Breaking point: Filling gaps in behavioral health services takes 'community collaboration'
This is an epilogue to the three-part article series "Breaking Point." We speak with First Lady of North Dakota Kathryn Burgum, Badlands Human Service Center Director Jessica Odermann and Dr. Rosalie Etherington, chief clinic director for the state’s human service centers, to hear more about what the state and local levels are doing to help enhance behavioral health and improve access to needed services.
In the three-part article series “Breaking Point” that launched in early August, The Press spoke with several community members from various sectors, advocating for additional mental health services but also raising awareness of the lack of services on the Western Edge. After much feedback, following the series, we are releasing an epilogue in which we speak with First Lady of North Dakota Kathryn Burgum, Badlands Human Service Center Director Jessica Odermann and Dr. Rosalie Etherington, chief clinic director for the state’s human service centers, to hear more about what the state and local levels are doing to help enhance behavioral health and improve access to needed services.
In this epilogue, Etherington begins by noting that though behavioral health is enhancing in the state, there remains gaps that require filling — especially in southwestern North Dakota.
“So, in our opinion, although the Human Service Center is available and has been available, it cannot meet all the needs of the community,” Etherington said. “So we do not believe that there are sufficient services in the Badlands region to meet all the needs that are identified. When we provide service, we do believe that our services are effective. It’s just that, again, it's not enough to serve all need.”
As First Lady of North Dakota, Burgum’s platform is centered around addiction and recovery. She serves as chair of the seven-person advisory council for the Office of Recovery Reinvented .
“We started out as focused solely on eliminating the stigma related to the disease of addiction, but it has grown... We have also really been connecting the mental health component with the addiction side and the substance use disorder side because they can be so closely tied together,” Burgum said, adding, “Oftentimes for people that struggle with mental health issues, addiction is the way to get rid of those issues… But yet, what happens then is that people develop addictions or they have negative consequences as a result of trying to deal with their mental health stuff when what they really need probably is some regular medication to handle mental health issues or some counseling or equine therapy or lots of acupuncture. There could be a lot of things that could help versus turning to drugs and alcohol.”
Burgum noted that the coronavirus pandemic has majorly affected North Dakotans and their overall mental health. In North Dakota, drug-related deaths soared to a nearly 50% increase from 2019's numbers with 118 people dead, according to the North Dakota Department of Health. In 2020, there were 118 drug-related overdoses.
For the past 19 years, Burgum has turned her own addiction story into a recovery success story that she now shares publicly on multiple platforms.
“As far as being an advocate, what I've learned is that there are a lot of opportunities and resources to connect with other people that can help. There's a lot of groups out there that are being advocates for helping to eliminate the stigma of addiction. So I'm just another one,” Burgum said. “... Once you start talking about this, there are more and more people that want to help, that want to get involved, they want to be advocates too. So that that in itself just creates this wave of opportunity for people to become advocates and to get involved.”
Recently, the North Dakota Department of Human Services and its Badlands Human Service Center in Dickinson have expanded access to behavioral health services for North Dakotans, including children and youth. One of the main changes includes transforming services for youth with complex behavioral health needs that put them at risk of being removed from his or her home. These services are provided by a specialized team of behavioral health professionals from the Badlands Human Service Center in the family home or other community setting and involve both the youth and his or her family, according to a statement from North Dakota Department of Human Services.
This service also provides support for youth and families in a capacity where they’re connected with a full team of multidisciplinary professionals such as a case manager, clinician and a licensed addiction counselor if needed, Odermann noted.
“The idea is really to keep kids in the home, keep families together and allow them to live in the community where they have that support. That's their environment they're familiar with, and so the idea is to really try to wrap those services around the child and their family or the youth in their family so that they can stay together. Then hopefully, (they will) not have to be in our services forever that we'll be able to help them and then they can move on and be a full family unit,” Odermann said.
Over the past year, North Dakota has launched a statewide comprehensive crisis care system to help those who are experiencing a variety of behavioral health crises. Odermann noted that this service is 24/7. Using the statewide number 211, individuals can call in when they’re experiencing a crisis and connect with a trained crisis response professional over the phone, who will help figure out what's going on, conduct a safety assessment, identify who the person is and “essentially triage that situation,” Odermann added.
“In many cases, some support will be provided. And in other cases where response is necessary and required, it acts a little bit like a dispatch service where then they would contact our staff at the human service center — again, 24 hours a day, seven days a week — where we would then respond to that individual experiencing the crisis,” Odermann said, adding that this is a mobile operation that would respond anytime wherever needed.
Odermann noted that this allows behavioral health professionals to work with individuals and connect them with a “safe and stable environment” to help stabilize them, provide services and determine whether there’s additional psychiatric needs or emergency departmental care required.
“That process is a really big piece of our expansion, and it's a really nice addition to our region and it's definitely needed,” Odermann said.
Badlands Human Services has also expanded its walk-in hours from 8 a.m. to 5 p.m. Monday through Friday, where any individual can walk into the building and get connected with services or screening to receive care. In the past, people could come in for 90 minutes to two hours.
“... The idea of that is to hopefully reduce wait time for individuals, (so) they can get connected right away. We don't have to schedule appointments so that individual has to wait for them; (now) they can come in right away,” Odermann said, adding, “And the other nice thing about that is that we're able to then if there is an immediate need to provide that service on site immediately. Maybe they are experiencing a crisis and then we've got staff on site that can also connect them that way. And it's a really positive addition as well to expand that service. It's kind of like a walk-in clinic essentially. You come in, we can identify what's going on and then we can determine, just like a clinic — they triage as well to determine what's going on with that individual and maybe they need something immediately or maybe we need to look at doing further assessment, and maybe that'll connect them to further care. So that's really the process of what we're calling ‘Open Access’ or our walk-in hours.”
Odermann noted that treatment for individuals dealing with serious mental issues can be difficult and vary from case to case.
“... We sometimes work really hard to engage folks who are experiencing pretty significant behavioral health issues and really work hard to try to engage them and sometimes situations with individuals can be really complex and difficult and sometimes our staff are out in the community really looking for people and trying to engage them. That is what our crisis team does,” Odermann said. “We are really working to work closely with law enforcement, the emergency department and the community to identify situations… so that we can engage folks who may be experiencing such significant impairment. Because it is often difficult to get them connected and get them worked into our services.”
Etherington added that “... because medical care does require that individual client consent, there are times when a person either isn't willing to receive the service or isn't willing to receive all of the possible services. Particularly for individuals with severe mental illness, for example, sometimes they refuse the very medications that would help alleviate the symptoms. And yet you cannot force those medications without clear understanding and an order from the court. And so, there might be times when a person came to receive assistance, (but) didn't accept the assistance or the assistance wasn't enough and they might be hospitalized. And then it might appear as if somehow they get better where they hadn't before. And that might simply be the issues about the medications and hospitalization.”
Odermann concluded that in order for mental and behavioral health services to prosper in this part of the state, it is going to take a community to work together.
“It really is going to take community collaboration to identify what the specific gaps are and fill those gaps and it's going to take everyone being at the table. Because I think it's really important that we're running parallel to each other and we're not being redundant with the services that we provide. And I hear oftentimes that there's a lack of mental health services or a lack of substance use disorder services, but more specifically than that, it's the type of service that there's a gap in. I think we really need to dig deep into what the specific services are that are missing and try to fill those gaps. Because no one should be competing with each other, we want to fill the gaps and provide the services so that we can serve everybody along with full continuum… There are most certainly are gaps. And so I want to acknowledge that, and that it really is a community effort.”