Montana's mental health advocates said state lawmakers addressed many of the state's pressing needs in the just-completed legislative session, but more work remains to be done.

The Montana Legislature addressed increasing funding for youth suicide prevention, adding beds at crisis care centers, improving Medicaid reimbursement rates for community behavioral health providers, increasing the number of community behavioral health centers and reworking conditional-release programs for offenders with serious mental health conditions.

Matt Kuntz, executive director of the National Alliance on Mental Illness-Montana, said it is exactly how lawmakers should address the state's critical mental health needs.

"There was a big, bipartisan push for mental health," Kuntz acknowledged. "There's a lot of things our country doesn't agree about right now. There's a lot of things our state doesn't agree about right now. But to see bipartisan agreement on mental health is really positive."

Kuntz pointed out while lawmakers did a lot to support mental health issues in the state, he and other advocates are already thinking about how to make more progress in the next legislative session.

While Medicaid reimbursement rates are slightly higher than they have been, Kuntz explained because reimbursement rates are still below where they should be, caregiver wages stay low, making it hard to attract providers to the profession.

"It's going to be a challenge to keep moving forward with increasing the number of care providers, both clinicians and technical staff," Kuntz cautioned. "Getting those bodies to serve and care for the people and make mental health their career is a long-term challenge, especially coming out of COVID."

Kuntz added he and other advocates are already planning to ask for higher Medicaid reimbursement rates moving forward.

Indianapolis is expanding its innovative Clinician-Led Community Response program, offering Hoosiers a new approach to handling mental health crises.

The program is a collaboration between the City's Office of Public Health and Safety and Stepping Stones Therapy Center. It pairs licensed behavioral health professionals with 911 dispatch to address nonviolent emergencies without police involvement.

Andrea Brown, director of operations for Stepping Stones Therapy Center, said it meets people where they are.

"Meeting people in the community with accessible mental health services is monumental for the city of Indianapolis," Brown asserted.

The city reports success in the Downtown and East Indianapolis Metropolitan Police Department districts, where the program recently expanded to 24/7 operations. The team answered 925 calls this year, assisting about 650 people.

Critics of similar programs argued law enforcement should remain involved in all emergency situations. However, city officials said the model frees police to focus on public safety while specialists manage mental health calls.

The next step happens later this month. It brings the program to the St. George Apartments near the north side, with a full rollout to the police department's North District in early 2025. The expansion brings an additional 192,000 residents access to mental health resources.

Ron Gibson, District 8 representative on the Indianapolis City-County Council, knows all too well the effects the program has.

"I know firsthand how important programs like this are," Gibson explained. "I've experienced family members in a behavioral health crisis, and it can be traumatic for all involved. But when you have experienced professionals show up, it makes all the difference in the world."

The program provides crisis intervention, de-escalation and referrals, while fostering long-term wellness. Supporters believe the expansion strengthens public safety across the city and builds trust within the community by addressing mental health needs directly.


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Some 380,000 Coloradans who need mental health care are not getting it, according to a Colorado Health Institute report.

Cost remains the biggest barrier, but one third of Coloradans reported having trouble getting an appointment. At least one provider in the state is addressing this deficiency.

Adam Roberts - president and CEO of Diversus Health - said after re-aligning staff and support systems to manage surges in demand, the Colorado Springs-based facility that serves all patients regardless of their ability to pay, can now provide care on the same day a new client reaches out.

"It's pretty brave when people actually want to come in and get care," said Roberts. "And so we look at it as, we should be ready at any time when a person recognizes they need care."

In as little as two hours after new clients call 719-572-6100 or walk into the Diversus facility in Colorado Springs, trauma-informed specialists will help clients navigate paperwork and provide an intake assessment.

Next, a clinician will review the assessment, provide a diagnosis, and clients leave with a series of next steps in hand.

State rules require that wait times for mental health treatment not exceed seven days. But in rural parts of the state, where mental health professionals are few and far between, wait times can be much longer.

Roberts said about half of their services are provided through telehealth - which allows them to serve clients anywhere with an internet connection, cell signal, or landline

"The telehealth option, the virtual option," said Roberts, "is an effective option to access behavioral health care for many people that have a hard time traveling to a provider."

More than one million Coloradans experience a mental health or substance use disorder each year.

Roberts said he hopes other providers will tap lessons learned at Diversus to offer same-day care for anyone who decides now is the time to get help.

"And I hope that others work towards that," said Roberts, "so that we can improve the mental health of the community that we live in, and the state of Colorado."




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The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.