Priority Area 1: Behavioral Health

Poor mental well-being affects thousands of Montanans. One in ten Montana adults (nearly 84,000) report frequent mental distress with 14 or more days of poor mental or emotional health in the past month. Suicide, a mental health crisis continues to affect every Montana community. Suicide-related deaths in Montana are two times higher than the U.S.; from 2011 to 2015, an average of 240 suicide deaths occurred each year in Montana.

Additionally, nearly 64,000 Montana adults struggle with substance use disorder (SUD). Alcohol is the most commonly abused substance in Montana, but use of illicit drugs like marijuana, cocaine, heroin, and methamphetamines continue to be a concern. Among Montana youth, 2.2% of high school students reported having used methamphetamines during their lifetime. Opioids are the leading cause of drug overdose deaths in Montana, accounting for 44% of all drug overdose deaths.

It is important that health care providers are educated on the delivery of care from a trauma-informed perspective, particularly in regards to historical trauma with the American Indian communities. 

Goals

  1. Improve access to timely, affordable, and effective behavioral health services.
  2. Prevent and treat depression, anxiety, and other mental health conditions.
  3. Decrease the prevalence and adverse consequences of substance use disorder.
  4. Develop, implement, and monitor effective programs that promote wellness and prevent suicide and related behaviors.
  5. Decrease overdoses and deaths associated with prescription and illicit opiates through coordination of prevention, monitoring, enforcement, treatment, and recovery services.
  6. Decrease behavioral health disparities among American Indian communities.
  7. Support steps toward the integration of physical and behavioral health care at the community level.

Objectives for all Montanans by 2023

  • Decrease the proportion of adults with frequent mental distress (greater than or equal to 14 days in the past month with poor mental health status) from 10.4% to 9.9% (Baseline: MT BRFSS, 2016)
  • Decrease percentage of high school students who report binge drinking in the past month from 17.6% to 16.7% (Baseline: MT YRBS, 2017)
  • Decrease the proportion of high school students who attempted suicide in the past year from 9.5% to 9.0% (Baseline: MT YRBS, 2017)
  • Decrease past month alcohol use from 9.9% to 9.4% and illicit drug use from 10.0% to 9.5% among adolescents aged 12 to 17 years (Baseline: MT NSDUH, 2014-2015 and 2013-2014)
  • Decrease the proportion of adults who report binge drinking in past 30 days from 19% to 18% (Baseline: MT BRFSS, 2016)
  • Decrease opioid overdose death rate 4.2 per 100,000 people to 3.8 per 100,000 people (Baseline: MT Office of Vital Statistics, 2016)

Objectives for health equity by 2023

  • Decrease proportion of American Indian adults with frequent mental distress (greater than or equal to 14 days in the past month with poor mental health status) from 15.4% to 14.6% (Baseline: MT BRFSS, 2016)
  • Decrease percentage of American Indian high school students who report binge drinking in the past month from 22% to 21% (Baseline: MT YRBS, 2017)
  • Decrease the proportion of American Indian high school students who attempted suicide in the past year from 18% to 17% (Baseline: MT YRBS, 2017)
  • Decrease the proportion of American Indian adults who report binge drinking in the past 30 days from 20% to 19% (Baseline: MT BRFSS, 2016)

Prevention and health promotion strategies

  • Implement evidence-based strategies in the Montana Suicide Prevention Plan.
  • Increase the number of communities implementing the “Communities That Care” model to prevent under-age substance use.
  • Promote tobacco-free behavioral health programs.
  • Implement a statewide public education campaign/ media campaign that includes harm reduction, reducing stigma, proper storage and disposal of prescription medications, and awareness of the risks and protective factors to reduce adolescent substance use (such as binge drinking, prescription drug misuse).
  • Increase awareness of and support for prescription drop boxes and disposal bags statewide.
  • Support local and tribal health departments and non-profit organizations in Montana communities to implement evidence-based Opioid Use Disorder/SUD prevention activities.
  • Retain Medicaid expansion.
  • Increase access to behavioral health professionals within schools for youth with mental health and substance use needs.

Clinical strategies

  • Promote routine screening for mental illness, anxiety, depression, SUD, and suicidal ideation in primary care and other medical settings using evidence-based screening tools (i.e. Screening, Brief Intervention, and Refer to Treatment, Alcohol Use Disorders Identification Test, Patient Health Questionnaire, Generalized Anxiety Disorder, and the Columbia Suicide Severity Rating Scale).
  • Promote primary care-based interventions and, when appropriate, referrals and engagement in specialty services.
  • Increase access to integrated behavioral health services and medical care, including telehealth and increased workforce, particularly in rural and frontier communities.
  • Increase and promote use of evidence-based medication assisted SUD treatment services for SUDs and opioid addiction.
  • Increase access to SUD services for pregnant women with SUDs.
  • Promote tobacco screening and cessation services and products in behavioral health, primary care, and other health settings.
  • Increase training in Adverse Childhood Experiences (ACEs) and trauma-informed care among medical and behavioral health professionals.
  • Increase the use of peer recovery supporters as a cost-effective way to improve the timeliness of entry to care and engagement in care throughout the treatment course, and to reduce recidivism after discharge from inpatient or residential treatment and incarceration.
  • Train and increase number of Licensed Addiction Counselors and dually-licensed mental health and substance use providers and peer supporters.
  • Increase the number of providers who have obtained the required training to prescribe buprenorphine (a DEA x-waiver). Buprenorphine is one of the three FDA-approved medications used to treat opioid addiction as Medicaid Assisted Treatment (MAT).

Policy strategies

  • Develop strategies to work across Montana’s behavioral health system (mental health and SUD) to align payment reform, address workforce shortages, identify access barriers, ensure rapid and effective crisis response, and provide treatment in the least restrictive environment.
  • Increase collaboration and successful "warm handoffs" for individuals admitted to and discharged from state-operated facilities, hospitals, residential behavioral health/psychiatric facilities and community-based healthcare providers to lower annual readmission rate and to serve individuals in their own communities whenever possible.
  • Increase the use of certified behavioral health peer specialists in recovery support to improve timeliness of entry to care and engagement in treatment, and to reduce repeat hospitalizations and incarcerations.
  • Increase direct collaboration and coordination of services between the SUD and mental health care system and the criminal justice and corrections system.
  • Support administrative and legislative policies to increase prescribing according to the Centers for Disease Control and Prevention guidelines.
  • Support policies requiring pharmacists to check identification before dispensing narcotics.
  • Better utilize the Montana Prescription Drug Monitoring System to prevent over-prescribing of opioids or unintended drug-drug interactions.
  • Improve data surveillance of suicide deaths in Montana through participation in the National Violent Death Review System.

Health equity strategies

  • Expand culturally relevant behavioral health services for diverse and health disparate populations (American Indian, LGBTQ, veterans, low income, rural, and frontier).
  • Increase wraparound support services to individuals receiving or needing behavioral health services (crisis stabilization, care coordination, and recovery support).
  • Increase number of integrated behavioral health programs providing SUD services who can access Medicaid reimbursement, including supporting tribally-operated clinics, Urban Indian Health Centers, Federally Qualified Health Centers, Rural Health Clinics, and hospitals.
  • Foster collaboration, particularly between frontier and rural areas and larger urban centers, to improve continuum of care in communities.

Text/HTML

Workgroup meeting materials

Date Agenda Minutes
March 4, 2020 03/04/2020 03/04/2020
December 11, 2019 12/11/2019 12/11/2019
September 13, 2019 09/13/2019 09/13/2019
June 11, 2019 06/11/2019 06/11/2019

Data

See additional data related to opioids use and mental health and create customized reports with MT-IBIS. For help with MT-IBIS, contact the Office of Epidemiology and Scientific Support (OESS). You can also access all recent data reports on multiple topics from OESS.