BILLINGS – For people with substance use disorders and mental illness issues living on the streets of Billings, daily life is challenging.
In a crisis, they may be taken to a local resource, but often end up right back on the streets with little change to their circumstance.
The Billings Police Department has three downtown resource officers that help keep tabs on the city's homeless community.
“Sometimes it feels like, as far as law enforcement goes, we’re kind of stuck in the middle. On one hand, we’re trying to serve the downtown businesses, make sure everyone downtown feels safe. And at the same time there are people suffering from mental health issues, getting the help that they need,” said Officer Moses Richardson.
Officers can issue citations for quality-of-life issues like public urination, littering, or nuisance downtown, among other crimes.
Richardson said a mental health crisis is often characterized by a manic episode, and officers get called when the person enters a business downtown.
When an incident like that occurs, officers are expected to find a way to handle it, but they say they deal with the same people and resource limitations, over and over.
“I know we’ve had issues with the State Hospital. People actually get committed, they get sent there for a short period of time, and then they bus them straight back and drop them off at the rescue mission with no caseworkers or anything like that. Usually, they are right back on the street doing what they were doing before,” Richardson said.
He said he started noticing this happening in the past two or three years.
Billings Clinic is an option for mental health crisis care if someone is homicidal or suicidal but if not – patients may be discharged and referred elsewhere for services after evaluation, Billings Clinic spokespeople said.
Richardson says it's frustrating that people are taken to the hospital and sometimes released hours later.
He told MTN this example of an unnamed person in a recent interaction.
“She’ll have some sort of manic episode, to the point where she needs to go somewhere. We tried to take her to the Crisis Center, she was above their level of care. So we took her to Billings Clinic even though she wasn’t suicidal or homicidal, and I think she was out of there within a couple of hours, back on the street,” Richardson said.
Billings Police Chief Rich St. John says the department and Billings Clinic are close partners and have a working group in place to discuss issues that arise when taking people in a mental health crisis to the hospital.
Rimrock Foundation Peer Support Specialist and Homeless Outreach Team member Kyle Duneman said the population they work with could use more mental health treatment options in Billings.
Duneman said it’s been tough to try to provide services with limited resources.
“The hospitals are pretty busy and pretty full. It just seems like there’s not enough for the problems that we have,” he said.
People living on the streets experience an increased risk of physical and sexual assault.
Duneman said one of their main tasks is checking to make sure people are OK and offer them support if something has happened.
“It's showing them someone is there for them and someone does care about them. They’re not alone,” he said.
The Crisis Center is a collaboration between hospitals and mental health care stakeholders in the community.
“They are full and there’s a lack of staffing in some of the organizations that we work with. They don’t have the adequate staff that they need either to provide the care, so those waiting lists get longer and longer,” said Crisis Care program director Marcee Neary.
The Crisis Center tends to be busy because it's a place where people are immediately assessed, even if there are no available beds to take someone in, Neary said.
Many communities use their jail as an alternative for people in a mental health crisis, but overpopulation at the Yellowstone County jail limits that option as well.
“Most of the time, the jail is not an option, to take them there. Even if they have committed a crime, it's usually still not an option, unless the crime is violent, and then the jail might keep them…but most of the time it's not the place they need to be to begin with,” said Richardson.
He said a good point of contact for people living downtown with someone who manages their medications and knows their history would be helpful.
“I think the major thing we need is a person, like a point of contact, that we can go to and say, ‘Hey this person is really struggling on the street, we think they need help,’ and maybe someone who can monitor that person. Because the problem we have is someone that can be repeatedly having some sort of manic episodes, but there’s no one there to monitor all that, to say this person should maybe be committed involuntarily into the hospital to get them back on their meds,” he said.
The person and role Richardson is describing used to exist in Montana.
Medicaid-funded caseworkers across the state would help manage the healthcare and lives of people with severe, disabling mental illnesses who qualified for case management so they could live in the community.
But in 2017 the Montana legislature cut funding for this work, largely eliminating the state’s system of community-based mental healthcare.
Lawmakers circled back around to the issue this session. The 2023 legislature just passed a $300 million measure to rebuild the state’s continuum of care.