Wide-Open Lonely Spaces

In all of eastern Montana, the state with America’s highest suicide rate, there’s exactly one practitioner. Rural America has a mental health care crisis

- Monte Reel

1 The mental health unit inside the Glendive Medical Center is dark, and when Jaime Shanks declares that a light switch surely must be around here somewhere, a faint echo chases the words down an empty hall.

“Here it is,” she says. The lobby flickers into clear view. “As you can see, everything is state-of-the-art, and it’s just a gorgeous facility.” She approaches a window and motions to the greenery beyond. “And isn’t this beautiful? A little courtyard you can look out on.” She admires it for a moment. “They didn’t want an atmosphere that felt too institutionalized. The colors all around, if you notice, are very warm.”

Behind a nurses’ station, a dry-erase board says that today is March 30. It’s actually late June. For three months the unit has been dormant, lights out. Shutdowns are hardly unusual; sometimes they last years. Since its grand opening in 2002, this unit— the only place in eastern Montana where a person with a mental health emergency can be admitted for inpatient care—has languished in a state of desertion more often than not.

The problem isn’t a lack of demand; Montana is cursed with the highest suicide rate in the nation, and it’s higher in this predominantly rural part of the state than in any other region. During the rare times when the unit is up and running, the supply of incoming patients is predictably, and sometimes frantically, consistent. The problem here is staffing. Administrators can’t find anyone to run the place.