Sam Hubbard. He’s the vice president in charge of operations
at the Glendive Medical Center, which means he’s in charge
of filling the vacancies in the psychiatric department. Here’s
the job advertisement his hospital sent out to the wider world
after its psychiatrist quit this year:
Welcome to Glendive, Montana! Outdoor enthusiasts will thrill to almost
limitless possibilities around Glendive. Imagine watching the Milky Way
nightly and counting shooting stars as you fall asleep; quiet so deep you
can hear your soul relax; hunting or just having a staring contest with
wildlife. The Yellowstone River, the nation’s longest untamed river, starts
in Yellowstone Park and flows through the heart of Glendive. It’s a great
source of recreation, agate hunting, and paddlefishing ... .”How could it be so hard to attract mental health
professionals to such a place? When I asked a version of that
question separately of Dickson and Shanks, the hospital’s mar-
keting director, their instant responses were word-for-word
copies: “Because it’s 70 miles to a Walmart.”4
WHILE THE GLENDIVE UNIT
remains unstaffed, anyone in eastern Montana who
is suicidal and needs inpatient mental health care
will likely be sent to the Billings Clinic. For the towns tucked
into the farthest corners of the region, that’s a five-hour drive.
“We’re hanging by a thread some nights,” says Melinda
Truesdell, who runs the 6 p.m. to 6 a.m. shift at the clinic’s
Psychiatric Stabilization Unit. “It’s all these little towns.” The
clinic regularly admits 20 to 25 patients a night. The task is
mental triage—guiding patients toward something resembling
equilibrium, so they might be released in 24 hours or so to
seek other, longer-term solutions. “It’s a revolving door,” she
says. “We bring people in, and we’ll get them propped up and
stabilized. But once they leave our doors, they’re going right
back out there.”
The suicide problem in
Montana has caught the atten-
tion of its lawmakers. At both
the state and federal levels this
year, they’ve introduced bills to
start more prevention programs
in schools and community cen-
ters. But last year, the state leg-
islature cut funding for exactly
the sort of case management
the patients who are released
from the Billings Clinic depend
on. This year, Governor Steve
Bullock, who’s also a candidate
for the Democratic presidential
nomination, restored some of
that funding, but mental health
advocates in Montana say the fall-
out has lingered.
“We have people who are
admitted to us who say they’ve
been trying to get on waiting liststo be seen by case management for weeks,” Truesdell says. It’s
a common complaint across the country: Hospital emergency
departments have been forced to bear the brunt of the esca-
lating shortage of psychiatric services. The number of patients
admitted for psychiatric services jumped 42% during a recent
three-year period, according to the Association of American
Medical Colleges.
Truesdell is from Glasgow, Mont., one of the little towns her
unit absorbs when the Glendive facility is down. She’s a mental
health nurse practitioner, which means she has the authority
to prescribe medications. This makes her a particularly valu-
able regional asset. She says no one near Glasgow—150 miles
from Glendive—is willing or able to prescribe antidepressants
or other mental health medications, so she takes it upon her-
self. Every month, the Eastern Montana Community Medical
Health Center flies Truesdell to Glasgow to spend a couple days
prescribing medications for the locals.
The clinics can afford the flights, which are government sub-
sidized and cost less than $50 each way. But Truesdell knows
that even such a modest expense could someday be targeted
by cost-cutters. “Everyone’s answer to these sorts of problems
is tele-psych,” she says, referring to the practice of treating
patients remotely, via internet-based video consultations. “But
it’s a Band-Aid. It’s treated as this panacea on a grand scale
for rural medicine, but it’s falling way short when it comes to
mental health.”
A growing body of evidence shows that televisual consul-
tations between rural patients and doctors can be effective—
or, at least, significantly more effective than no treatment at
all. But Truesdell and others who’ve administered such treat-
ments are quick to identify their shortcomings. “You don’t feel
the energy of that person, you don’t know the demographics,
you don’t know the families—it’s just not enough,” she says.DOWNTOWN GLENDIVEBloomberg Businessweek August 19, 201946