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.
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MAP posted-by: Jay Bergstrom