Addiction and mental health are major contributors to crime in Cascade County. The issues are complicated, but many in the community are working to find solutions and The Electric spent the last few weeks learning about a few of the current efforts.

Mental Health Treatment Court at Municipal Court

Recognizing that many of the same people are in his courtroom over and over again, Judge Steven Bolstad and city prosecutors decided they needed a different approach.

They’ve been working for months to establish a mental health treatment court within the City of Great Falls’ Municipal Court and “it’s kind of just falling into place,” Bolstad said.

Cassidy Blomgren, a city prosecutor,  said they noticed the repeat offenders in their court and that many were dealing with various mental health issues so they started having conversations with health care providers, law enforcement and others in the community.

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The idea continued to take shape and Municipal Court is now operating a preliminary, basic framework of a mental health court as they formalize the program.

There’s a segment of the population in the criminal justice system that takes up large amounts of time, Blomgren said, and when it comes to jail, “the typical sentence is not constructive.”

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So, they decided to change their perspective.

We need to stop looking at them as criminals and figure out how to help treat their underlying issues, whether it be mental health or substance abuse, that’s landing them in the criminal justice system, Bolstad and Blomgren said.

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“These are the inconvenient people. It’s difficult. You can’t just answer the problem with a fine,” Blomgren said.

She said that since they started working on this concept, participants have been thankful to have someone show they care enough to help and that’s helped them better engage in seeking treatment and addressing their legal issues.

Many with mental health issues who end up in Municipal Court haven’t committed a serious enough offense to be sent to the Montana State Hospital at Warm Springs, so they often bounce in and out of jail, which can make matters worse, Blomgren said.

“We need to take care of these folks,” Bolstad said. “There has to be justice, but there has to be a level of justice that’s commensurate with the reality of the situation.”

Ideally, if they’re successful, Bolstad and Blomgren said the mental health court could reduce the strain on law enforcement and the court.

The hope is catching people at the misdemeanor level and preventing some from reaching the felony level and being committed to Warm Springs.

Bolstad said that when he worked as a prosecutor, some people mentioned being in crisis when they did something that landed them in court and for some, “jail isn’t always the right place.”

“There’s gotta be a better way,” Bolstad said. “In the long run, we’ll probably all be better off.”

They’re loosely basing their program on the treatment court model at district court and Judge Greg Pinski has offered to assist.

Right now they’re working on formalizing the program but since some people need help now, they’re testing a preliminary program.

The program would have criteria for those who have been convicted to be put on a structured program with local providers and the court and if they do well, fines could be waived and records expunged. The trick is figuring out criteria and a structure that protects everyone and allows everyone in the criminal justice system to still do their jobs.

“It’s been a real challenge,” Bolstad said.

“We have to look at each person individually,” Blomgren said. “Jail is probably not a great sanction,” for many of those with mental health issues.

They’re working with the Center for Mental Health in Great Falls, among other agencies, and the program will have a mental health team meeting weekly to keep track of participants, their cases, treatment and plans.

“The more we work together in the community with all the involved agencies, the better off we’ll be,” Blomgren said.

It’s been a lot of work for the city legal department and Municipal Court, both of which are already stretched, Bolstad said, “but this is something I think has to be done.”

The program is helping those in the criminal justice system build relationships with law enforcement outside of crisis situations.

So far, because of those relationships, Officer Clint Houston of the Great Falls Police Department has been able to solve problems with a phone call versus an issue turning into a situation that prompts an emergency response, Blomgren said.

Municipal Court is working with the jail to help some people there on city offenses with mental health issues to either get them out of general population or on some sort of structured plan, Blomgren said.

Mental health court won’t work for everyone, Bolstad said, but it can work for some.

“We need to be more creative,” he said. “It’s everybody’s problem.”

Mental Health Officer

In conjunction with the effort to create a city mental health court, the Great Falls Police Department is pursuing grant funding to establish a mental health officer who would be stationed at the Center for Mental Health.

Capt. John Schaffer heads the investigative bureau at GFPD and has written a grant to the Montana Mental Health Trust in the hopes of receiving funding to cover the match portion of the grant they’re also pursuing from the federal office of Community Policing CHP Program.

GFPD requested $234,074.28 from MTMHT to match the $201,744 in requested federal grant funds for a total 4-year project cost of $435,818.28

In the application, Schaffer wrote: “The mental health of the citizens of Great Falls has long been a concern of both the GFPD and mental health professionals for decades. Community leaders have long looked for solutions to provide improved outcomes for those with mental illnesses. Currently, programs in Great Falls lack the ability to identify, prevent crisis and provide treatment options for a large portion of community that has not sought services. Police officers can help bridge the gap between crisis and care as they are on the front line when responding persons experiencing a mental health crisis.”

The proposed pilot is for four years, during which a GFPD officer would be stationed at the Great Falls Center for Mental Health and “work with providers to assist and provide a coordinated treatment plan to avoid unnecessary criminalization of citizens experiencing mental health problems,” according to the grant application.

In the application, Schaffer wrote that the model used by Hurst, Euless and Bedford, Texas, or the HEB model, as a template for Great Falls.

In an interview with The Electric, he said officials in Gallatin are testing a program that stations a mental health provider within the sheriff’s office. Schaffer added it will be interesting to see what works with each model and that maybe at some point in the future, they could have both.

According to Police Chief Magazine, jurisdictions with similar programs have reported a 70 percent reduction in repeat calls from people with mental health problems that interacted with the program teams, leading to less incarceration and institutionalization.

The program goals, Schaffer wrote, are:

• Address mental health problems before they become crises
• Reduce over utilization of the Emergency Department at Benefis Healthcare
• Reduce re-institutionalization
• Partner with mental health caseworkers
• Coordinate Treatment: Emphasis on persons likely to reach a crisis point; Recognize persons and situations that create crisis; Recognize patterns for crisis prevention; Crisis plan development (community based); Medication contracts
• Response to in crisis calls
• Work with and assist in the establishment of a Co-Occurring Mental Health Treatment Court in Great Falls Municipal Court
• Follow up from contacts, hospitalization etc.
• Tracking of high risk clients, emotionally disturbed persons (EDP); prohibited persons agreements (firearms)
• Relationships/Identification/Treatment of mentally ill within the community
• Coordinate team members

The mental health officer would complement the existing Crisis Response Team, which is activated as needed and could be a mental health provider, therapist or other person trained in crisis intervention.

“We’re seeing really, really good outcomes,” Schaffer said.

Since November 2017, the team has responded to 61 calls. The idea is to keep people out of jail or hospitals while also addressing their needs in a time of crisis.

When the CRT is called, they prevent a trip to the hospital 72 percent of the time and prevent jail 92 percent of the time, Schaffer said.

“It’s pretty impressive,” he said.

CRT isn’t always called, but “these are the ones where people are in a crisis and we need to get them through the crisis,” Schaffer said.

“The ER becomes a kind of go-to place,” Schaffer said, and they want to reduce that.

According to 2016 statistics, Schaffer said 60 percent of people from Cascade County at the state hospital in Warm Springs have never had mental health services in the community.

There’s a place where the criminal justice system and mental health intersect “and if we work together, we can improve outcomes,” Schaffer said.

In August, there were 117 mental health related calls, Schaffer said.

“There’s plenty of work,” he said. “If we can get them at the misdemeanor level and keep them from becoming felons, that’s huge.”

For years, agencies were all doing their own thing, Schaffer said. “It isn’t working, so we need to do something different.”

So they’re altering their strategy and when these programs work, everyone benefits, Schaffer said.

It’s an exciting time, Schaffer said, in that there’s a lot of work being done on promising solutions and “we’re not just banging our heads against the same wall anymore.”

County Pre-trial Services

On the Cascade County side, County Attorney Josh Racki, Judge Elizabth Best and others are working on developing pre-trial programs to keep low risk people who haven’t been convicted out of jail while awaiting trial. But the only way it works is to have pre-trial monitoring services, Racki said.

The Montana Supreme Court is using a risk assessment tool, developed by the Laura and John Arnold Foundation, and has offered access to Cascade County. It’s already in use in other Montana counties, including Lewis and Clark County.

The court enters information about someone who has been charged with a crime, felony or misdemeanor, and the algorithm determines their scores with a matrix that considers the public safety risk and needed pre-trial monitoring.

If Cascade County adopts the tool and associated monitoring programs, the judges would still have discretion at keeping a person in jail or imposing other requirements if they felt it necessary, Racki said. Prosecutors would get the results and use them to argue bail.

Racki met with County Commissioners and the sheriff’s office Friday afternoon to discuss the risk assessment tool and the types of monitoring the county wants to offer, if any.

The preliminary idea would be to create an agency under the commission office to handle pre-trial to avoid any potential conflicts having it run through the county attorney or the sheriff’s offices, Racki said. Challenges in creating pre-trial monitoring include the cost and ensuring that it’s lawful and fair to those in the system.

Racki said his office has already met with Gateway and the Community Health Care Center to develop plans for evaluations and treatment programs when needed.

Depending on types of crimes and offenders, judges can order a person to get a substance abuse or mental health evaluation and depending on the results, can also order that they participate in a treatment program.

Gateway and the CHCC have recently launched a partnership that would allow them to provide those services and monitor whether the offender is completing their treatment and report to the court and county attorney’s office. Racki said they’ve also been working on substance testing options and alcohol monitoring programs already exist in the county.

The tool from the Montana Supreme Court would send reminders for court hearings to anyone in the system and research has indicated that can significantly increase appearances and keep people from getting into more trouble for failure to appear.

“The idea is to decrease the jail population, but also secure community safety,” Racki said.

More people could be released either on their own recognizance or with monitoring and that would decrease the strain on the jail and allow lower level offenders to keep working and get treatment if needed. Some who end up in jail have addiction or mental health issues and letting them out without treatment often sets them up for failure and they end up back in jail.

Addiction issues also go beyond criminal activity and Racki said there are about 400 youth in needs of care cases, many of which are related to parents who are addicts and unable to care for their children.

Racki said they chose 20 inmates currently in th county jail and ran them through the risk assessment tool as a test. For the most part, it kicked out scores that appeared appropriate to Racki, but it wasn’t quite right in some cases.

Addiction Services Partnership

The Community Health Care Center and Gateway Community Services have launched a partnership to offer addiction treatment services.

The CHCC is finishing construction of two exam rooms and lab space at Gateway’s downtown location.

That will allow care coordination on site, helps with referrals and tracking, finding resources and other care if needed, said Trista Besich, CHCC director. They’ll offer counseling and addiction treatment.

The CHCC’s federal funding agency has been encouraging expansion into substance abuse treatment, but no county or federal tax money is being used for the construction project, Besish said. Instead, the project is being funded through their operational reserves.

“This is something we’ve grown ourselves,” she said. “For us, it’s a really good investment.”

CHCC will have providers at Gateway that can offer medically assisted treatment to those at Gateway.

“It further expands the idea of integrated care,” Besich said. “The goal is to make sure the patient gets what they need.”

The partnership will significantly increase access to primary care for those seeking addiction services through Gateway, Besich said. The hope, she said, is that with primary care access, people will have more success in staying sober.

Many of those struggling with addition typically seek health care at the emergency room, which can be costly for the community and ineffective in providing consistent medical care.

Once open, the CHCC site at Gateway will be open 8 a.m. to 5 p.m., Monday through Friday, Besich said, and patients don’t have to be a Gateway client to receive CHCC services.

Bob Wigdorski, Gateway director, said the nonprofit has been offering outpatient addiction treatment in Great Falls for 50 years. They’re a state approved addiction center that sees about 900 clients annually and has about 140 people in treatment at any given time.

“This is the future of behavioral health,” Wigdorski said of the partnership.

The partnership between Gateway and CHCC creates a “one stop shop for people who primarily need addiction treatment, but can also get medical care,” Wigdorski said.

“The most exciting thing is that this partnership with CHCC, it’s the first of its kind for Montana and I think we’re going to be the model for a lot of other organizations and cities in Montana to follow,” Wigdorski said. “It’s a pretty big deal.”

In the past, addiction counselors would talk to someone about their physical health issues and say, go see a doctor, but they couldn’t force it or track that it was happening, Wigdorski said. Now, the doctor will be in the building and clients will be able to get a physical and address medical issues related ot their past as an addict at the same time they’re in addiction treatment, he said. Research has indicated greater success in treating addiction when medical care is part of the plan, he said.

“It sounds like it should have been done all along, but for Montana, we’re catching up to the rest of the U.S. in how addiction work is done,” he said.

The doctors from CHCC are MAT trained, so if a client needs prescription drugs to help fight addiction, it will be available at Gateway so patients don’t have to go to a third-party to get Suboxone or other treatment.

“Everything can happen here and communication can happen between the treatment team,” he said. “For us, it’s pretty exciting stuff.”

Of those who walk in, most have hit rock bottom before asking for help, Wigdorski said. Many come with problems on top of addiction, such as having lost their job or housing. A lot of people walk through Gateway’s front door and at the moment they come in, they’re beyond Gateway’s ability to care for them in an outpatient setting, Wigdorski said.

His team works to get their paperwork done and keep them engaged until they can get them to an inpatient program, which can take 2-3 weeks. For those on Medicaid, they have to go to state facilities and “there’s only so many beds and there’s a lot of people trying to get those beds,” he said.

Often they lose contact with the person before any of that happens.

Over the last three years, Wigdorski said they’ve probably double the number of clients they see, but he doesn’t believe it’s because there’s more addicts, rather it’s they have better capacity to care for people. If he had the money to double the size of the building and staff, they’d still be very busy, he said.

A long-term goal, he said, would be to open an inpatient facility in Great Falls.

“That takes a whole lot of money,” Wigdorski said. “It’s kind of a pipe dream right now, but if we had a facility and could start treatment, I think our success rates would be pretty good at that point.”