Author: Andrew

Supporting Mental Health in Missoula

In Missoula, the Riverwalk Crisis Center plays a vital role in providing compassionate care to adults experiencing mental health crises. We sat down with Dr. Ann Douglas, the center’s Director, to learn more about the services they offer, the impact of their work, and their vision for the future.

About the Organization

Q: Can you introduce yourself and give an overview of the services Riverwalk Crisis Center offers?

Dr. Douglas: I’m Dr. Ann Douglas, Director of Riverwalk Crisis Receiving Center. We are a voluntary crisis receiving center for adults aged 18 and older. Our role is to provide immediate support for individuals who define themselves as being in crisis, whatever that crisis may be. Our focus is on helping guests stabilize and then connecting them with community resources for ongoing support.

Q: What are the criteria for being seen at Riverwalk?

Dr. Douglas: The only requirement is that the individual be 18 or older. Beyond that, anyone who feels they’re in crisis can come to us for help. It’s entirely self-referral, based on how the person feels.

Q: Can you walk us through the process when someone arrives at Riverwalk?

Dr. Douglas: When someone arrives, they’re greeted by our security specialist, who provides an orientation and explains the behavioral norms. From there, they meet with a nurse for a general medical assessment to ensure the crisis is not a medical emergency. If everything checks out, they work with a mental health professional to create a treatment plan, focusing on their strengths and using culturally appropriate care to empower them through the crisis.

Q: What makes Riverwalk unique in addressing mental health crises?

Dr. Douglas: The environment sets us apart. Our facility is designed for those in mental health crises, and we prioritize empathetic care. We have the time and space to truly listen to our guests and tailor our support to their needs, creating a calm, open, and supportive atmosphere.

Q: How long can a guest stay?

Dr. Douglas: Currently, we’re open 12 hours a day, from 9 a.m. to 9 p.m., seven days a week. Guests can stay for those 12 hours. Once we expand to 24/7, guests will be able to stay for up to 23 hours and 59 minutes.

Collaboration & Impact

Q: Riverwalk was the result of a community effort. Can you talk more about the collaboration that made this possible?

Dr. Douglas: Absolutely. Riverwalk was developed through the Behavioral Health Strategic Alliance in Missoula. Key partners included Providence, Western Montana Mental Health Partnership, All Nations Health Center, Community Medical Center, the Mobile Support Team, and 988 Lifeline. Together, we recognized the need for a receiving center where individuals could access short-term stabilization that wasn’t the ER or jail.

Q: Can you share a success story from Riverwalk?

Dr. Douglas: There are many stories. For instance, we’ve had guests who, after a few hours with us, leave visibly calmer and more in control. We’ve also connected people to services they’ve struggled to access for months. The combination of compassionate support and tangible resources makes a real difference.

Q: How do you measure the effectiveness of your interventions?

Dr. Douglas: We follow up with every guest 72 hours after discharge through an exit survey. This allows us to track their progress and gather feedback on how we can improve our services.

Challenges & Opportunities

Q: What challenges does Riverwalk face, especially with the current 12-hour operational window?

Dr. Douglas: I think the 12-hour limit is currently the greatest challenge. My goal is to get to a 24/7 model. Additionally, we need more staff, especially nurses and LPNs for night shifts. In regard to funding, we need to secure more grant funding to ensure we can provide care without financial barriers for guests. We currently bill Medicaid as well as private insurance, but I want people to know that if they cannot pay, they will not be turned away. 

Q: What are your funding sources, and how is Riverwalk structured?

Dr. Douglas: Riverwalk operates under Western Montana Mental Health’s license, with Providence covering my wages and Western funding the rest of the staff. Missoula County provided initial funding for the building renovation, but moving forward, we will continue to rely on Medicaid reimbursements, private insurance, and grants.

Q: Where does the state fit into the picture in terms of supporting Riverwalk?

Dr. Douglas: The state plays a role through Medicaid. We operate under policy 450, which governs Medicaid reimbursement for receiving and stabilization services.

Q: Montana has been in the national spotlight due to its high suicide rate. Do you think the state could help address service gaps in facilities like Riverwalk?

Dr. Douglas: Absolutely. Increased funding and awareness would be incredibly beneficial, particularly for suicide prevention. Our center plays a critical role in intervening at the stage of suicidal ideation, helping people before they reach the point of an attempt. Expanding receiving centers across the state would not only improve outcomes but also help destigmatize mental health treatment. When people see that mental health facilities like ours exist, it sends a message that it’s okay to seek help.

Q: Is Riverwalk the only facility of its kind in Montana?

Dr. Douglas: No, Riverwalk is the second of its kind in the state. The first is the Billings Crisis Center, which has been operating for about 17 years. I’ve worked closely with MarCee [Neary], the director there, and she’s been doing incredible work in this field for a long time.

Looking Forward

Q: What are Riverwalk’s future goals?

Dr. Douglas: Our primary goal is to expand to 24/7 operations. This would help us reach more people in crisis and make our services sustainable long-term. We’re also exploring the possibility of opening a crisis receiving center for youth, as this is a frequent request from the community.

Q: Is there anything else you’d like to share about Riverwalk’s role in mental health crisis intervention?

Dr. Douglas: Just that Riverwalk wouldn’t exist without the community’s support. We’re here because Missoula saw the need and worked together to fill it. Our mission is to be the calm in the chaos for those in crisis, and we’ll continue to grow and adapt to meet the community’s needs.

New Crisis Receiving Center Opens in Missoula, Montana

By Ellen Barry

We look at promising, evidence-based efforts to prevent suicide.

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“The bridge is sealed up.” Last month, with those words, the general manager of the Golden Gate Bridge announced the completion of a suicide barrier — stainless steel netting that extends about 20 feet out from the walkway for the length of the bridge, making a jump into the water below extraordinarily difficult.

For decades, friends and family members of people who had jumped pleaded for a barrier. And for decades, my colleague John Branch recently reported, officials found reasons — the cost, the aesthetics — not to build one.

But something is changing in the United States, where the suicide rate has risen by about 35 percent over two decades, with deaths approaching 50,000 annually. The U.S. is a glaring exception among wealthy countries; globally, the suicide rate has been dropping steeply and steadily.

Barriers are in the works on the William Howard Taft Bridge in Washington, D.C., the Penobscot Narrows Bridge in Maine and several Rhode Island bridges. Universities in Texas and Florida have budgeted millions of dollars for barriers on high structures. Scores of communities are debating similar steps.

Research has demonstrated that suicide is most often an impulsive act, with a period of acute risk that passes in hours, or even minutes. Contrary to what many assume, people who survive suicide attempts often go on to do well: Nine out of 10 of them do not die by suicide.

Policymakers, it seems, are paying attention. I have been reporting on mental health for The New York Times for two years, and in today’s newsletter I will look at promising, evidence-based efforts to prevent suicide.

A single element

For generations, psychiatrists believed that, in the words of the British researcher Norman Kreitman, “anyone bent on self-destruction must eventually succeed.”

Then something strange and wonderful happened: Midway through the 1960s, the annual number of suicides in Britain began dropping — by 35 percent in the following years — even as tolls crept up in other parts of Europe.

No one could say why. Had medicine improved, so that more people survived poisoning? Were antidepressant medications bringing down levels of despair? Had life in Britain just gotten better?

The real explanation, Kreitman discovered, was none of these. The drop in suicides had come about almost by accident: As the United Kingdom phased out coal gas from its supply to household stoves, levels of carbon monoxide decreased. Suicide by gas accounted for almost half of the suicides in 1960.

It turns out that blocking access to a single lethal means — if it is the right one — can make a huge difference. The strategy that arose from this realization is known as “means restriction” or “means safety,” and vast natural experiments have borne it out. When Sri Lanka restricted the import of toxic pesticides, which people had ingested in moments of crisis, its suicide rate dropped by half over the next decade.

Arresting an urge

Other countries, like Israel, have brought down suicide rates dramatically by restricting access to guns. But in the U.S., about 400 million guns are circulating in private hands, said Michael Anestis, who leads the New Jersey Gun Violence Research Center. “We don’t know where they are, and even if we did, we would have no way of getting them,” he said.

Twenty-one states have passed red flag laws, which allow the authorities to remove firearms temporarily from individuals identified as dangerous to themselves or others. A follow-up study found that firearm suicides dropped 7.5 percent in Indiana in the decade after the law’s passage; Connecticut saw a 13.7 percent drop over eight years as the state began to enforce the law in earnest.

Another promising approach is to change gun storage habits, which Anestis likened to public health campaigns around smoking or drunken driving. He threw out some ideas, including financial incentives, such as providing gun owners with a hefty coupon for a gun safe, and encouraging gun shops to install lockers so people could temporarily store their guns outside of the home.

Even brief counseling sessions can change a gun owner’s habits, trials show. Anestis recalled one subject who was particularly dismissive of the counselor’s advice but returned six months later with a different outlook. “Since I was last here, I broke up with my fiancé and I let my brother hold my guns. If I hadn’t done that, I’m pretty sure I’d be dead,” the subject told researchers.

If you are having thoughts of suicide, call or text 988 to reach a lifeline for help.
More resources are available here.