Suicide has plagued Montana for decades, despite broad efforts to raise awareness about risk factors and improve access to mental health services. The state has had the troubling distinction of one of the five highest suicide rates in the nation for 30 years.
Health Care Service Corporation's Montana health plan launched an initiative in 2018 to help fight opioid abuse, rising suicide rates and methamphetamine and heroin epidemics. The company also helped fund a new psychiatry residency to bring more mental health professionals to Montana, as well as other programs.
Now leaders say it’s critical to become more strategic in coordinating access to life-saving services for members throughout the state — particularly in its most isolated areas. For example, residents in tiny Wibaux in Montana’s far eastern plains should be able to access care closer to home rather than choose between traveling 250 miles to Billings, 170 miles to Bismarck, N.D., or forgoing treatment altogether.
“Behavioral health access is really a challenge, and it’s incredibly disruptive to families to have to travel long distances to get care,” says Dr. David Lechner, the company's vice president of health care delivery and chief medical officer in Montana. “How do we help our behavioral health providers and increase the capability to get care closer to home?”
To improve access, leaders are working with providers and policymakers to develop care models that will keep members closer to home and reduce obstacles to care, including expanded telehealth services. The effort id part of Lechner's larger initiative to create more medical and behavioral health access and better care management for members no matter where they live.
“In my ideal operational model, we truly influence how the right care is provided at the right time across the state,” Lechner says. “Innovation is the life blood of a corporation. If you don’t innovate, you’re going to be left behind. In Montana’s case, people are going to be hurt.”
In less than six months the insurer has identified ways to revise internal credentialling of providers of substance use disorder treatment, potentially increasing access to more intensive outpatient centers statewide, Lechner says. Steps also have been taken to increase access to care for members with eating disorders.
Leaders believe more people could potentially be saved with primary care and behavioral health professionals working together in collaborative care groups to identify and help at-risk patients. Research shows many people who die by suicide visit a doctor shortly before their deaths — some within 24 hours, according to a state report.
Dr. Frank Webster, HCSC's chief behavioral health medical officer, says more timely and efficient diagnosis and treatment could significantly affect a lot of people. About 90% of those who complete suicide had a diagnosable mental illness — with major depression most frequently identified, according to the Montana Department of Public Health and Human Services.
In Webster’s view, a primary care provider could screen a member for depression and anxiety. Depending on the results, the provider may prescribe a medication, make a rapid referral to a psychiatrist or other specialty resource, or have the patient meet with a behavioral health professional to ensure the member receives needed resources and advice and monitor progress.
“Some people don’t need to go straight to therapy,” Webster says. “This model really gives a level of support for depression and anxiety. The demand is definitely there.”
A 2021 telehealth expansion law could help grow behavioral health networks. Montana law does not mandate established relationships between patients and doctors or restrict geographic and locations between providers and patients. It also permits additional types of technology like audio-only calls to accommodate more residents.
Some providers believe telehealth prevented suicides during the COVID-19 public health emergency, according to a University of Montana survey.