Reopening Lake House could help county with mental health crisis

The Lake House, located just south of Providence St. Joseph Medical Center, opened in 2015 and closed in 2023. While the facility went away, the need did not, as a number of people attested at last Thursday’s meeting at the Lake County Courthouse.

“I got a tour yesterday of the facility over at the Lake House, and I was equal parts surprised and very disheartened,” Lake County Attorney James Lapotka told the large gathering of law enforcement, elected officials and healthcare providers.

“It's local, it's empty, it apparently cost us several million dollars to build, and it's just sitting there as office space for a couple of gals right now,” he added.

Lake House offered up to eight beds to help stabilize people in the midst of a mental health crisis, including two secure rooms. According to Lake County Commissioner Gale Decker, the county contributed around $500,000 to design and build the facility; Providence owns the property and signed a 99-year lease with Western Montana Mental Health Center, which owns the building.

Lake House closed when WMMHC shrank its footprint across the state nearly two years ago, citing staffing shortages and a significant budget shortfall due, in part, to low reimbursements for care and inability to keep beds occupied.

Lapotka spoke about the challenges of finding a safe place to house someone suffering from an acute mental health crisis, where they pose a risk to themselves or someone else.

“The law requires that we consider the least restrictive placement for them,” he said. “And for the majority of my career, the only option is the state hospital, which is the most restrictive option.”

Dr. Rebecca Bontadelli, an ER physician at St. Joseph, pointed out that the care patients receive at Warm Springs is much more extensive than the care Lake House was equipped to offer. A patient at the state hospital receives group and individual therapy, psychiatric and nursing care, and a social worker to help with discharge planning.

“I think that's a huge disconnect of having somewhere to put them,” she said. “Yeah, it's a bed, but it's not as good as Warm Springs, in my opinion.”

Erin Rumelhart, director of nursing at St. Joseph, said she had worked at Lake House when it first opened “because we saw the value in the institution.” Her concern is that a five-to-seven day stay at the facility often wasn’t sufficient to help someone regain stability.

“What we're really hoping to find, I think, is the moderate level of care,” which might mean a stay of up to two or three weeks.

Lorina Massey, a psychiatric nurse practitioner at St. Joseph, says she used to treat patients at Lake House too. “There were several very mentally ill people that we did a 14-day diversion with,” she said. “I was able to get them stable. They didn't have to leave their community. Their family could come visit them.”

Lapotka noted that  having two “lockdown” beds in the facility was probably sufficient for the estimated dozen involuntary commitments his office files each year. 

“If we had a facility where they could step down from that lockdown to more of a voluntary stay for a couple of weeks, continue to get care in the community with those providers they've established relationships with, things would stick better,” he predicted. “People would stay well longer after those acute episodes.”

State funding could help

Bob Lopp, the new executive director of Western Montana Mental Health Center was on hand to answer questions and gather information about what the community needs from the Lake House.

He began by acknowledging the limitations of WMMHC. “What they can deliver at Warm Springs is certainly different than what we can do here,” he said. “And we should also be absolutely clear that Western does not have the expertise or capability to be doing full-on lockdowns.”

Even though the facility has two high-security beds, the staff won't have the training nor can they legally accommodate violent patients, he said.

There was also a conversation about a significant increase in state funding, approved by the Legislature in 2023, that could help pay for community-based services such as those provided at Lake House.

House Bill 872 allocated $300 million over a period of time to reform and improve behavioral health and developmental disability services in Montana. Gov. Greg Gianforte’s proposed budget for the biennium provides $100 million to fund various recommendations made by an interim study commission. Those include money to expand and sustain Certified Community Behavioral Health Clinics, such as those services provided by WMMHC.

Despite the infusion of funding, Rep. Linda Reksten of Polson said financial accountability is crucial. “We need to know where the hang-ups for delivering service are that’s costing a lot of money in order for us to pass through the legislation and bring those costs down,” she said.

Sen. Greg Hertz of Polson, who chairs the Senate Taxation Committee, pointed out that law enforcement and hospitals in Sanders and Mineral counties also need similar services, and might be able to help keep the Lake House full.

Community collaboration

Decker, who previously served on the board for the WMMHC, said the Lake House “had a model in place that didn't fill the beds” and ended up using money from its profitable services to keep the doors open in Polson.

“How can how can we keep those beds full at the Lake House where Western can make a little money and we can make it the most cost-effective that it can be?” he asked. “How can we get the biggest bang for our bucks?”

Massey recalled the era when the Lake House “started going downhill and the money was an issue.” Patients were admitted who had dementia, were incontinent, or required insulin, she said, and staffing and patient safety became an issue.

“Yes, we need beds, but they need to be appropriate beds,” she said.

Lopp agreed. “We can't put the entire organization at risk for one location or the other because we're delivering the wrong services and we're not protecting ourselves from the liability,” he said.

He added that “community collaboration” could be a key part of solving the puzzle.

Another challenge, according to Lake County Detention commander John Todd, involves Medicaid reimbursement. He noted that if someone is incarcerated for assault, they immediately lose Medicaid benefits – even if the violence was precipitated by a mental health condition – which often makes them ineligible for mental health services.

Another complication, according to Polson Police Chief George Simpson, is substance abuse. Under the previous guidelines, he said Lake House didn’t accept those who were under the influence of alcohol or other drugs, even if they were nonviolent and wanted to sign themselves in to the facility.

“So we're missing a huge population that would use those voluntary beds but can't,” he said.

Question of accountability

Psychologist Vince Rivers, who often works with Lake County on finding placements for people who wind up in jail with mental health issues, expressed his frustration with the system.

“My understanding was that this meeting was to talk about the reopening of the Lake House, and I'm left not clear who is going to be eligible to go there or who, if anybody, I am going to be able to get sent there,” he said.

Lapotka noted that Rivers often serves as “a travel agent, trying to find a bed for someone someplace.” He suggested that the Department of Public Health and Human Services should develop “a clearing house for venues that would be available across the state and their level of care, something that we could reference, because usually we're dealing with an emergency.”

Desiree Fox, Behavioral Health Division director and clinical psychologist for CSKT Tribal Health, voiced her overall concern about the future stability of the behavioral healthcare system.

“First of all, we don't just want beds, we want quality service, we want people to get the services they need, we want them to get better, we want them to get connected with where they need to go,” she said.

She also said accountability was an issue.

“We've worked with Western Montana Mental Health before, and it sounds like you're asking this community to trust you to provide this service again,” she said. “And I'm wondering what your accountability to this community is going to be, because when we had this before, these services ended with, what, two weeks notice? And then we were all left scrambling, figuring out what to do with these individuals.”

“This is the first I've heard from this group since that happened,” she added.

“People are pissed off, and it's justified,” Lopp admitted.

“I'm going to ask you to help us and me understand what it is that you need, what we can do that doesn't take shingles off of somebody else's roof, and how we support it as part of the community,” he added.

Decker said Monday that WMMHC is committed to reopening Lake House, but hasn’t set a date yet because of uncertainties about staffing and funding.

    Desiree Fox, Behavioral Health Division Director and Clinical Psychologist for CSKT Tribal Health, voices her concerns about the future stability of the behavioral healthcare system during a meeting last Thursday at the Lake County Courthouse. (Kristi Niemeyer/Leader)