Rural MT Facilities Struggle To Maintain Staff, Provide Care

By Consumers For Quality Care, on August 28, 2019

Since it opened in 2002, the mental health unit in eastern Montana’s Glendive Medical Center unit has been empty much of the time. Even though the town has a small population of around 5,000, there’s no lack of need for mental health care as Montana has the highest suicide rate in the country. The region, however, has struggled to keep mental health jobs filled, Bloomberg reports. The lack of care is putting even more strain on an already vulnerable population.

Across the country – but especially in places like rural Montana – individuals are in increasing need of help. Since 1999 the national suicide rate has increased 33 percent, and the increase in rural counties is even higher at 52 percent. A 2017 report from Montana’s Department of Public Health and Human Services found that roughly 15 percent of seventh and eighth-grade students had one or more suicide attempts in the previous year. Astonishingly, the issue is even more prevalent for adults.

In much of America, and especially in places like Glendive, mental health care is a profession defined by severe imbalances. Overall demand for psychiatric services has never been higher, yet the number of providers has been falling since the 1960s. … There’s been a slight uptick in psychiatric residencies in the past five years, but more psychiatrists are leaving the profession than entering it, and about 60% are over the age of 55, according to the Association of American Medical Colleges.

There is only one psychiatrist, Dr. Joan Dickinson, who prefers to go by Mutt, in the 400-plus mile stretch from Bismarck, North Dakota to Billings, Montana. She was Glendive’s Medical Center’s founding director and ran the center for four years, before she hit her limit.

Every single night, she says, she’d get at least two calls from emergency rooms or law enforcement agencies scattered across the region’s 17 counties, and she’d be expected to help them handle and harbor a troubled citizen who seemed truly suicidal.

Now, she has a small dual primary care and psychiatric practice in the town. The practice helps Mutt care for community, while maintaining enough autonomy to care for herself and ward off burnout.

While no one knows exactly why the suicide rate is so high in rural Montana, Mutt and others have hypotheses. The area is isolated, with long, frigid and dreary winters. The economy has not recovered from the 2008 recession the way more urban areas have and money is often tight. The closest super store to Glendive is a Walmart 70 miles away. Many of issues that afflict the local populations make it difficult to recruit for the taxing work required to treat them.

The state’s suicide rate has caught the attention of its lawmakers. Both at the state and federal levels, legislation has been introduced to expand prevention programs in schools and community centers. Health care professionals, too, are trying to use whatever resources at their disposable to help consumers.

Melinda Truesdell, a mental health nurse practitioner from Glasgow, Montana, is one of the other few individuals who can and will prescribe medications like antidepressants to individuals in the region. Every month, she is flown around the area to help prescribe medication for locals in remote regions. Additionally, Truesdell and Mutt have both helped consumers via remote-internet consultations. They know it is better than no care, but it is far from ideal.

“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.”

Mutt, and others, have tried and failed to attract more talent to the area. But she is not giving up on her community. After closing her practice for a number of months to nurse her ill-sister, Mutt returned Glendive.

When she reopened her office, demand for her services was as high as it had ever been, as was her conviction that she was exactly where she needed to be. She guesses she’ll probably live and work in Glendive until the day she dies.