Lawmaker warns people 'are going to die' due to ND's persisting mental health gaps
FARGO--A troubled man shoots and kills a Fargo police officer responding to a domestic incident, weeks before the shooter's wife says he was scheduled to see a specialist for worsening depression and memory loss.
FARGO-A troubled man shoots and kills a Fargo police officer responding to a domestic incident, weeks before the shooter's wife says he was scheduled to see a specialist for worsening depression and memory loss.
A rash of opioid overdose deaths plagues the community-among them, several men in their 20s who had been in and out of all-too-short addiction treatment programs.
A young man dies by suicide in a Fargo park. His family says the mental health system failed him.
These incidents in the last few months demonstrate what some lawmakers say are dangerous shortcomings in North Dakota's behavioral health care system, which includes mental health and substance abuse treatment.
In 2014, a consultant identified "major gaps" in such services statewide, particularly in western North Dakota, which she described as "in a crisis." Renee Schulte of Iowa-based Schulte Consulting cited extreme shortages of behavioral health workers, inadequate emergency services and the state's refusal to spend money on expanding services.
Rep. Kathy Hogan, D-Fargo who chairs the interim Human Services Committee on behavioral health, likens the problem to a complex jigsaw puzzle for which the state has only 100 of 1,000 pieces in place.
"Until then, people are going to fall through the cracks and are going to die," Hogan said. "It's almost criminal."
Two years later, Sen. Tim Mathern, D-Fargo, says only minor changes have occurred.
"I read the Schulte report, sat on the committees," said Mathern who is also public policy director at Prairie St. John's, a Fargo psychiatric hospital. "I saw what little we did when we had all this money."
At the time, the state's coffers were full, with oil production clipping along. It's a different story now with oil's downturn and slumping agricultural profits, which prompted Gov. Jack Dalrymple earlier this year to order 10 percent in cuts to state agency funding for the two-year budget cycle starting next summer. Lawmakers will approve those budgets in next year's session.
Hogan says one major change has happened since the consultant's report came out. She estimated only about 30 percent of the legislative leadership previously acknowledged mental illness and substance abuse as a rapidly growing problem.
"Everybody owns it now," Hogan said.
Hogan said about 90 recommendations for improving the state of behavioral health in North Dakota came out of the Schulte report.
Among the long list of suggestions:
-Law or policy changes, including deferring prosecution of first-time drug offenders upon conditions of successful treatment and increasing speeding fines to generate funds for more involuntary commitment beds
-Program expansions, including drug courts, electronic monitoring, and peer support
-Workforce issues, including loan forgiveness for people training to become addiction counselors and increasing use of telemedicine.
Almost none of the dozens of recommendations have been enacted.
The handful of accomplishments include a voucher program that just took effect Friday, July 1, for people who need substance abuse treatment but don't have insurance coverage, Hogan said.
For example, someone living in a smaller town wouldn't have to drive to one of the state's eight regional human service centers. They could be treated in their hometown and the voucher system would reimburse the provider.
However, Mathern says the bill that passed made the voucher plan much smaller than the original $3 million. The program was cut further by allotment, the cuts to most state budgets of about 4 percent ordered by Dalrymple earlier this year.
"So, it's like one-tenth of a new idea was funded," said Mathern, who also sits on the interim Human Services Committee.
Hogan cites improvements in data collection and reporting, saying they're starting to get a handle on what percentage of people who need behavioral health services are receiving them.
Sen. Judy Lee, R-Fargo, offers mandatory training for teachers to spot mental health issues as another positive step. But she admits services and resources still run "terribly short."
"It's something that could make you lay awake nights a lot," said Lee, also a member of the interim Human Services Committee.
Mathern compares the situation to 1980, when a federal class action lawsuit was filed against the state by the Association for Retarded Citizens challenging the institutionalization of people with developmental disabilities. A judge's ruling forced the state to spend money on integrating them back into society.
Like then, people who have family members suffering from mental illness or substance abuse problems are demanding an alternative and the legislature hasn't responded, Mathern said.
"The time to consider that these behavioral health things are sort of a moral choice that people make is way gone by," he said.
Mobile crisis units
A few of the more recent changes in mental health care in the state are designed to get patients in to see a professional more quickly and to keep them out of hospital emergency rooms. Again, those improvements are limited due to funding.
What's called "open access" will eventually be offered at all regional human service centers, where a patient can walk in and be seen during business hours, rather than being scheduled weeks out or put on a waiting list. However, only centers in Minot and Williston have that system in place for now.
Chief clinics officer Rosalie Etherington, who oversees all eight of the regional centers, says patients are triaged, with the most urgent cases being seen first, followed by more routine cases.
"We may ask them to return, but they would be seen that week," Etherington said.
Outside of the regular work day, "mobile crisis units" aim to fill in the gaps. Anyone experiencing a mental health or substance abuse crisis could call for real-time, face-to-face assistance from a mobile crisis team.
This program is also limited due to lack of funding. Only the Fargo-based southeast center is able to offer it at this time.
Southeast, with its existing 24/7 on-call service, teamed up with Solutions Behavioral Health, which provides the mobile team. There are seven people on the crisis team, with two of them on call between 5 p.m. and 8 a.m. weekdays, and on weekends and holidays.
Katie Nystuen, admissions and regional intervention services supervisor at Southeast Human Services Center, says after a crisis call comes in and contact is made with the crisis team, their average response time to a person's residence is 18 minutes. The team consults with an on-call psychologist initially and can check in anytime during the visit. The goal is to avoid hospitalization.
"We really feel like we want to set people up with support to stay in the community," Nystuen said.
Last year, the mobile crisis team handled 524 crisis calls in the area, averaging just under two hours apiece. Of those, only 29 patients ended up having to go to a hospital for an assessment.
Team member Brandon Germain, who provided on-call support on the Minnesota side before Southeast Human Services also began offering the mobile crisis program in 2013, says he enjoys seeing the success stories.
"From people calling ten to 15 times a week, too anxious to make it through the night, and now they're calling two and three times a month," Germain said.
Finding the money
There are other gaps in behavioral health care across the state.
"We have some communities with no psychiatric hospital beds, some with larger amounts. Some with a residential addiction component, some with none," Etherington said.
Hogan said every inpatient psych hospital bed in the state is typically filled, prompting spillover to other facilities.
"Some people are in jail because they need supervision, or are in ER's waiting for an inpatient bed," she said.
And there is difficulty recruiting mental health specialists, especially to the western part of the state.
"There's one psychiatrist west of a line between Bismarck and Minot," Lee said.
Mathern is bent on finding more mental health funding and has several strategies in the works. He's running for state treasurer, with the platform that he would work to eliminate the office and divert the cost savings to behavioral health services. Mathern says the treasurer's duties can easily be absorbed by other agencies.
"I am not okay with saying there isn't enough money," Mathern said.
Treasurer Kelly Schmidt, a Republican running for reelection this fall, says her office's duties are significant and not something other agencies can do. State voters have twice turned down ballot measures to eliminate the office, she pointed out.
Schmidt said she's as concerned as anyone about mental health, but it's not tied to the treasurer's position.
"We all have neighbors, family affected," Schmidt said. "That to me is a completely different part of the conversation."
Another option to raise money for mental health services is an initiated measure to raise the state's tobacco tax. At 44 cents per cigarette pack, it's the fourth lowest in the country.
Rep. Hogan is hoping for an increase of $1.76 a pack, to $2.20. About 50 percent of the revenue raised would go to veterans, 35 percent for behavioral health and the remainder to tobacco prevention.
House Majority Leader Al Carlson, R-Fargo, says the state does have to commit more resources to mental health. However, the problem isn't a lack of spending but a lack of priorities, he said.
"You can't throw a lot of money at it and expect it to go away," Carlson said.
"We have a $2 billion dollar plus budget for Human Services," he said. "They (DHS) should be coming to us to readjust."
Hogan says if we were talking about another illness, things would be different.
"If this was Ebola, just think what we would be doing," Hogan said. "That's where the stigma of mental health and behavioral health is still a factor."
How many are affected?
In North Dakota, according to the 2012-2013 National Survey on Drug Use and Health:
-49,000+ adults have a substance use disorder
-93,000+ adults with a mental illness
-23,000+ adults with a serious mental illness
-17,000+ adults with both a substance abuse disorder and mental illness