The Session Subscribe: Apple Podcast | Spotify The Session | The Montana State Hospital, doulas and St. Paddy’s day at the Capitol EPISODE DESCRIPTIONIt’s week 12 for the 69th Legislature. Lawmakers are considering policy related to the Montana State Hospital and health and welfare in Indian Country. This is The Session, a look at the policy and politics inside the Montana State House.EPISODE TRANSCRIPT Shaylee Ragar:  It is Week 12 for the 69th Legislature. Lawmakers are considering policy related to the Montana State Hospital and health and welfare in Indian country. This is The Session, a look at the policy and politics inside the Montana State House. I’m Shaylee Ragar with Montana Public Radio. Mara Silvers: I’m Mara Silvers with Montana Free Press.Nora Mabie: And I’m Nora Mabie with Montana Free Press. Shaylee Ragar: Nora, so good to have you on the podcast. You are a new addition to the Montana Free Press team, but you are definitely not new to Montana. Tell us more about yourself. Nora Mabie: Yes, I’m so excited to be here. So I’ve been covering indigenous communities in Montana for five years now. I started at the Great Falls Tribune and then I went on to the Lee Montana newspapers and now I’m at the Montana Free Press covering tribal issues. So I’m really excited. Shaylee Ragar:Yeah, thanks for being here today. Mara, you’re an old addition to Montana Free Press.  How are you doing?  Mara Silvers: I’m good, I’m good. I’m feeling a little old. It feels like we’ve been here for a while, but we’re pushing through and we’ll finish at some point. Shaylee Ragar: It is kind of crazy to think about the first week of the session, like it feels like a year ago.But let’s get into what we wanna talk about today. We are talking about a wide variety of health and welfare proposals, and an issue that continues to be super complicated and expensive at the legislature is care at the Montana State Hospital, the only public psychiatric hospital for adults in Montana, and how people get there and when.Mara, give us a brief overview of what’s going on with the facility. Mara Silvers:Right, so the Montana State Hospital has over 200 beds for people. It’s down in Warm Springs, which is near Butte, and it lost federal certification in 2022 after a series of preventable patient deaths and injuries. So that certification encompassed a lot of things and it’s been something that the administration of Governor Greg Gianforte has been trying to get back ever since. Shaylee Ragar: So what kinds of proposals are lawmakers looking at right now? Mara Silvers: The proposals that lawmakers are considering now are really about how people get to Warm Springs and why the category of bills that we’re looking at are called civil commitment bills and they really have to do with when the legal system gets involved in somebody’s mental health care, when they’re a risk to themselves or other people and how judges and county prosecutors and other groups evaluate and determine whether the state hospital is the best place for them. Shaylee Ragar:So what are the sticking points of involuntary commitments and why are lawmakers looking at them?Mara Silvers: The big question is, if not the state hospital, like if people aren’t just automatically going to the state hospital, where else do they go? And the other options are essentially community beds, hospitals, local hospitals, or if somebody decompensates to the point that they are more involved with the criminal justice system, jails, that kind of constellation of options–those are all stakeholders. Those are people and organizations and institutions that have very strong feelings about who should be in their hospitals, their jails, who they have the capacity to care for, and who they don’t have the capacity to care for. And I think at its very root, some of these bills that we’re seeing be brought forward, make it harder for somebody to get to the state hospital, it sets up a series of hurdles, kind of ‘if then’ tests of where else those people can go before they go to the state hospital. We heard in a committee meeting a couple of weeks ago, just before transmittal, local hospital leaders really pushing back against that. “We can’t change the laws to direct people towards beds that don’t exist.”“Our state’s mental health crisis is undoubtedly devastating and it is unfortunate that the state hospital faces the level of demand for the care that it does, but leaving those patients in the care of facilities that aren’t designed to meet their needs is not the answer.” Shaylee Ragar: Can you walk us through kind of the mechanics of some of these policies and how they would work?Mara Silvers: This is kind of a package of bills all brought by Senator John Esp, who’s a Republican from Big Timber. There’s Senate Bill 429, Senate Bill 430, and Senate Bill 435. One of those bills, Senate Bill 435, has already advanced quite a ways through. It is, I would say, the least controversial of the three.That is a bill that would clarify in law that it is appropriate to have local facilities that do 72-hour crisis holds for people who are in crisis and are trying to figure out whether or not they need to be institutionalized. And hopefully that 72-hour period can help give people just a little bit of time and space to get the care that they need and figure out whether they need to go to a higher level of institutionalization.Shaylee Ragar: So what about these other two more controversial bills? Mara Silvers: So these are the bills that essentially say that the state hospital has the ability to say no to people. Both of these bills have this way of really putting the Department of Public Health and Human Services in the driver’s seat for deciding whether or not somebody can come into their facility.But for a long time, the state hospital in Montana has been the place that always has to accept people because there might not be those resources in other parts of the state. Those are the bills where you start to hear local hospital leaders, where you start to hear local county attorneys saying, this is not workable.“We believe the state is abdicating its responsibility to care for the mentally ill.”So that’s some of the crux that we’ve been listening to. Shaylee Ragar: So lots of work left to be done on those bills. Let’s switch gears now though to another vulnerable population that that policymakers have been talking about.Nora, you’ve been tracking the Montana Indian Child Welfare Act for years now. Remind us what this policy does. Nora Mabie: Yeah, so the Montana Indian Child Welfare Act is a version of the federal Indian Child Welfare Act, which is often called ICWA. So the federal law was enacted in the 1970s and what it was responding to was decades of Native children being separated from their families in the foster care and adoption systems. This law, ICWA, what it’s meant to do is include Native parents and tribes in decisions related to foster care and adoption that they may Have been excluded from in the past. The Montana Indian Child Welfare Act really came about last session in 2023, and the reason we saw it in 2023 was because at the time the federal law was under threat, the U.S. Supreme Court was considering a case that had potential to undo parts of the federal law or do away with it altogether. And so at that time, we saw several states writing that law into state law, but that Montana Indian Child Welfare Act is set to sunset this year. So that’s why we’re seeing more legislation come up. Shaylee Ragar: Got it. So what are lawmakers trying to do with the policy this time around?Nora Mabie: Yeah, so this time around there’s Senate Bill 1 7, which is brought by Senator Jonathan Windy Boy, he’s a Democrat from Box Elder, and what this one would do is it would eliminate the termination date of the Montana Indian Child Welfare Act, and then it would also add some additional protections. One of those protections that’s gotten some attention is the idea of cultural compacts, and what that does is it basically asks families that adopt or foster Native children to document their efforts in making sure that that child is connected to their tribe and their culture and history and tradition and things like that. Shaylee Ragar: Are we seeing opposition to this bill, Nora?Nora Mabie: So opposition tends to center around people saying, why can’t we have this for all kids in Montana? And to that Native advocates say, Native Americans have a unique history in this country and a unique government to government relationship. And really they hone in on why the federal law was even passed in the first place. It’s because Native children were separated from their families at disproportionate rates and suffered cultural loss as a result. And even now with this federal law in place, Native children remain disproportionately represented in foster care.So they argue that it’s really important to have these additional protections just given the unique history of assimilation and things like that. Shaylee Ragar: Nora, you’ve been following. Another interesting bill that I wanna get into, it would increase access to doulas or trained non-medical professionals who provide physical, emotional, and informational support to pregnant people, both during pregnancy and postpartum.What would this bill mean for Indian Country? Nora Mabie: Senate Bill 319 is brought by Senator Cora Neumann. “I’m a doula.”And basically it would do two big things: One, it would allow for doulas in Montana to apply for and receive licensure in the state. And then two, it would allow state certified doulas to receive reimbursements from Medicaid so some of their services would be covered by Medicaid.And basically proponents of this bill have said that this will expand access to doulas. As a lot of people who need them, can’t afford them, and they argue that that could improve health outcomes for mothers and for babies. And they also say it would help make the doula profession more sustainable.“One of the areas of a real need in this country is around pregnancy, prenatal care, postpartum care for families, for pregnant families.” So on the first hearing, there were about two dozen people who spoke in person, and many of them were from tribal communities and served as Indigenous doulas.And they basically argued that doulas play an outsized role in tribal communities where access to maternal care is already really limited. “In my studies and work, whether we’re talking about improving maternal and infant health outcomes, or revitalizing traditional knowledge and cultural practices, the solution always comes back to doulas.” “Birth support is not a luxury. It is a necessity.” Opponents have argued that this bill essentially is an example of government overreach and that it’s too costly. Pretty much everyone who’s spoken in opposition to it acknowledged that they really think doulas do great work and that their services are needed.But the conversation really did focus on the role of government and one Republican Senator said on the floor:“One of the reasons I am a Republican is because I believe in limited government. This bill is the opposite of limited government.” Shaylee Ragar: Thank you both so much for all your reporting today. We’ll have to leave it there for now, but before we go, I wanna ask each of you, what was your favorite moment last week? Mara Silvers: Yeah, so I have one. It was actually on St. Paddy’s Day. I was listening to the Senate Judiciary Committee. They were having a bill hearing about medical malpractice, and after the proponents kind of finished testifying, the chair of the committee, Senator Barry Usher, said, all right, everybody ‘hold that thought for a second, because as you can see, many members of the committee have left to go watch the dancers,’ and he was referring to a troop of Irish dancers who were in the rotunda, dancing up a storm, just having a blast.And of course that was way more fun than listening to any kind of hearing on medical malpractice, probably any hearing in general. But so they took a brief break, I think it was a 15 minute break to go and enjoy a little bit of cultural festivities and then get back to work. Shaylee Ragar: I love St. Patrick’s Day at the session. I feel like every session lawmakers look forward to it. I think my favorite memory from last week is also from St. Patrick’s Day because, legislative fashion is a thing. I love to see what people wear to the Capitol, and St. Patrick’s Day is like, people go all out. The ties, the green suits, people have so much fun and everyone was in green. Nora, what was your favorite moment last week? Nora Mabie: Last week, I spent a lot of time talking to members of the American Indian Caucus, and what I enjoyed is they’ve been reflecting on this session and basically have said that the tone is a little different than years past and they’ve been having more success advancing a lot of their priority bills than usual.I thought that was really interesting to see. Shaylee Ragar: This has been The Session, a look at the policy and politics inside the Montana State House. Thank you both. Mara SIlvers: Thank you. Nora Mabie: Thanks, Shaylee.The post The Session | The Montana State Hospital, doulas and St. Paddy’s day at the Capitol appeared first on Montana Free Press. ...read more read less