BISMARCK — Consultants are urging North Dakota to use an implementation team to push through reforms of the state’s “broken” mental health system which has been in an acknowledged crisis for a decade.
The recommendation was one of many presented in a final report received Thursday, April 28, by an interim legislative committee that is studying ways to fill gaps in services for those who have mental illnesses.
“The key to moving this forward is having someone to keep an eye on the ball,” said Jason Haglund of Renee Schulte Consulting, a firm that is guiding the North Dakota Legislature’s Acute Psychiatric Treatment Committee.
A forceful champion will be needed, given the complexity of the issues involved that will take multiple years to address, he said.
“North Dakota nice is a real thing,” Haglund said. “It helps to have a buffer.”
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Sen. Kathy Hogan, D-Fargo, agreed prodding and persistence will be required to drive the changes needed — the urgency of which was underscored by testimony from family members frustrated with the system.
“It won’t happen without some solid, solid leadership,” Hogan said.
Rep. Jon Nelson, R-Rugby, chairman of the committee, noted the committee was formed to explore what’s needed in a new State Hospital, which has broad support.
“This is much bigger than a big building,” he said, adding that he’s learned “over and over how broken the system is.”
The consultants also recommend that North Dakota perform a fiscal audit of the State Hospital and regional human service centers to get a detailed picture of how the state spends money and to enable it to track trends and identify ways to increase efficiency.
Sen. Judy Lee, R-West Fargo, agreed periodic audits would be helpful and suggested hiring independent auditors with expertise in health care.
Rosalie Etherington, chief clinics officer and superintendent of the State Hospital, said crisis services have increased 65% over the past 12 months even though the system was fully operational for only six months.
“We expect that to rise and double by this time next year from what we have now,” she said. Human services officials have been working with North Dakota’s 36 rural critical access hospitals to provide mental health crisis services, also available at each of the state’s eight regional human service centers.
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The state has doubled services to Cass County Jail, both from the Southeast Human Service Center and the State Hospital, yet Lee said services are inadequate for the high level of mental illness among some inmates.
Nelson said he hears that from law enforcement officers in his district and elsewhere in the state. “They’re frustrated that there’s not treatment services available to them,” he said.
“There is more need than we can currently provide,” Etherington said, adding sometimes state providers lack important information about the patients they receive. “Good assessment relies on good information,” she said.
“You can use telepsychiatry to a much greater degree than it’s being used today,” Haglund said. “You can absolutely do this.”
Almost half of the calls for crisis services are in the Fargo region, Hogan said, adding that could be partly because the crisis response system started in Fargo.
Noting that “demand for services in Fargo has outpaced all the other human service centers,” Etherington said, “there is a higher discontent in the Fargo region for that reason.”
Legislators and consultants have received numerous complaints from family members who are frustrated by the system’s failures in helping their loved ones. Those complaints should be formally captured and analyzed to point the way to improvements, Haglund said.
“You all need a dysfunction hotline,” he said.
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A case in point came from Jeanne and Rebecca Anderson, from Moorhead and Dilworth, respectively, who spoke of their inability to get adequate treatment for mentally ill relatives in North Dakota. Too often, they found it difficult to get treatment and even when treatment was available, hospital stays were too short to be adequate, they said.
“Extended time of care is needed, and it needs to be mandated,” Rebecca Anderson said. Family members have had to wait too long for help, and their mental health has deteriorated, sometimes causing them to run afoul of the law, she said.
Carlotta McCleary, executive director of Mental Health America of North Dakota and a spokeswoman for the Mental Health Advocacy Network, supported the report's findings and recommendations, including a new state hospital, fiscal audits and expanded peer support services.
The interim committee is working on legislative proposals to present during the 2023 session.
