There are a lot of issues in play when an interim committee of the North Dakota Legislature begins meetings in September regarding mental health services and the role of the North Dakota State Hospital, according to Rosalie Etherington, superintendent of the State Hospital.
The study replaced a bill introduced in the 2019 Legislature that would have constructed a new 65-bed State Hospital. The initial budget provided $35 million from the North Dakota Legacy Fund to construct the new hospital with the existing State Hospital campus being utilized as a minimum security prison to house inmates currently at the Missouri River Correctional Center near Bismarck. The Missouri River Correctional Center would have then been used for female inmates that would be moved from the Dakota Women's Correctional and Rehabilitation Center in New England, North Dakota. Lawmakers instead decided to study the issue.
The study sets out to determine how to deliver as much mental health treatment in community-based settings as possible. Once that is established, the committee would look at what capacity a new State Hospital facility would need.
"We're hoping to expand community services and make them right-sized," Etherington said. "Then determine how many beds the State Hospital needs."
Etherington said the goal is to treat mental health problems at the lowest level prudent in the person's community. This allows the patient to stay close to family and jobs while getting the help he or she needs in the most economic manner. To accomplish this, Etherington said North Dakota will need to develop "robust crisis centers" across the state for the first time.
Other components of community care could be expanded staff at the regional human services centers and a statewide call line for people seeking help.
If the person's needs exceed what can be treated at the local level, he or she would be transferred to the State Hospital.
"If we accomplish all this, the State Hospital is too big," Etherington said. "The State Hospital is the safety net in this program as it is now but the number of beds may change."
Currently, the State Hospital provides care for more than 200 patients including substance abuse treatment, mental health issues and the sex offender program. Care for those patients is spread among five buildings with a separate coal-fired heating plant and surrounded by 357 acres of grounds.
"A smaller, newer hospital would be safer, provide better care and be more efficient," Etherington said.
The study could change how the State Hospital treats mental health problems in North Dakota, according to Rep. Kathy Hogan, D-Fargo, a member of the interim Human Services Committee.
"We haven't defined the role of the State Hospital in many years," she said. "Once we have a role for the State Hospital, then we look at the model of how we provide service."
Rep. Dwight Kiefert, R-Valley City, also a member of the interim Human Services Committee, said he is glad to see a reevaluation of mental health treatment in North Dakota.
"Hope to see expanded care that helps more people," he said. "... this is something we need to do."
Kiefert said there continues to be a need for the State Hospital.
"There is a population that needs help on an inpatient level," he said. "My concern is about ones that are violent. We need to head off those problems."
If a new State Hospital is built, much of the existing facility could be utilized by the North Dakota Department of Corrections and Rehabilitation, according to Sen. Terry Wanzek, R-Jamestown, a member of the interim Department of Corrections and Rehabilitation Review Committee.
"Even during the last session we were looking at some of the buildings of the State Hospital," he said.
Etherington said the State Hospital would likely retain control of the superintendent's home and the two cemeteries on the grounds.
Any construction project for a new State Hospital building is at least four years in the future, Etherington said. The study is slowing down the process for research, she said.
"We have to make sure we have the capacity we need," she said. "We have to maintain a size that meets the needs of the state."
Information on details like staffing levels and the location of a new State Hospital facility are also years in the future.
"There has been no discussion on moving it out of Jamestown," Etherington said, "and we have a lot of land here at the State Hospital."