FARGO — The coronavirus pandemic is imposing an enormous toll on the mental health of a wide swath of society and will serve as a catalyst for extending behavioral health care to underserved rural areas in North Dakota.

The University of North Dakota School of Medicine and Health Sciences and Sanford Health are working in partnership on an initiative to expand behavioral health services using telehealth, including contact with a clinician.

“COVID-19, for better or worse, has really opened up our eyes to what is possible,” said Dr. Andrew McLean, a psychiatrist and chairman of the department of psychiatry and behavioral science at the UND medical school. “But we’ll have to see what happens.”

The initiative centers on two areas: providing individual treatment virtually, and virtual training of health professionals and case review. That approach has resulted in significantly shorter waiting times elsewhere, since psychiatrists can greatly expand their reach, McLean said.

The scope of the project has yet to be determined. “It’s certainly still in the discussion and planning phases,” he said. McLean and his partner, Dr. Stephen Wonderlich, a clinical psychologist and vice president of research at Sanford Health, hope to be able to link multiple online virtual health systems.

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“It may turn out that it’s not feasible,” McLean said. Information technology specialists will have to determine the feasibility. “The different systems need to be able to talk to themselves,” he said.

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The effort is an outgrowth of a program, Behavioral Health Bridge, that the two organizations have launched to help health care workers cope with the strains of increased demand for health services during the pandemic, including those sick with COVID-19.

Wonderlich said the stresses brought by the prolonged pandemic exacerbate an already challenging mental health environment, especially in underserved areas of rural North Dakota.

Before the pandemic struck in March, there were ample signs of a mental health crisis in the state:

  • 25% of North Dakota residents met criteria for a mental health or substance use diagnosis.

  • An estimated 30% of North Dakotans binge drank in the last month, according to a 2016 survey.

  • North Dakota experienced the nation’s highest growth in suicide deaths from 1999 to 2016, an increase of 57%. Suicide ranks as the second leading cause of death among those 10-24 in North Dakota.

  • All but five North Dakota counties — Cass, Burleigh-Morton, Grand Forks and Ward, corresponding to the state’s four major medical hubs in Fargo, Bismarck-Mandan, Grand Forks and Minot — are designated as behavioral health professional shortage areas.

  • Behavioral health and mental health emerged as the top health concerns, with 23% and 20%, respectively, of respondents citing them, according to a ranking from a 2017 survey by the UND Center for Rural Health.

“Many of us feel that’s likely to increase in the near future,” Wonderlich said, referring to a wave of mental health problems as a result of the pandemic — often called the second pandemic.

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Expanded telehealth services should start becoming available during the first half of 2021, using funding provided by UND and Sanford Health, Wonderlich said.

“I think we’ve got enough to keep us going for about a year from when we started,” he said, adding that he hopes public funding and grants will sustain the effort. “We need to get money.”

Both Wonderlich and McLean are optimistic that the telehealth project to extend behavioral health services will launch, but said important details are yet to be worked out.

“It’s going to happen,” McLean said. “I don’t know who’s going to manage it or whether it’s going to be a collaboration of different systems. I think the technology’s going to be there. I think the public interest and lobbying’s going to be there.”

Because many effects won’t show up until after the pandemic, and lingering effects will remain long after it’s over, it will be important to have services available and accessible for those who need them, Wonderlich said.

Before the pandemic, in 2019, 10-11% of those surveyed in the U.S. reported significant anxiety — and by 2020, those levels had multiplied three to four times, according to Centers for Disease Control and Prevention figures cited by Wonderlich.