The future of the public psychiatric hospital – which has lost his federal certificationis $17 million over budget and operating with 45% vacancies — remains uncertain, the state’s top health official said Friday, though an assessment may provide clarity in the coming months.
On Friday, state lawmakers had the opportunity to ask Charlie Brereton, the newly appointed director of the Montana Department of Public Health and Human Services, questions about the Montana State Hospital, whose l The future has been thrown into question as state officials have so far kept plans to seek federal accreditation near the vest again. Brereton was appointed Director of DPHHS in June as his predecessor, Adam Meier, announced his resignation.
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Democratic lawmakers on the Interim Committee on Children, Families, Health and Human Services took the lead Friday on prying responses from Brereton, to whom they had sent a letter earlier this week outlining their concerns.
“Since MSH’s loss of accreditation began, there have been significant concerns that DPHHS is seeking to privatize or close the state hospital altogether,” the August 22 letter said.
Brereton said Friday that seeking a future agreement with the Centers for Medicaid and Medicare, which provide about $7 million a year to the state to reimburse the costs of certain services, could be a costly and protracted undertaking given existing conditions at the facility. Whether the state pursues recertification or another path, he told the committee, will largely depend on the assessment due next month by Alvarez & Marsal, a consulting firm hired earlier this year to stabilize the workforce in all state-run health care facilities and offer recommendations on improving operations.
Brereton made it clear that the administration had no plans to privatize the public hospital, but paused before adding a caveat: “at this stage.”
Rep. Danny Tenenbaum, a Democrat from Missoula, pressed Brereton on another option, which would essentially be to shut down the state hospital and bolster community mental health care providers across the state. Tenenbaum floated a similar idea to end admissions of dementia patients to the facility, which was never intended to accept dementia patients, to free up staff for their scheduled duties. Rep. Llew Jones, R-Conrad, in a recent grandstand suggesting using the state’s budget surplus — sitting comfortably at $1.6 billion — to invest in a regional mental health model that could theoretically save $50 million a year from running the hospital of state.
“We’re very interested in exploring a similar model and working internally, at the early stages, but exploring what a more regionalized mental health system would look like,” Brereton said.
The state hospital, however, is the state’s “safety net” for people with severe mental illness who are either involuntarily committed to the facility or have nowhere to go. Building a regional mental health care system would take many years, according to Brereton. The Legislative Assembly, which meets in January, could begin to lay the groundwork for such a change, he added.
Alvarez & Marsal representatives joined Will Evo, the state’s new DPHHS Deputy Chief of Facilities, to share an update from Warm Springs. Evo described some “wins” for the facility, particularly in improving training compliance over the past few months. The monthly update says the culture is improving under the interim leadership installed after the removal of the former state hospital administrator, and the facility has been able to handle recent COVID-19 outbreaks. , while the lack of infection control in January led to several preventable deaths. .
Still, Evo said, employees are reporting burnout at facilities across the state. Montana State Hospital, whose DPHHS reported a $7 million budget overrun in May, ended fiscal year 2022 with a $17 million budget overrun due to a reliance on itinerant or contract staff. Less than a year ago, DPHHS reported a 40% vacancy rate among permanent staff. By Friday, that updated number had risen to 45%.
Evo himself has held town hall meetings at healthcare facilities and tried to be warm with staff as he travels the state in his new role.
“It’s important that these facilities feel supported by our Helena team,” he said.