“We all believe that there should be as many options as possible with no wrong door for people that need the access to mental health (care),” Juneau said.

Kirsten Smith, coordinator for the Gallatin Behavioral Health Coalition, broke down the coalition’s “crisis now” initiative.

That included adding a 988 service line for people in crisis, which Smith said was added in the county in July. She said that 75% of all calls that come in on that line are resolved on the phone.

There has also been work to bolster response and receiving services for mental health needs. One approach was through mobile crisis services in the county. Smith said that the hope was to expand mobile services to a 24 hours a day operation.

Another is through the psychiatric emergency unit at Bozeman Health Deaconess Regional Medical Center, which opened late last year.

Nicole Madden, system director of behavioral health for Bozeman Health, said over 100 crisis evaluations were completed in the first month that the psychiatric emergency unit was open. She said that the hospital has been successful in stabilizing people in crisis, and has returned about 60% of people that come to the unit to their families.

She said that Bozeman Health has hired 35 behavioral health-specific employees, and expects to hire between 35 and 50 more people as the hospital expands.

Work has continued on the in-patient psychiatric care unit at Bozeman Health. Madden said that the plan is to have the unit open by mid- to late-summer 2024.

Dr. Anne Thomas, a psychiatrist and director of behavioral health for Bozeman Health, said that the hospital has a successful outpatient psychiatry practice that has grown from zero to four psychiatrists in the last six years.

She said that practice is one of the few that takes all insurance, or even no insurance for care.

Smith said that there still is not a crisis receiving center in the county, nor space for emergency detention for people in crisis. She said that if emergency detention services are needed, people are sent to Warm Springs or the Montana State Hospital.

The county partnered with Connections Behavioral Health Solutions last year to work to fill that void.

Connections is leasing the Bozeman Health-owned Spanish Peaks Plaza building on North 19th, and completed renovations on the facility in December.

Paige Bichler, vice president of clinical operations at Connections, said that the organization is still waiting on permits, and once the permits are finally approved construction would begin on the building. She said that construction could take five months, and that Connections would occupy the building about a month after work is finished.

The center would accept “every single person who walks into the door,” she said. Bichler added that involuntary or emergency detentions would be prioritized by the center.

Bichler said that the mobile crisis services provided by Connections have been successful. So far, the organization has hired a team of five people, which included two therapists and three responders.

A handful of people spoke during the update, and were concerned about Connections’ for-profit model, security at the crisis center and finding people to work at the facility.

Commissioner Zach Brown said that he had the same concern about the organization’s for-profit model, but was encouraged by Connections’ open door policy.

“Your crisis receiving center is an open door for anyone, regardless of insurance… and importantly regardless of intoxication as well,” Brown said.

Brown noted that a factor in the state of mental health care services in the county was because the state pulled reimbursements for case management for mental health cases in 2017.

He said that the county built a system that was highly dependent on those reimbursements, and once the reimbursements were pulled the system began unraveling.