The highly anticipated film adaptation of Killers of the Flower Moon comes out on Friday, Oct. 20.

The Montana State Hospital in Warm Springs, the state’s only public adult psychiatric facility, is continuing to see high staff vacancies, budget deficits, and shortfalls in health and safety standards more than a year after losing federal accreditation following investigations into patient deaths and injuries.

In a virtual public meeting Tuesday with the hospital’s governing board — composed of top administrators from the Department of Public Health and Human Services and the Warm Springs facility — staff and consultants delivered presentations about safety trends and plans for improvement while touting encouraging changes at the state-run facility. 

The state health department has said that the oversight from the recently created governing board and focus on improving conditions at the facility is part of the Gianforte administration’s commitment to regaining the hospital’s federal certification from the Centers for Medicare and Medicaid. One of the consultants hired by the state to help oversee hospital operations described that effort in a written report on Tuesday as a multi-year “rigorous journey,” an assessment echoed by members of the group during the hour-long meeting.

The hospital is currently operating at roughly 80% capacity, with about 216 patients residing there, including the geriatric-psychiatry Spratt unit and a forensic wing for evaluating and treating criminal defendants. The hospital’s forensic unit was the only part of the facility with a wait-list. It is licensed for 54 beds, but has operated at a consistently lower census since last year. As of June, it was occupied by 46 people with 70 people across the state waiting for admission that month.

There have been 159 patient falls — one of the key indicators of patient safety that federal investigators flagged in 2022 — recorded across all parts of the facility so far this year. The highest frequency of falls — an average monthly rate of 12.1 per 1,000 patient days — has occurred in the Spratt unit. Staff told the governing board on Tuesday that falls are being tracked and reported more accurately across the facility and are down on the geriatric unit by roughly 25% compared to last year. 

The hospital also reported failing to meet its goal of zero chemical restraints used on patients in the main hospital and geriatric wing. Chemical restraints — defined by the federal Centers for Medicaid and Medicare as “any drug used for discipline or convenience and not required to treat medical symptoms” — were most commonly employed in the main hospital, where the intervention was reported at an average rate of 8.85 instances per 1,000 patient days in 2023. The practice was less common in the Spratt unit, while the hospital’s forensic unit reported zero instances of chemical restraint this year.

A 2022 clinical resource document created by the American Psychiatric Association said that using medication to treat a patient’s agitation should be voluntary and that medication should “never [be] used as a ‘chemical restraint,’” but noted that the term is poorly defined and misunderstood. Involuntary medications, the publication says, “should be used as a last resort for situations that present as acutely dangerous.”

A spokesperson for the health department did not respond before deadline to questions about how the hospital defines “chemical restraints” and what counts as an “occurrence.” 

Bernie Franks-Ongoy, director of the federally designated oversight group Disability Rights Montana, said Thursday that while eliminating the use of chemical restraints entirely should be a priority, defining and documenting the misuse of medication is often complicated.

“It is difficult to know exactly what the numbers represent without knowing precisely how the term ‘chemical restraint’ is defined under current hospital policies and what the reporting requirements are,” Franks-Ongoy said. “It would be good to know, for example, how many occurrences of chemical restraint were the result of genuine patient safety concerns and how many were based on staff convenience.”

The rate of patient seclusion also exceeded goals in different parts of the facility, sometimes significantly. In the main hospital, hours spent in seclusion per 1,000 patient hours ranged from 16.68 in January to 1.81 in May, far exceeding the goal rate of less than .36 hours.

In the forensic unit, rates of seclusion also varied widely, recorded at .05 hours per 1,000 patient hours in March to 24.73 hours in May. In the Spratt unit, rates of recorded seclusion were much less common and consistently below the hospital’s goal.

The hospital’s quality improvement metrics did not include how many of its patients have died this year. A health department spokesperson did not respond to multiple questions from Montana Free Press about patient deaths before deadline. 

Safety issues resulting in serious injuries continue to occur, officials said Tuesday, with a total of 10 recorded between the main hospital and the Spratt unit so far this year, compared to 14 in the prior year. 

One patient recently ingested a “toxic cleaning agent” brought into the facility by a contractor, interim hospital administrator David Culberson said. The patient was transferred to another facility for a higher level of care and later returned to the psychiatric hospital. That patient has since been discharged, Culberson said, and the hospital has implemented five new safety protocols to more closely monitor contractors entering the facility in the future.

The hospital reported a 37% employee vacancy rate in June, down from 45% last summer. After a hiring surge in January, February and March of this year resulting in a net gain of 39 employees, the hospital reported losing nine staff members in May and June. 

The highest vacancy rates are among registered nurses, with an 82% vacancy rate, and clinical therapists, whose vacancy rate was 72%, according to the hospital’s latest finance and human resources report. 

With high rates of contract staff and traveling professionals continuing to work at the facility, the hospital’s director of nursing, Jocelyn Peterson, told the governing board that Warm Springs is working to extend the length of traveler contracts to 26 weeks instead of 13 weeks to increase training opportunities for short-term workers.

“This way we can give them a couple more weeks of actual training and speak to some of those areas of safety, and things to look for, and kind of give them a better idea of what the facility is like and how important it is to treat our patients and make sure that they’re safe,” Peterson said. 

Culberson also told the board that the hospital is working hard to respond to the passage of House Bill 29, which will restrict the admission of patients with a primary diagnosis of Alzheimer’s, dementia or traumatic brain injury to the Montana State Hospital beginning in 2025.

“That’s a good portion of the folks in [the] Spratt [unit] right now. And we will not only have to turn down admissions, but we will have to discharge everybody with those three diagnoses,” Culberson said. “So it’s a big project we’ve started here with the help of [contractor Alvarez & Marsal] and then the care team in Spratt.”

As of June, the hospital reported overspending its annual budget significantly, with about $93 million in expenses versus its stated budget of $48.9 million, a trend that has continued from 2022. Of the listed expenses, the finance report said roughly $3.9 million was spent on the cost of traveling staff in June, a figure that has fluctuated month-to-month.

The hospital was given nearly $16 million in additional funds by the 2023 Legislature to make facility repairs and upgrades to help regain federal certification. 

Out of that total budget for capital projects, the hospital’s Tuesday report outlined specific uses for $5.9 million, including repairing the HVAC system, replacing fire doors, and other safety and medical upgrades. The report said the remaining $10 million in legislative appropriations will be set aside as “contingency for unanticipated repair projects impacting recertification.”

The group did not receive any public testimony during the designated public comment period. It is slated to meet again in the fall.

The post Montana State Hospital tallies high rates of falls, chemical restraints and staff vacancies appeared first on Montana Free Press.

For the first time in 20 years, mental health and addiction are more pressing health concerns than getting access to basic healthcare, according to a survey of rural  stakeholders.

Rural Healthy People 2030, released by the Southwest Rural Health Resource Center, surveyed a national sample of people “working to improve the lives and health of rural Americans,” to determine the most important issues facing rural residents. Participants included people working in health care, public administration, education, human services, and other fields.

In 2010 and 2020, the biggest issue in the survey was access to health care.

While access to health care remained one of the top five issues according to survey respondents, researchers said, the growing impact of mental health and addiction took the number one and two spots on the list regardless of age, race, region or occupation.

“For the past two decades, health-care access has been, far and away, the most important topic no matter how we cut the data,” said Timothy Callaghan, one of the survey authors. “The fact that mental health and addiction came out ahead of health-care access this time… certainly surprised us, but when you start thinking about the context of the past decade and the context of the pandemic in which you launched the survey, the findings are a bit less surprising.”

Callaghan said the rise of the opioid epidemic prior to the Covid-19 pandemic, and the growing recognition of the lack of mental health resources in rural America since the pandemic may be part of the reason. But changes in health care through the Affordable Care Act may have improved health-care access, bringing other issues to the top of the list, Callaghan said.

According to the U.S. Department of Health and Human Services, nearly 20 million people signed up for insurance as part of the Affordable Care Act during open enrollment this past year. During 2022, 35 million people signed up for insurance during the open enrollment period, 21 million of whom were part of Medicaid expansions. 

Still the fact that mental health and addiction rose to the top across all categories was striking, he said.

“You’re going to see small changes in characteristics over the course of decades,” he said. “But the extent to which mental health and addiction have risen and were so consistently selected by stakeholders, demonstrates how big those issues really are.”

Stakeholders may have been focusing on what were the most pressing needs given the moment, Callaghan said. The survey was presented to stakeholders 2021. Partnering with rural health organizations like the National Rural Health Association, the Centers for Disease Control and Prevention, the American Hospital Association, and the National Association of Rural Health Clinics, the research center sent out links to the survey and asked stakeholders to comment. In addition, the center sent the survey to people who had filled out the survey in previous decades and asked stakeholders to identify others they felt may be able to provide insight.

According to the Pew Research Center, an estimated 40% of American adults suffered from increased mental health issues during the pandemic. A survey done by the Kaiser Family Foundation and CNN found that 90% of the American public felt the country was facing a mental health crisis. Adults across the country during the pandemic reported increased symptoms of anxiety, depression, hopelessness and sadness and suicidal ideation, as well as increased drug and alcohol use. 

In all, 1,291 respondents answered at least one of the questions between July 2021 and February 14, 2022.

“I think part of (the rankings) could be that a lot of the rural stakeholders participating understood that we’re looking at 10 year trends,” he said. “Our data didn’t allow us to identify specifically why, for example, vaccination isn’t in the top 20 even though we might have expected it to be, due to the pandemic.”

Major concerns besides health-care access in previous surveys included heart disease and stroke, diabetes, and nutrition.

Callaghan said as a country we’ve made significant strides in those areas. A report by the research center to the Federal Office of Rural Health Policy found that rural America has made progress on some leading causes of death.

“We’ve seen some pretty considerable gains in heart disease deaths,” Callaghan said. “We still do have a gap between urban and rural America, but there have been some pretty considerable gains.”

Callaghan said it’s not clear if that is because rural health-care providers are better at managing the disease, or educating patients about the diseases, or if other topics have just become more important.

For now, Callaghan said, the study reveals where the focus of rural health systems should be, according to rural health stakeholders.

“We now have a better sense of the areas that are particularly in need of rural health investment,” he said. “We now know that addressing addiction and addressing mental health issues have become increasingly important to rural experts over the past decade and while health-care access remains important… we nonetheless have to start prioritizing the issues that are most important which are addiction and mental health.”

The post For Decades, the Top Rural Health Issue Has Been Access to Basic Care; Now It’s Mental Health and Addiction appeared first on The Daily Yonder.

SODUS, N.Y. — Daniel Bennett’s office at Sodus Intermediate School is a haven for kids in crisis.

When fourth, fifth or sixth graders here are fed up, ready to fight, or exhausting their teacher with their unfocused energy, they can visit Bennett’s office to jump on the mini trampoline, bounce on the balance ball chairs, or strum out their frustration on one of the guitars that hang on one wall.

Sometimes, the kids arrive angry, outraged at how they’ve been treated by a classmate or teacher; other times they show up sad, or overwhelmed. This spring morning, a boy came in crying, complaining he’d been treated unfairly during a game in gym class. He told Bennett he didn’t understand the game’s rules and was punished for breaking them.

Bennett, a doctoral student at Roberts Wesleyan College here on a year-long internship, helps each student identify their feelings, and validates them. While the student calms down, they might play a board game, shoot darts or mess with fidget toys.

On this day, though, the boy wasn’t interested in toys or games. He just wanted to talk — and be listened to.

“Sometimes you need to sit and be quiet,” Bennett said later.

Besides Bennett, Sodus Intermediate has two licensed psychologists on staff. But one functions as a school counselor, responsible for academic advising in addition to mental health counseling. Even with Bennett on board, it can be hard to meet the needs of all the kids and teachers in this low-income, rural district — especially since the pandemic.

“There’s a lot of trauma, and there are only so many hours in a day to meet with kids,” Bennett said.

Rates of anxiety and depression among youth and adolescents have reached record highs across the country, with the surgeon general calling kids’ declining mental health the “defining public health crisis of our time.” Yet, nationwide, there was just one school psychologist for every 1,127 K-12 students in 2020-21, a ratio well below the 500 students to one psychologist recommended by the National Association of School Psychologists. The shortages of school social workers and counselors are just as bad.

These deficits are due both to a lack of funding and a lack of providers. Some schools know they need more mental health providers, but they can’t afford to hire them. Others have the budget to hire, but can’t find a qualified provider. Colleges just aren’t producing enough of them, and low pay pushes some would-be school counselors into private practice or other specialties.

Now, spurred by an influx of federal funds, schools and colleges are undertaking an unprecedented effort to recruit and retain more school mental health providers. Districts are offering stipends to grad student interns, providing mentors to new hires, and creating online communities for isolated rural providers. Colleges are creating new programs to introduce high schoolers to school mental-health careers and launching virtual graduate degrees to attract busy professionals and far-flung students.

Bennett’s position at Sodus Intermediate, a 45-minute drive from Rochester, is funded through one of a pair of federal grant programs that received a huge funding increase in the Bipartisan Safer Communities Act, passed last year in response to the May 2022 mass shooting at Robb Elementary, in Uvalde, Texas. The grant programs are also part of President Joe Biden’s effort to double the number of school-based mental health professionals.

Since December, the U.S. Department of Education has awarded $286 million to 264 grantees in nearly every state to boost the training and hiring of school mental health professionals, particularly those from marginalized racial and ethnic backgrounds. The agency estimates that the infusion of cash will prepare more than 14,000 new providers. And that’s just a portion of the $1 billion funding increase, with the remaining grants to be doled out over the next five years.

Schools also spent an estimated $2 billion in federal pandemic recovery dollars to hire mental health professionals — an investment that helped increase the number of social workers by nearly 50 percent, and the number of school counselors and psychologists by 10 percent, according to the education department.

Nationwide, there is just one school psychologist for every 1,127 K-12 students, a ratio well below the 500 students to one psychologist recommended by the National Association of School Psychologists

Bennett, the son of a school psychologist, said he feels drawn to the mental health field. He briefly considered a career in law, but settled on psychology after working in an inpatient clinic for children and adolescents after college.

“There were cases that would break your heart,” Bennett said. “But it kept pulling me back.”

But with one week remaining on his internship, he’s not yet sold on a career in school counseling. He’s worked in several settings since starting his program in clinical and school psychology in 2020, and found interest in them all.

“I’m open to seeing where the wind takes me,” he said.

Related: A surprising remedy for teens in mental health crises

At lunchtime, Bennett hurries to the cafeteria to collect four rambunctious fifth grade boys for a skills group. Trays in hand, they race down the hall to Bennett’s office, scarfing up tater tots directly into their mouths.

The topic today is listening. The group starts with a silly song about being a “whole body listener,” drawing or coloring what they hear or think as they listen.

When the song ends, Bennett asks the students to describe their drawings and then share which classmate did the best job of listening while they spoke.

Josh holds up a picture of a guy playing with his ears, and Bennett asks what it represents.

“Hear teachers talk,” Josh answers.

“And who was the best listener?” Bennett asks.

“You,” Josh says. “Your eyes were on me, and you weren’t tapping the floor.”

Matt, who is dressed head-to-toe in Spider-man attire, jumps in to defend himself. “The way I focus and calm down is by fidgeting,” he explains.

Tim goes next. Licking a red popsicle, he holds a drawing of an all-green face in front of his own. “I drew me a new face so I can make more friends,” he says.

The phone rings, interrupting the sharing. It’s a teacher who wants to know if she can send a student who is in crisis. Bennett says he has five minutes after the skills group ends — after that he’s got to meet with another teacher.

He hangs up the phone and turns back to Tim. “What about this face will help you make friends?” he asks.

“It’s green,” Tim responds.

“And who was the best listener?” Bennett asks.

“Apollo — he was listening with his ears,” Tim says.

When the session ends, Bennett returns the boys to their classrooms, and picks up the student who the teacher had called about. As they walk to Bennett’s office, the student says that he accidentally squirted water on his teacher’s phone, and she smacked him on the arm. “Now I’m mad all day,” the student says.

They head back to Bennett’s office, where the student calms down by strumming on a guitar. Bennett asks the boy what type of music is his favorite (country, he says), and tells him he used to play bass in a high school band; he had hair down to his shoulders. They talk about the recent evaluation the student received for special education services, and the boy confides that he’s started a new medication.

When five minutes are up, Bennett tells the student it’s time to go. As the boy leaves, Bennett asks what one thing he could do to get through class.

“Ignore my teacher,” the student says.

“Let it wash off you like water,” Bennett says, encouragingly, before rushing to meet another teacher.

Related: School counselors keep kids on track. Why are they first to be cut?

Rural districts tend to have a harder time recruiting school psychologists, said Kelly Vaillancourt Strobach, director of policy and advocacy for the National Association of School Psychologists. There are fewer training programs near rural districts than near urban ones, and graduates often look for work close to where they’re trained, she said.

But even if more graduates were willing to relocate, the number of students graduating from programs in psychology, counseling and social work isn’t keeping pace with districts’ growing demand for mental health services. Opening up the programs to more students isn’t really an option, either — there aren’t enough faculty or site supervisors to train them, according to Strobach.

Another reason schools struggle to recruit and retain mental health providers is in part because of the low pay. (The average salary for a school psychologist is about $88,000; for clinical and counseling psychologists it’s $103,000; industrial psychologists, who work in businesses and organizations, earn an average of $145,000.)

Since December, the U.S. Department of Education has awarded $286 million to 264 grantees in nearly every state to boost the training and hiring of school mental health professionals, particularly those from marginalized racial and ethnic backgrounds.

In addition, schools often ask providers, especially school counselors, to take on administrative duties, like test proctoring and cafeteria and bathroom monitoring.

While counselors expect to perform some duties beyond their professional specialty, asking them to do too much “pulls them away from the work they’re passionate about” and contributes to counselor turnover, said Eric Sparks, deputy executive director of the American School Counselor Association.

New York is doing better than some states in hiring and retaining school psychologists: Its ratio is 1:662. But before the six districts received the grant, only 5 of 19 schools had a social worker on staff, Lustica said.

With the help of the federal dollars, the districts have been able to hire roughly 20 interns in psychology, social work and counseling each year for the past four years. They pay them a stipend and mileage — a rarity in graduate internships — and place them in interdisciplinary groups that meet twice a month to review cases and share ideas on how to approach them.

By paying their interns, and nurturing a spirit of collaboration among them, the districts hope to convince them to return to work in a school when they graduate. So far, that strategy seems to be working: More than three-quarters of former interns have been hired into high-need districts in New York, Lustica said.

Boston Public Schools is also using stipends to attract potential job candidates — particularly those that match the district’s demographics. Though Boston has had more success recruiting than many districts, it’s struggled to hire bilingual providers and those from underrepresented racial and ethnic backgrounds, said Andria Amador, the district’s senior director of behavioral health services.

“Trying to enter a field that makes you work for free for two years is impossible for some of our economically disadvantaged populations,” Amador said.

“Trying to enter a field that makes you work for free for two years is impossible for some of our economically disadvantaged populations.”

Andria Amador, senior director of behavioral health services, Boston Public Schools

Other recipients of the federal grants are trying different approaches. In Texas, a “grow your own” program is paying teachers to pursue degrees in counseling; in Wisconsin, a new virtual master’s program is reaching Native students on reservations located hours from a college campus.

Leah M. Rouse, an associate professor at the University of Wisconsin at Milwaukee who is helping lead the effort to recruit Indigenous students, said that colleges used to be reluctant to offer online programs, worrying quality would suffer. But “the pandemic showed we can do quality training and supervision with remote instruction,” she said.

Nevada, which in 2021 had just one school psychologist for every 2,000 students, has started recruiting in high school, offering a course on school mental health professions that lets high schoolers earn college credit. Its colleges have begun training “school psychology assistants” to take over some of the administrative duties placed on licensed school psychologists, freeing them to spend more time with students.

And in Virginia, educators are tackling high turnover among isolated rural providers through an online professional development program that connects the providers to colleagues in other schools.

Related: Campus religious groups step into a new realm: mental health counseling

Back at Sodus Intermediate, Bennett is running late for his meeting with Jennifer Gibson, a longtime special education teacher with a challenging class. But when he arrives in the cafeteria, Gibson isn’t there. She shows up a minute later, saying she got caught up disciplining kids.

Bennett and Gibson meet fairly often to discuss strategies for dealing with difficult student behaviors, he says. Their sessions typically start with venting, and this day is no exception.

“I love the community in schools — getting to eat lunch with colleagues, being surrounded by youngsters. But it would be very hard to support myself on the entry level salaries in this setting.”

Daniel Bennett, doctoral student on a year-long internship as a school counselor

Gibson tells Bennett she’s relieved that a particularly disruptive student has left her class, and frustrated that he was put there to begin with.

“He would have been better served elsewhere, don’t you think?” she asks Bennett.

“I don’t know,” he says. “I hear your frustration.”

Then, they move on to problem-solving. Bennett asks Gibson what she was disciplining students for.

“Just kids being sassy,” she says. One student, in particular, wouldn’t settle down after lunch.

“What do you think was the reason?” Bennett asks.

Gibson speculates that it might have been the change in seasons — the warmer weather always makes transitions harder.

Then Gibson remembers that the student hadn’t eaten; he’d hit a kid on the bus and spent the lunch period in suspension. She’d forgotten to give him his usual “brain break” after lunch, too.

“So that’s my fault,” she says, guiltily.

“There’s no blaming or shaming here,” Bennett reminds her. They discuss how Gibson can ensure the student gets his energy out before returning to class after lunch.

At one point in the meeting, Gibson asks Bennett when his last day is. Next Thursday, he tells her.

“That’s awful,” she says. “I wish we could pay to hire you.”

More than three-quarters of former interns have been hired into high-need districts in New York via a federal grant program.

Stephen Humbert, Bennett’s supervisor and the school’s practicing psychologist, said having interns in the building two days a week helps him support more students and teachers. It also exposes staff to fresh ideas and theories, he said.

But Bennett, who starts a new internship at a healthcare organization in Pennsylvania later this month, now doubts he’ll settle in a school when he finishes his doctoral program next spring. With $150,000 in student debt, he’ll need to find something a little more lucrative.

“I love the community in schools — getting to eat lunch with colleagues, being surrounded by youngsters,” Bennett wrote in an e-mail on the last day of his internship. “But it would be very hard to support myself on the entry level salaries in this setting.”

This story about federal grants for counseling was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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