Jennifer Carlson: Recent people-driven turnaround at Warm Springs hospital is for real
Jennifer Carlson of Manhattan is a former Republican lawmaker and chair of the Legislature’s Transition Review Committee for the Montana State Hospital.
To my knowledge, no one has ever accused me of being a Pollyanna or of wearing rose-colored glasses, so imagine my surprise at my growing confidence that, regarding the Montana State Hospital, the light at the end of the tunnel is not a train.
During my time in the Legislature, I worked from 2021-2025 on legislation for reforms at the Warm Springs mental hospital and then chaired a legislative committee with oversight of the implementation of those reforms. As chair of House Human Services Committee and a member of the HHS interim committee, issues at MSH were always at the front of my mind.
I have toured the facility three times since 2021 and have had hours and hours of conversations with employees, industry watchdogs, family members of patients, and several administrators there. You may recognize me as an outspoken critic of the administration of MSH, with very little tolerance for the patient conditions that existed in 2021 or for the pushback we received from hospital, agency and administration for insisting on immediate, sweeping reform.
After my first tour of the state hospital four years ago, I toured the Montana State Prison. It sticks in my mind that I mentioned to my colleague after about 10 minutes at the prison that if it came down to it, I’d rather be at the prison. That I am telling you, because it would be rude to say what I was thinking when I walked out of the hospital after my first visit.
It wasn’t just me. Due to a laundry list of infractions, in 2022 the federal Centers for Medicare and Medicaid Services withdrew their certification of the hospital and the money that went along with it. More important to me than this loss, the conditions for the patients at the hospital were simply unacceptable.
I was not OK with the phrase “placement of last resort.” Montanans who experience mental health crises must have a quality place to get real help — including those who have no choice in the matter.
I know you have read articles about the problems at MSH for years, necessary articles that shone a light on the areas where improvements were required. Issues and problems were top to bottom and have been detailed multiple times in this paper and others.
What I have not seen is an article that celebrates the successes of the past several years and tells you where we are today.
My latest visit to Warm Springs was early December and just my treatment on arrival was night and day difference from April 2024, when the visit itself made waves as “uninvited legislators arrived for hostile tour.”
I was welcomed by the new CEO, Dr. Dan Bemporad, a psychiatrist with years of experience providing care at Galen and Warm Springs. He is dedicated to treating Montanans who need mental health care.
He was also willing to sit down and answer as many questions as I had for him — not a small offer for someone who has heard of me. We were joined by Social Services director Kaila Tamcke, who was eager to show me the progress that has been achieved in quality of patient life.
What had been missing in my 2024 visit, and I found in December, was a pride in their work that naturally made me hopeful by extension. For the first time I believed that Montanans did not have to feel dread at the prospect of a loved one being committed to the State Hospital for care.
The recent facility renovations have resulted in a space that is bright and clean, and more importantly, with multiple safety upgrades. The recreation building, which was shuttered at the time of my first visit, was in use and includes a small gym and fitness center, art room, and classroom space. Patients had a full schedule of group therapy, activities and personalized medical care.
The medical clinic has undergone renovations. I am skipping over much of the physical plant improvements, which are beneficial, because I think the most important piece to restoring our state’s hospital for treating patients with Severe Disabling Mental Illness is the people.
The Social Services Department in December had 10 licensed staff, with four more just interviewed the day before — a stark contrast from just a few years ago when the number was zero. A new psychiatrist hire has just been announced.
DPHHS has made a commitment to hiring nurses and other providers in a concerted effort to move away from contracted “travelers.” It may not be apparent what an improvement this can make. As much as travelers were necessary in the past five years, long-term use of short-term contractors can create a two-tiered system where camaraderie is the casualty.
Quality of life for employees is vital to treating patients. Serving the most vulnerable patients is hard work, and I applaud the department for “putting our money where our mouth is” and not just paying lip service to elevating this work.
I hope that going forward, with recertification with CMS, the hospital will continue to attract employees who can choose this valuable work without making personal sacrifices to their own quality of life.
Although this Montana State Hospital reform process has been stop-and-go and quite a bumpy ride for several years, I am confident the state can regain the trust of Montanans. I have found this new leadership team to be professional, transparent, and responsive.
DPHHS has submitted the CMS recertification application and now begins the intense process of multiple site visits, and most likely several months of adjustments and surveys and follow-up visits. I am hopeful that we have made it over the worst of the terrain and are finally back on the road.