Montana Institutions Reboot Contest



NAMI Montana created the Montana Institutions Reboot contest as a way to jump start the conversation about how to redesign Montana’s public health institutions. What should our state institutions look like in five years?  Ten years? We know that we don’t have all the answers and are looking for help.  There are some brilliant people involved with Montana’s public health treatment system (including you) and we’re excited to help share those visions with the state’s policy members and advocacy organizations to help make them a reality.

Why Think About Redesigning Montana’s Public Health Institutions? 
The understanding of mental illness and recovery has changed dramatically since Montana established it’s public mental health institutions.  The treatment and funding options are evolving and they are going to evolve further. The state’s public insitutions have experienced some major upgrades and changes over the years, but the system is ripe for an overall design review.  The clearest example of this need for redesign comes from Legislative Mental Health Study from 2008 described the two largest institutions housing Montanans with serious mental illness as the Montana State Prison and the Yellowstone County Detention Center.  (Page 108 in the description of inmates in those facilities that are prescribed psychiatric medications in comparison to Montana State Hospital’s 189 licensed beds.)

Why Now? 
The time period between governor administrations is the perfect time to analyze where Montana’s public institutions should be headed. The campaign season is over, but day-to-day administrating hasn’t truly begun. It’s the first and last shot for the new governor and their department administrators to look at the system with truly fresh eyes.The ideas generated during this time period will be primed for review by the interim committees following the 2013 Montana legislature for potential long-term funding.

Contest Entries:
Contest entries must be submitted to NAMI Montana by 11:59 p.m. on November 20th, 2012.  Send contest submissions to  Contest entries will be made available to the public for comment from November 28, 2012 through December 12, 2012.  The prizewinners will be announced on January 9, 2013.

The two criteria for judgment will be quality of care and cost-effectiveness. These are purposefully very broad, multi-faceted criteria in order for entrants to creatively tackle role of institutions.

In order to be successful, contest entrants must address the current medical treatment needs served by the four institutions listed below along with an additional hundred beds for Montanans with mental illness involved in the criminal justice system. The addition of children’s mental health crisis beds will also be viewed favorably.

We recommend that all contest entrants address the challenges/benefits of larger, consolidated facilities versus smaller, more geographically-disbursed facilities. Be particularly mindful of the exclusion from Medicaid payment for stand-alone inpatient psychiatric facilities with more than sixteen beds. (described in depth in this report- Medicaid Financing of State and County Psychiatric Hospitals, U.S. Department of Health and Human Services). Please also consider innovative hybrid models that combine sixteen inpatient treatment beds with other types of services.

The length of contest entries should be between ten and twenty pages, including references, with double spacing and either 11 or 12 point font. Please let us know if you would like your submission to be anonymous.

The first prizewinner will receive a $500 cash prize and a cruise (special thanks to Jon Foxman for donating the cruise).  The second and third prizewinners will each receive a $250 prize.

We’ve got a great three-person panel to judge the entries: Dan Anderson, Alicia Plichette, and Quentin Schroeter.  Dan Anderson is a NAMI volunteer and the former director of the State of Montana’s Addictive and Mental Disorders Division. Alicia Plichette is the director of the Board of Visitors and the family member of someone who lives with a brain condition. Quentin Schroeter is in recovery from bipolar disorder and is a powerful advocate for his peers.

Please direct all questions to Matt Kuntz of NAMI Montana. Matt can be reached at (406) 443-7871 or at this email.

Recommended References:

Montana Board of Visitors Reports

Medicaid Financing of State and County Psychiatric Hospitals, U.S. Department of Health and Human Services

Report to the State of Montana: Legislative Mental Health Study, October 7, 2008 by DMA Health Strategies.

The State of Vermont’s thought process in replacing their state hospital with a 16-bed psychiatric facility may provide some insight into Medicaid funding and it’s role in state institution design.  Here is an article describing the Vermont Senate’s approval of that facility.

Sara Rosenbaum J.D., Joel Teitelbaum J.D., LLM, D. Richard Mauery MPH, DrPH Analysis of the Medicaid IMD Exclusion, December 19, 2002

Overhaul of Mental Health Laws Improves Recovery Rates – Report by BBC News on increasing recovery rates through compulsory treatment in the community, rather than in a hospital.

Information about the Medicaid Psychiatric Emergency Demo (IMD)

Information about Olmead Enforcement Actions by Justice Department:

Information about Delaware’s Olmstead Settlement: ,