised, or not. That’s what I was thinking as I read this article and the example given for why this law is supposedly needed.

One member of the public, Erin Harris, tearfully shared the story of her father as he slipped into dementia.

He would aim his guns at imaginary ghosts “who were oftentimes innocent people,” she testified before the committee. But Harris said her family was told they could not receive guardianship over her father until he committed a crime, which eventually occurred during a drunk driving incident.

“An extreme risk protection order would have given my family and I the opportunity to safely intercede and get professional medical help for our father,” she told the committee.

I am actually familiar with scenarios like these, where someone with cognitive decline is exhibiting behaviors that make them a danger to themselves, or others, yet families are often told by those in authority that there is nothing they can do until crimes are committed. Even WHEN crimes are committed, those without capacity to stand trial can find themselves riding the revolving door merry-go-round.

The link above is an article that includes a quote from one of the defense attorneys currently defending Charles Michael Covey in the Lee Nelson murder trial. Here is Daylon Martin referencing the unrealistic expectations when it comes to community care:

Daylon Martin, a Great Falls defense attorney, said that if clients whose charges were dropped because of an illness are hospitalized, their discharge is often the end of their care. “People just get released back into the community with the expectation they’ll take their medication,” Martin said. “There needs to be a better transition.”

The state-run hospital has long had a waitlist. Dr. Virginia Hill, a recently retired psychiatrist who worked at the Montana State Hospital for more than 35 years, told lawmakers this spring that a typical stay is two to four weeks, “a short commitment in the big scheme of things when you’ve been charged with a very serious felony.” She said that a patient typically leaves the hospital with medicine in hand and local appointments booked but that the patient then exits the system.

“That is the revolving-door population that we have,” Hill said. “The charges are dismissed, and out they go. And they’re usually pretty ill.”

I would love to see the system improved for everyone involved, but the legislative fixes being proposed aren’t going to improve things unless REAL money is dedicated to building REAL community capacity.

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