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.