Initiative aims to treat mental health in primary care

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The Salish and Kootenai Tribal Health Department and North Valley Hospital are part of a half dozen health care systems in Montana splitting more than $700,000 in grants to weave mental or behavioral health treatment into primary care.

The Montana Healthcare Foundation announced the statewide initiative this month, which plans to award more than $3 million in grants for the effort over the next two years.

Foundation CEO Aaron Wernham said it is crucial for Montana doctors to be able to recognize and support mental health concerns to fill gaps in specialty resources, especially in communities where it is a social taboo for someone to admit they need help beyond a physical illness, he said.

“We hear from hospitals and health-care providers around the state that their top problems are alcohol abuse, addiction and depression,” Wernham said. “Communities are struggling to treat those issues effectively.”

He described the initiative as pulling resources, as diverse as patients, under one roof. For example, it would allow a doctor to evaluate a patient’s depth of anxiety along with checking the person’s blood pressure.

The tribal health department will use its $35,000 lot in the funds toward building a plan to move toward integrated behavioral health.

North Valley will use the $150,000 it received to continue to build its school-based health center programs.

WERNHAM SAID whole-person care results in people getting better care at a lower cost compared to waiting to treat mental health issues until it appears as an emergency.

“We’re learning that addiction and mental illnesses like depression are very common and affect the outcomes of primary care work,” Wernham said. “They can make managing chronic health conditions like diabetes more difficult. As a result, some people end up in the ER or even dying decades early.”

Untreated mental health issues also create a financial burden on state resources.

According to a 2009 Montana Meth Project report, 50 percent of inmates housed by the state department of corrections are tied to methamphetamine convictions. The report — which outlines the most recent figures on the cost of meth to Montana — estimated the state spent nearly $12 million on removing kids from parents using the drug and placing them in foster care in 2008.

Another study released by the Bureau of Business and Economic Research in 2009 placed the cost of caring for people with alcohol addictions at more than half a billion dollars — that includes the money spent by businesses, individuals and governments and the dollars lost to the economy.

KEVIN HOWLETT, the director of the Confederated Salish and Kootenai Tribal Health Department, said the department’s initial focus on this project will revolve around chronic pain.

“Chronic pain and opioid abuse are some of the most gripping problems in our community, and our primary care providers are on the front line addressing these issues,” Howlett said. “By integrating our primary care with behavioral health and other ancillary services, we will bring the full force of the Tribal Health Department to these epidemics.”

He said the department’s strategic plan will include ways to train behavioral health staff and primary care providers on interview and intervention strategies for patients who show a cause for concern.

Howlett said from there, the department will expand its integrated services to other preventable diseases such as diabetes, obesity, heart disease and mental illness.

North Valley Hospital plans to continue to expand its school clinics that act as an extension to the North Valley Professional Center in Columbia Falls and North Valley Behavioral Health in Whitefish.

Rhonda Tallman, who manages North Valley clinics, said treating kids in school means their education is not stalled by driving to doctor appointments in the middle of the day.

“We initially integrated telemedicine into these sites to work with students where they are with a grant the foundation gave us last year,” Tallman said. “But telemedicine is not going to be the right solution for treatment every time. This new grant will allow us to provide some more face-to-face services.”

She said along with providing students with help in schools, the program aims to broaden early education around recognizing mental and behavioral health concerns.

“We want to get students thinking about health as not just a physical condition — it includes taking care of yourself mentally and physically,” she said. “This (grant) will allow us to take the time to really visit with the schools and identify where are the biggest gaps we hope to bridge.”

Wernham said while the foundation’s goal to spread integrative behavioral health across Montana may seem lofty, it’s already a plan set in motion in dozens of Montana-based health care systems.

“We’re not planning on grant funding for every practice,” Wernham said. “But what we’re really hoping to see is a statewide system emerge, that demonstrates how integrating behavioral health could work and what else needs to happen to make this successful. And I think we’re not far off.”

Reporter Katheryn Houghton may be reached at 758-4436 or by email at

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