Problematic: Lack of housing and in-patient psychiatric care on Western Edge grows

DICKINSON — As the Regional Director at Badlands Human Service Center in Dickinson, Jessica Odermann is a leader in the ongoing struggles to address mental health issues amid troubling increases in suicide rates — highlighted in a four part series .

During a panel discussion on issues facing Dickinson during the annual State of the City meeting on Feb. 3, Odermann said occupational licensing regulations continue to hinder her organization from reaching its full potential in mitigating issues. According to Odermann, the lack of a homeless shelter and hospital beds for in-patient psychiatric care has gone from concerning to outright problematic.

“Oftentimes we may get a South Dakota or Montana resident who has been practicing for years in their professional discipline, who cannot obtain reciprocity to practice in North Dakota,” Odermann said. “We’ve seen… licenses taking up to a year to obtain. And that is a major hurdle.”

This issue is not unique to the Western Edge, Odermann said.

“I know Southeast Human Service Center in Fargo also experiences a lot of difficulties because they're right on the border as well. Same with the Grand Forks area,” she said.

Executive Secretary for the North Dakota Board of Counselor Examiners, Marge Ellefson, said the licensing requirements are unique to different types of mental health professionals. For a Licensed Professional Counselor, the most generalized position, she said the prerequisites include a background check, 60 credit hour master’s degree in counseling with a 600 hour internship, passing score on the National Counseling Exam (NCE), three letters of recommendation and a plan demonstrating how they will attain two years of supervised experience.

If someone has adequately fulfilled these requirements in another state, she explained, the board will recognize that and give them certification.

“Our job is to make sure that when an application lands in front of us that the applicant has the proper requirements,” Ellefson said in a phone conversation with The Press on Friday. “Our job is to protect the public, and to make sure that these people are qualified under the laws of North Dakota.”

Yet, Odermann said these obstacles are imposed in an untenable manner because Badlands can’t employ someone who is not legally permitted to provide them with a billable service. She also said there are issues with transparency and an overbearing state bureaucracy.

“(There is a) lack of transparency with some of the licensing boards or cumbersome processes where you do step one and then you need to get approval, then do step two and you need to get approval rather than the whole process being cohesive” she said. “They review a transcript and if the coursework on that transcript doesn’t align exactly the way the board wants it to they’re sending some providers back to school to take coursework before they can obtain their license, which does not make sense if someone’s been practicing successfully and doesn’t have any disciplinary action in their history.”

The panel’s moderator, Rep. Mike Lefor, R-Dickinson, agreed and said it is something the state’s congressional delegation should consider in it’s next session.

“I think it’s important to maybe look at this legislatively next time and compare what’s done in other states. If you’ve been in the workforce for 20 years and you’ve done the job, let’s not go through unnecessary red tape. Let’s get somebody on the job,” Lefor said.

He added that state policymakers are currently crafting a plan to boost resources for substance abuse treatment in the area.

“I do want to tell you, too, that we're working to bring drug and alcohol addiction centered initiatives to Dickinson and we'll find out here in the next 30 days, but it's looking very good right now,” Lefor said.

When asked if the pandemic has imposed an increased burden on the institution, Odermann said that’s difficult to measure because they were already working with severely impaired individuals prior to March of 2020. In addition to walk-in evaluations, Badlands provides in-home behavioral healthcare to these patients through various strategies of intervention, treatment, recovery and crisis response. She said their services are in high demand.

“Those folks are already kind of in crisis all the time. I do think our crisis services program is busier, our law enforcement is busier and the suicides are way up,” she said. “Badlands staff doesn’t provide services on-site in the building. Typically we are in people’s homes, in their natural environments every day. So you can imagine the stress and overwhelm of the staff when I'm saying, ‘Hey, wear a mask, go into this house of someone who was maybe a hoarder, or incredibly mentally ill.’”

Odermann said she believes the Dickinson area desperately needs both a homeless shelter and transitional housing for those experiencing tough times.

“If this is someone's home, why should we be getting them on a bus and sending them to Bismarck so they can sit in a homeless shelter until they can come home and get on housing (assistance)? There’s often a bottleneck effect where people are on waiting lists for housing but until it gets approved, they’re homeless,” she said. “That is one thing that we absolutely need is to keep our citizens here, especially those who are needing help and who are extremely vulnerable. And that may require some support from the city.”

They are frequently left with no other options than to jail unstable individuals for a period of 24 - 72 hours, which she described it as criminalizing mental illness.

“This is a systemic issue. So oftentimes, an individual who is experiencing a behavioral health crisis, they need a safe place to go. And Dickinson does not have one, the entire western third of the state does not have a safe place for someone who needs to be in a locked situation where they're a danger to themselves or others,” Odermann said. “Unfortunately, sometimes we have to utilize (the jail) because someone is so unsafe. And so finding. We need beds, we need beds to stabilize people here.”