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988 mental health hotline doesn't fix the lack of in-person resources in rural areas

AILSA CHANG, HOST:

One of the goals of the new 988 national suicide hotline system is to make it easier for those experiencing a mental health crisis to get the help they need. But in rural states like Montana, the in-person resources to respond to and treat those people calling for help are often insufficient or nonexistent. Montana Public Radio's Aaron Bolton explains.

AARON BOLTON, BYLINE: Randy Lairmer lives in Bozeman, one of Montana's largest cities. Still, he has struggled to find help when his adult child has experienced a mental health crisis.

RANDY LAIRMER: With bipolar II, basically, what our family member has is a manic episode where they can run for weeks without sleep.

BOLTON: He says these episodes have led to suicide attempts. Mental health professionals say crisis systems need three components - someone for people to call, someone to physically respond and somewhere for people to go for treatment. Montana does pretty well with that first step. Their three crisis call centers tied into the 988 system de-escalate about two-thirds of callers, according to state data. But Lairmer says when that call isn't enough, it's usually police that respond. And his family winds up in the emergency room, where the search begins for a mental health facility. But many in Montana have struggled to remain open due to staffing shortages and funding difficulties.

LAIRMER: And a lot of times, you spend a significant amount of time literally begging for a bed at a unit that can offer the help that your loved one needs.

BOLTON: And things are even more difficult in largely rural eastern Montana. Brenda Kneeland is CEO of the Eastern Montana Community Mental Health Center, which doesn't offer crisis services. She says her clients are usually hundreds of miles away from the nearest mental health facility, where waitlists can be three weeks long.

BRENDA KNEELAND: That's a reality in Eastern Montana that we face every single day.

BOLTON: Rural communities across the country face these sorts of challenges, says Ben Miller, a psychologist and national mental health policy advocate.

BEN MILLER: I'm afraid that what's going to happen is that a lot of individuals are going to continue to show up in the emergency department from their call to 988 or 911 unless we have a place that we can send them.

BOLTON: He says they don't get the help they need that way and could face worse consequences, like being jailed. Miller also points to research that shows 1 in 4 fatal law enforcement shootings involve someone with a serious mental illness. The ideal, Miller says, would be for states to offer mobile crisis units to de-escalate someone or transport them to a regional crisis bed, where they can receive treatment. In Montana, most of the state's six crisis teams are in urban areas that can afford them. But the state is modifying its Medicaid plan to add a new source of funding. Melissa Higgins with the Montana state health department hopes that will increase the number of teams, especially in rural areas.

MELISSA HIGGINS: Certainly, it's dependent upon each community and their resources, but that would be the ideal result.

BOLTON: As for crisis treatment facilities, which have been dwindling, Higgins says the state will offer more grant funding for mental health providers to stand up additional beds. But mental health providers say that funding isn't enough. Brenda Kneeland in eastern Montana says if her organization were going to start offering crisis beds in rural areas, they'd need a much larger infusion of cash.

KNEELAND: Eastern Montana Community Mental Health Center, just like every other social service provider in the state, is struggling to hire and retain employees - ever-rising costs. Now is really a difficult time to look at taking on an endeavor like that.

BOLTON: The state has an ongoing assessment that could offer up some potential solutions for the crisis system ahead of next year's legislative session. But what the legislature will fund is still unclear. For NPR News, I'm Aaron Bolton in Columbia Falls, Mont. Transcript provided by NPR, Copyright NPR.

Aaron is Montana Public Radio's Flathead reporter.