Montana State Hospital reports stronger discharge planning as emergency detentions surge

Kayla Tamke, director of social services at Montana State Hospital, told the Legislature's health subcommittee on March 1 that the hospital has strengthened its discharge planning operations and filled many clinical vacancies, but a sharp increase in short emergency detentions is creating operational strain.

Tamke said the hospital has 19 full‑time behavioral health care planner positions responsible for discharge documentation and plans, and that ‘‘we've successfully onboarded 7 care planners since April of 2024’’ with three more starting orientation next week — a change that will bring ‘‘17 of 19 positions filled,’’ she said. She told the panel care planners begin discharge conversations at admission and that social assessments are completed within 72 hours to identify needs for community aftercare. "Patient discharges are patient centered driven by the patient and patient preference, and we respect their autonomy," Tamke said.

The staffing gains extend to clinical therapists: Tamke said the hospital has six full‑time therapist positions and has "onboarded 4 licensed clinicians since April of 2024" with another clinician scheduled for orientation on March 3. She and other presenters said those hires let staff reduce caseloads and improve the quality and timeliness of discharge plans, which are sent to receiving community providers 24 to 48 hours before discharge.

Tamke reported operational metrics to the subcommittee: total admissions rose to 765 in fiscal 2024 from 681 in fiscal 2023; the facility's 30‑day psychiatric readmission rate is 9.2%, compared with a national average of 20.9%; and the hospital has begun routine audits and new…