Piggy Bank with a clamp on it.” Credit: TaxRebate.org.uk

April 10, 2018; KBZK

Helena Industries in Montana, which provides a “vocational and rehabilitative services utilizing real work, related services and individualized resources to empower persons with disabilities to lead productive and fulfilling lives in their communities,” has declared Chapter 7 bankruptcy this week after nearly 50 years of service. Chuck Siefert, the board’s vice chair, said it was “not what we were wanting to do,” but budgetary woes caused in part by state budget cuts left them no other option.

The Montana Department of Public Health and Human Services (DPHHS) cut funding for direct case management, which provided a third of Helena’s budget. In other words, it was a core component of the agency’s funding—and, presumably, its program—which left the organization vulnerable to such a move. Barbara Walsh, chief executive officer of Helena Industries, said the state budget cuts “hit all our programs” and they “could not adjust.” Still, the program may have felt relatively safe because of recent investments by Montana in its mental health system, which rose from 46th in 2011 to 39th  in 2014 on Mental Health America’s state-by-state ranking.

Richard Saravalli, chief executive officer of Butte-based Aware Inc. who used to work for Helena, said he was concerned the closure of Helena Industries would have a “domino effect” on other providers, as clients are shifted to other organizations.

Matt Bugni, chief information officer for AWARE, said that he sees the case management model being phased out in the state, in favor of state-run institutional programs. He told the Independent Record, “We don’t have the rates to afford it. We’re seeing a dismantling of that community-based system and we think a lot of clients are going to go into higher levels of care, including institutions.”

In an excellent piece for NPQ back in 2014, Tamie Hopp explained that the prevailing wisdom on care for people with mental health issues has swung between favoring institutionalization and decentralized community care several times since the 1970s, when the drive toward deinstitutionalization was supposed to have been coupled with the development of a robust system of community care. That system never emerged in any real sense, and since, then many states have defaulted to using their jails as institutional care, which left advocates fumbling for a patchwork of solutions. As of 2014, Medicaid funding was split about 50/50 between community and institutional options. Hopp argued that “we must figure out ways to meet individual needs versus wholesale approaches to providing care that end up being as bad as or worse than having an institution as the only option.” Of course, this will be more difficult without personal case management services like the ones Helena Industries provided.

Montana’s funding for mental health case management will decrease by $2 million in the next two years, and the state is ending case management contracts with service providers, like they did with Helena. Other organizations are having to adapt to keep their doors open. Bugni told the Independent Record, “We make more money per kid at those higher levels of care, but our mission is helping people live independently. We want to follow our mission of doing that, but also trying to stay in business.” Barb Mettler, with South Central Montana Regional Mental Health Center, said that her organization went from 20 case managers to two, and they’re “doing a really excellent job of covering, but we don’t know how much longer we can do that.” We can only imagine how overworked those two case managers must be in this overwhelmingly rural state.

DPHHS director Sheila Hogan said that her department was “deeply saddened to learn last week of their plans to close.”—Erin Rubin