Pubdate: Mon, 19 Dec 2005 Source: Billings Gazette, The (MT) Copyright: 2005 The Billings Gazette Contact: http://www.billingsgazette.com/ Details: http://www.mapinc.org/media/515 Author: Ed Kemmick Bookmark: http://www.mapinc.org/rehab.htm (Treatment) MONTANA'S CHEMICAL DEPENDENCY CENTER OVERBOOKED, UNDERSTAFFED When somebody using methamphetamine decides it's time to get treatment, it's usually not a good idea to wait. "If they can't get in when they want to get in, you've lost them to another round of drug addiction," said Mona Sumner, chief operations officer of the Rimrock Foundation. And getting in is often the hardest part at the Montana Chemical Dependency Center in Butte, the only inpatient treatment program administered by the state of Montana. During the first full week of December, MCDC Program Director Dave Peshek said people at the top of his waiting list would probably get into the center during the third week of January. Long list In the nearly seven years Peshek has been the director, the longest waiting periods have been up to eight or nine weeks, with 80 to 100 people on the list waiting to get in. "We don't consider this to be tolerable," said Bob Mullen, deputy administrator of the Addictive and Mental Disorders Division of the state health department, which administers the MCDC. There are several parts to the problem. The center was originally licensed for up to 76 beds, including six beds for detoxification. When the center closed the detox unit several years ago, that left it with 70 treatment beds. However, the center is also licensed for only eight counselors, and under the MCDC's collective bargaining contract with its licensed addiction counselors, the center must maintain a patient-to-counselor ratio of no more than 8-to-1. That means the MCDC could have, at most, 64 patients at any time. The trouble is, for years the center has had difficulty maintaining full staffing. As Sumner put it, the Butte area is "tapped out" in terms of counselors and social workers because there are so many state institutions there and in the nearby Deer Lodge Valley. More counselors needed Earlier this month, the center had six counselors, though one of them was working part-time for medical reasons, Peshek said. The patient count stood at 43, which is 21 fewer than the center could handle with full staffing. Figures compiled by the center show that its average daily census hovered at around 50 from 1998 through 2004, the last year for which numbers were available. The MCDC opened in Butte 10 years ago, and while there were times in the early years when it was full, Mullen said, "over the last couple of years, we have not approached 60 to 65 beds." And because the center does not solicit patients, instead taking referrals from community treatment programs across the state, the center's inability to absorb more clients puts a lot of pressure on the already underfunded community programs. Peshek said pay for a new counselor in training is $29,000 plus benefits, rising to about $35,000 for a starting licensed counselor. But better-paying jobs are available outside Montana, as is the case with most professions. "Sometimes we go a very long time trying to get applicants for the positions, and obviously there's a definite shortage in the entire state," Peshek said. Licensed addictions counselors right out of school "pretty much have a choice where they want to go," he added. "It's a very competitive area." Even so, things are looking up. Peshek was interviewing several candidates in early December and thought he might be at full staffing by the first of the year. It might take until February to catch up with the backlog, but after that the waiting period for new clients could be down to two weeks. "Right now, we're feeling very excited about our prospects of filling our positions," Peshek said. Even with full staffing, though, Sumner, of the Rimrock Foundation, thinks the state is unwise to put all its inpatient treatment beds in Butte. It is hard for people in many parts of the state to get there, she said, and it is chronically difficult to keep the Butte center at full staffing. "That is the problem, and the state has to get realistic," she said. Sumner said a better system would be to have a 30-bed treatment center in Butte, with 16-bed satellites in three other cities, including Billings. She said the state could save money in Billings because patients could live in one location and go to the Rimrock Foundation for daily medical, psychiatric and educational sessions, as residents of Michel's House, another state program, do now. Sumner said she has advocated that idea for years, to no avail. Now, the foundation is trying to force the issue. It has purchased 1.6 acres of land at North 17th Street and Eighth Avenue North, where it plans to build four 4-plexes to provide various residential treatment programs. One way or the other The first 4-plex will have room for 16 people, in addition to a cafeteria and office space for counselors and social workers on the ground floor. After the building is ready, sometime next year, Rimrock will try to persuade the state to use it as a satellite of the MCDC. If it doesn't, Rimrock will open its own program there. Mullen, with the Addictive and Mental Disorders Division, said he hadn't heard about that proposal. "She's a tough partner, that Mona," he said, half laughing and half sighing. But, he added, "We're interested. If we can find the money to do that, we're interested." The state division doesn't have a lot of extra money sitting around from the vacancy savings because of the understaffing at MCDC, Mullen said. Any unused money at the end of the year is distributed to community treatment programs around the state, and it doesn't usually amount to much. He said there are so many fixed costs at the center that being down a few counselors, or a couple of dozen patients, results in very little savings. In fact, he said, in the past fiscal year, for the first time in many years, the state had to use general fund money to shore up the division's chemical dependency budget. It wasn't a lot - about $40,000 - but it was the first time regular funding had fallen short. The regular funding comes from state alcohol taxes, plus a small block grant from the federal government. Sumner and Peshek agree that there are too few treatment options for people once they get out of MCDC. Ideally, someone who completes a course of treatment at the center would then be referred to long-term residential treatment, but there is very little of that available in Montana, unless you have a lot of money to spend. "We need more of the community-based, mid-level, longer-term treatment programs," Peshek said. For those who do get in, the MCDC offers a highly structured program where patients are kept busy most of the day from 6 a.m. to lights out at 10:30. They participate in intensive individual and group therapy, educational sessions, mental health counseling and exercise. There is no limit on the length of stay, but most people complete their treatment in about 38 days. Some stay as long at 70 days, Peshek said, but after that it's rare that anyone would need the level of care offered by the center. Everyone who leaves the center is referred to a lower level of care, whether it's intensive outpatient care or continued group sessions. The rate at the MCDC is $200 a day, though increased services including medication or special medical services can bump that to $350. The center accepts private insurance or Medicaid, but most of the people who come in have next to nothing and their treatment is paid for by the state. Details Statistics for the Montana Chemical Dependency Center, for the 12-month period ending in June: Total number of admissions: 224 females, 318 males. Average length of stay: Females, 40.4 days. Males, 39.7 days. Number of clients who listed alcohol as their primary drug of choice: 274. Methamphetamine: 134. Marijuana: 77. Other drugs listed include cocaine, heroin and other opiates. - --- MAP posted-by: Jay Bergstrom