By Katheryn Houghton, KFF Health News

POLSON, Mont. — When someone accused of a crime in this small northwestern Montana town needs mental health care, chances are they’ll be locked in a basement jail cell the size of a walk-in closet.

Prisoners, some held in this isolation cell for months, have scratched initials and the phrase “love hurts” into the metal door’s brown paint. Their pacing has worn a path into the cement floor. Many are held in a sort of limbo, not convicted of a crime but not stable enough to be released. They sleep on a narrow cot next to a toilet. The only view is a fluorescent-lit hallway visible through a small window in the door.

Lake County Attorney James Lapotka stood at the cell’s center talking about the people he helps confine here. He stretched out his arms, his fingertips just shy of touching opposite walls. “I’m getting anxiety just being in here,” Lapotka said.

Last year, a man sentenced for stealing a rifle stayed in that cell 129 days. He was waiting for a spot to open at Montana’s only state-run psychiatric hospital after a mental health evaluator deemed he needed care, according to court records.

A man in the next cell around the same time was on the same waitlist roughly five months. He faced near-daily stints in the jail’s emergency restraint chair — a steel contraption wrapped in foam with straps for his shoulders, arms, and legs. He regularly saw the jail’s mental health doctor. Still, Joel Shearer, a Lake County detention commander, said the man routinely experienced psychotic episodes and asked to be locked in the chair when he felt one coming on and stayed there until his screams subsided.

“Somebody who’s having a mental health crisis — they don’t belong here,” Lapotka said. “We don’t have anywhere else.”

Lake County’s two, roughly 30-square-foot isolation cells are an example of how communities nationwide are failing to provide mental health services — crisis care, in particular. Nearly half of the people locked in local jails in the U.S. have a mental illness.

More than half of Wyoming’s 23 sheriffs told lawmakers there that they were housing people in crisis awaiting mental health care for months, WyoFile reported in January. Nevada has struggled despite a $500 daily fine for each jailed patient whose treatment is delayed. Disability Rights Oregon has said delays in that state continue after two people died in jail while on the state’s psychiatric waitlist.

In Montana, counties are jailing mental health patients they’re not equipped to handle when the Montana State Hospital is at capacity. Few local hospitals have their own inpatient psychiatric beds. As a result, people arrested for anything from petty theft to felony assault can be jailed for months or longer as their mental health worsens. Many haven’t been convicted of a crime.

Montana officials have known for years they have a problem. State officials have said they don’t have space for all the people ordered to the hospital. The psychiatric hospital has 270 beds, with 54 for people in the criminal justice system. Staffing shortages can shrink that capacity further.

The Montana Department of Public Health and Human Services backed two bills this legislative session that would shield the state from liability for delays when the Montana State Hospital is full. Ahead of the bills, the agency wrote the hospital has “struggled to maintain appropriate levels of care” due to money and staffing constraints, a lack of community-based services, and having no control over the flow patients Montana courts send its way.

The agency also announced April 23 that $6.5 million was available through one-time grants to help set up jail-based mental health stabilization services.

Officials have said patients deserve care closer to home, in less restrictive settings. But counties say the local services needed don’t exist.

“You have to do the hard things first,” said Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness. “You have to build the beds.”

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Health advocates have backed a proposal that would require the state to pay for community commitments. That measure is headed to Republican Gov. Greg Gianforte after passing the state House and Senate. Another bill that was still pending would create a new psychiatric hospital for people in the justice system. But implementing those ideas could take years.

The number of inpatient beds for people with a serious mental illness nationwide has plummeted. At one time, that drop was intentional, part of a movement away from locking people up in state-run mental hospitals. But the intended fix, local homelike centers, hasn’t filled the void.

One of Montana’s biggest providers, Western Montana Mental Health Center, had to close some of its crisis sites because of money problems, said Western’s CEO, Bob Lopp. That includes a facility less than a mile from the Lake County jail.

“If that’s not where the funding is, you can’t just do it for the sake of argument and hope that it comes,” Lopp said.

Gianforte has promised to pour money into rebuilding the state’s behavioral health system. Mental health workers in small towns find such promises hard to trust after seeing local services come and go for years.

Health department spokesperson Holly Matkin said the agency is proud of its work to fix “systems that have been broken for too long” and that it will improve services for people who need inpatient care in their communities.

Lake County is known to outsiders as an Instagram-worthy stop on their way to Glacier National Park. It overlaps with the Flathead Indian Reservation, land of the Bitterroot Salish, Upper Pend d’Oreille, and Kootenai tribes. It’s home to a slice of the Rocky Mountains and a gateway to millions of acres of wilderness. Polson, the county seat and site of the jail, is a town of 5,600 on the southern shore of Flathead Lake, one of the largest lakes west of the Mississippi River.

Vincent River has worked as the jail’s sole mental health clinician for 25 years. He said he’s not always available because he’s the only psychologist in four northwestern Montana counties evaluating whether a person in jail needs psychiatric care.

Some are released without care if they linger too long on the state hospital’s waitlist.

“I talk to these family members. I hear them plead with me with their fear in their voices and tell me all that’s been going on for days or weeks or months,” River said. “And then I can’t get people into the hospital. That is a giant crisis.”

It’s not just the state hospital. River said he can’t get people into any psychiatric bed in Montana because there are too few. Instead, he tries to stabilize people while they’re jailed. That has shortfalls.

The jail can’t force someone in psychosis to take medication without a court order and a qualified doctor on hand to administer the prescription. Lake County’s aging facility has faced lawsuits because of poor conditions amid overcrowding, and River has to see patients wherever there’s room.

There isn’t even space for the jail’s restraint chair. Jail workers leave strapped-down prisoners in a hallway or locker room.

River said many gradually get better and leave isolation. Some don’t.

“They languish there, psychotic and lonely,” he said, “at the mercy of what the voices are telling them.”

Locals are working to fill some gaps. A mobile team launched in February is staffed by people who have lived with mental and substance use disorders to provide peer support. But someone truly in crisis has only two options: jail or an emergency room.

The room reserved for people in crisis at Providence St. Joseph Medical Center in Polson leaves patients both isolated and without privacy. The locked door’s thick glass looks onto a busy emergency room hallway.

Those who deteriorate enough to be deemed dangerous to themselves or others are sent down the road to jail.

Rebecca Bontadelli, an ER physician, said patients can be housed in the room for days as hospital staffers scour Montana and nearby states for an open psychiatric bed. Some reject care in the meantime.

“We’re not really helping them,” Bontadelli said. “They feel like they’re in prison.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

An automated external defibrillator at Stillwater Area High School helped save sophomore Keegan Hawke’s life last fall after he went into cardiac arrest during a Tuesday afternoon football practice.

Fortunately, the school was unlocked and certified athletic trainers were on hand to administer the AED, said Craig Dowdle, the president of Teddy’s Heart, a nonprofit that educates and advocates for AEDs in public athletic parks and places.

“They got it from inside the school,” Dowdle said. “If it had happened an hour later, or two hours later, or on the weekend, it would have been a different outcome – because the school would have been locked.”

Craig and Emily Dowdle, of Cottage Grove, created Teddy’s Heart as a way to honor their son, Teddy Dowdle, who collapsed and died of sudden cardiac arrest in 2022 after going up for a rebound while playing basketball with his older brother and friends at Woodridge Park in Cottage Grove. He was 22.

Teddy’s Heart last week dedicated a new SaveStation AED device near the turf practice field where Keegan, 16, collapsed on Sept. 24, 2024, the day before his 16th birthday.

“We thought this was the best place for the first one,” Dowdle said. “A lot of soccer tournaments are held here.”

The Dowdles hope to raise enough money to install a second SaveStation AED this fall at a location closer to the baseball fields at Stillwater Area High School, Dowdle said. Each device costs about $8,000 with installation.

The one dedicated last week was the 22nd paid for by Teddy’s Heart; the Dowdles hope to hit 30 by the end of the year, Craig Dowdle said.

“We want to make sure other families don’t have to go through what our family went through,” Dowdle said. “Hearing what happened to Keegan and the outcome is unbelievable, and that’s what we want to happen every time. With having AEDs available, it’s happening more often.”

Keegan Hawke’s cardiac arrest has been linked to Torsades de Pointes, a type of heart-rhythm disorder, and he has had defibrillator implanted under the skin in his chest to monitor his heart rhythm and deliver electrical shocks to correct life-threatening arrhythmias, Katie Hawke said. He will undergo an ablation later this month at Minneapolis Children’s Hospital, she said.

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Katie Hawke said she is grateful for the AED and people who restarted Keegan’s heart and saved his life. “He would not have survived if all of those people and equipment weren’t in place,” she said.

Installing an AED is for one of those “high-risk, low-frequency events” that may never occur, she said.

“The hope is that they are an expensive piece of equipment that never has to be used, but when you need it, it needs to be there, and it needs to be ready and you need to know how to use it,” she said.

A plaque on the SaveStation AED at Stillwater Area High School Practice Field No. 2 notes that it was installed to honor both boys.

“Always and forever in our hearts,” it reads.

By Sam Hornblower, Bloomberg News

More than one in five people prescribed extended-release painkillers such as OxyContin developed an addiction within a year, according to a newly released study mandated by the U.S. Food and Drug Administration.

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The study, repeatedly delayed by more than a decade and released Monday, revealed a far higher percentage of pain patients addicted to opioids than drugmakers’ sales reps claimed in their marketing materials and representations to physicians.

The FDA now faces the question of how to use this data to evaluate whether the agency should make changes to opioid regulation, limiting broad approvals of long-acting opioids for extended use. The FDA is currently holding hearings to discuss the findings and is being asked by advocates to change the drugs’ labels, which guide how doctors prescribe them.

When the opioid market was thrown open to millions of chronic pain patients in the 1990s and early 2000s, Purdue Pharma’s sales reps and promotional videos asserted that fewer than 1% of patients became addicted to painkillers. Extended-release pills were designed to continually dose opioids to stave off chronic pain.

Data released Monday show that 22.5% of pain patients who started on extended-release, long-acting drugs developed opioid use disorder, or addiction, within a year. The findings stem from a post-marketing study requirement mandated by the FDA in 2013, which was funded by a consortium of opioid manufacturers including Purdue, Mallinckrodt Pharmaceuticals and Endo Pharmaceuticals – all of which have filed for bankruptcy following settlements.

“The findings are striking and disturbing and they raise ethical questions because so many study subjects were harmed,” said Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing. “How can you have a label that suggests this is safe and effective when you now have evidence that it’s unsafe and still don’t have evidence that it’s effective?”

In March, Purdue filed a $7.4 billion bankruptcy plan to resolve thousands of lawsuits related to the company’s role in the opioid epidemic. A representatives for Purdue declined to comment. Spokespeople for Mallinckrodt and Endo weren’t immediately available.

Efforts to get a clear picture of exactly how addictive these long-acting opioids are have been thwarted through the years as drugmakers and patient advocates lobbied for easy access to opioids and disputed the definition of “addiction.” The epidemic has claimed more than 800,000 lives in the US since 1999 and remains a major public health problem.

Millions of Americans have become dependent on opioid pills, even as mounting evidence suggests these drugs should never have been approved as safe and effective for chronic pain. The agency’s own labeling — meant to define a drug’s use, flag its risks, and limit its marketing — helped legitimize widespread, high-dose, long-term prescribing without the clinical evidence to support it, as revealed in a Businessweek investigation.

©2025 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

By JOSH BOAK

WASHINGTON (AP) — The more President Donald Trump talks about his efforts to reach deals with America’s trading partners, the more confusing the tariff picture gets. His team seems good with that, saying Trump is using “strategic uncertainty” to his advantage.

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Trump says the United States does not have to sign any agreements, and that it could sign 25 of them right now. He says he is looking for fair deals on all sides, and that he does not care about other countries’ markets. He says his team can sit down to negotiate the terms of a deal, and that he might just impose a set of tariffs on his own.

“I am struggling to make sense of it,” Chad Bown, a senior fellow at the Peterson Institute for International Economics, wrote in an email.

Although Trump’s team holds up his best-selling book “The Art of the Deal” as proof that he has a master plan, much of the world is on tenterhooks. That has meant a volatile stock market, hiring freezes and all kinds of uncertainty even as Trump continues to promise that new factories and jobs are on the horizon.

A look at how the trade talks may play out:

Trump still wants tariffs

As part of any deal, Trump wants to keep some of his tariffs in place. He believes the import taxes can generate massive revenues for a heavily indebted federal government even though other countries see the whole point of striking a deal as getting rid of tariffs.

“They’re a beautiful thing for us,” Trump said recently about tariffs. “If you can use them, if you can get away with using them, it’s going to make us very rich. And we’ll be paying off debt, we’ll be lowering your taxes very substantially because so much money will be taken in that we’ll be able to lower your taxes even beyond the tax cut that you’re going to be getting.”

So far this year, the U.S. government has collected $45.9 billion from tariffs, about $14.5 billion more than last year, according to the Bipartisan Policy Center. Those revenues could escalate sharply given the 10% baseline tariffs, the 145% rate being charged on Chinese goods and rates as high as 25% on steel, aluminum, auto and Mexican and Canadian imports.

To reach Trump’s stated goals of repaying the $36 trillion debt and reducing income taxes, his tariffs would need to raise at least $2 trillion annually without causing the economy to crash in ways that lead to lower overall tax revenues. That would be close to impossible mathematically.

How do negotiations work?

The Republican administration has said 17 of its major 18 trading partners have essentially presented them with term sheets, which list the possible compromises that they are prepared to make. Agreeing to a mutual understanding of the terms would be only the start of any trade talks.

But foreign leaders have said it is unclear exactly what Trump wants or how deals could be codified into a durable agreement. They also know Trump approved the United States-Mexico-Canada Agreement in 2020, only to charge new tariffs on those same two trading partners this year.

While meeting with Trump on Tuesday, Canadian Prime Minister Mark Carney suggested the next version of that agreement would need to be strengthened to prevent a repeat of the fentanyl-related tariffs imposed this year by Trump that Canada saw as arbitrary.

’Some things about it are going to have to change,” Carney said.

Treasury Secretary Scott Bessent testifies before the House Committee on Appropriations, Subcommittee on Financial Services and General Government, oversight hearing of the U.S. Department of the Treasury on Capitol Hill in Washington, Tuesday, May 6, 2025. (AP Photo/Jose Luis Magana)

Can the US reach a deal with China?

The 145% tariffs on China — and the 125% tariffs on the U.S. that Beijing imposed in response — hang over the entire negotiating process. Treasury Secretary Scott Bessent acknowledges that those tariffs are not “sustainable.”

The first talks between the U.S. and China are set to begin this weekend in Switzerland, but they will likely be limited to finding ways to de-escalate tensions enough for meaningful negotiations to take place.

The key issue is that China is the world’s dominant manufacturer, which makes also makes it a leading exporter in ways that can supplant domestic industries. Because China suppresses domestic consumption and focuses on production, the rest of the world buys what it makes because there is not enough internal demand. The U.S. wants to rebalance trade, but it has done so also through tariffs on countries that could be its natural allies in defending their auto and tech industries against China.

“Obviously in this trade puzzle, China is the biggest piece,” Bessent said this week. “Where do we end up with China?”

Chinese Foreign Ministry spokesperson Lin Jian has suggested that a meaningful way for the Trump administration to jump-start talks would be to pull back on its rhetoric and punitive import taxes.

“If the U.S. truly wants to resolve the issue through dialogue and negotiation, it should stop threatening and pressuring and engage in dialogue with China on the basis of equality, respect and mutual benefit,” Lin said Tuesday.

Would Congress need to approve any deals?

Not necessarily.

Trump unilaterally imposed his universal tariffs without Congress, using the 1977 International Emergency Economic Powers Act to do so, which has led to multiple lawsuits. The administration also maintains that any agreements to change the rates would not need congressional approval.

Previously, presidents, including Trump in his first term with his “Phase One” China deal, could negotiate only “more limited agreements that have focused on select bilateral trade and tariff issues,” according to a Congressional Research Service report updated this April. Other examples of limited deals include a 2023 agreement on critical minerals and a 2020 deal on digital trade with Japan.

The challenge is that Trump has also made nontariff barriers such as safety regulations for autos and the value added taxes charged in Europe part of his talks. He wants other countries to change their nontariff policies in exchange for the U.S. reducing the new tariffs he introduced. Other countries, in return, might object to U.S. subsidies to its companies.

In theory, it would take House and Senate approval to complete a deal that would address “non-tariff barriers and require changes to U.S. law,” the Congressional Research Service report said.

Is it really a deal if Trump just imposes it?

If other countries fail to satisfy him, Trump has suggested he will just do some kind of internal deals and set a tariff rate, although he technically already did that with his April 2 “Liberation Day” tariffs. The import taxes announced by Trump then led to a financial market sell-off that caused him to pause some of his new tariffs for 90 days and charge the lower 10% baseline rate while negotiations take place.

It appears Trump will agree not to impose the originally threatened tariffs if he thinks other countries are making adequate concessions, essentially meaning that the U.S. gives up nothing because the tariffs are new. But Trump might also pull back his tariffs without necessarily getting much in return.

“Trump is notorious for making maximalist demands and then retreating as negotiations go on, so we’ll see how long he sticks with his formula,” said William Reinsch, a senior adviser at the Center for Strategic and International Studies, a Washington think tank. “But so far it is pretty clear that countries coming in and wanting a ‘normal’ trade negotiation with both sides making substantive concessions are being rebuffed.”