Posted 11/01/16 (Tue)
By Kevin Killough
This election season, one thing District 2 House candidates all agree on is the need for better mental health care services in rural northwest North Dakota.
This kind of bi-partisan support would suggest the budgetary needs of the service providers are going to firmly weather the debates over finances that are sure to be the main focus for the coming biennium session.
But speaking to providers, the challenges of providing rural mental health care isn’t entirely about money.
“Things are a lot different than they were a year or two ago,” said Laurie Gotvaslee, regional director of the Northwest Human Service Center in Williston.
The center serves Divide, Williams, and McKenzie Counties.
A common story to the region is the sudden and overwhelming demand of the oil boom, and mental health services had it no easier than any other social service need.
As the demand grew, the wait list grew. And it created a cycle. The person in need of help would call to make an appointment, which would be scheduled for weeks out.
In the meantime, the person either moved, gave up, or in the case of substance abuse, he or she just kept on using. The no-shows were becoming more and more common, and that was taxing the system.
“We were really struggling with our traditional system,” said Tammy Ness, clinical director of the center.
Finding adequate staff to reduce the wait list wasn’t just a matter of getting more money from the state.
They’ve had a certified nursing assistant position open since Dec. 2012.
Recruitment of mental health service professionals is a nationwide problem.
“That will trickle down to North Dakota,” Gotvaslee said.
Last year, Gotvaslee said, North Dakota had more people choosing not to renew their licenses or retiring than they had new licenses issued. At the center, they’ve lost staff to people moving away. The husbands lose their jobs in the oil fields and they take their families with them when they go.
“I think if we were fully staffed we’d be doing fine,” Gotvaslee said.
Patrick Butler, CEO of Community Health Center, attributes the recruiting problems to the fact it takes a certain type of person who wants to live in rural areas where there are fewer services and amenities.
“Most professionals want to be in the urban areas,” Butler said.
Northland operates a clinic in Ray, and the location successfully recruited a licensed independent clinical social worker. Butler said they were lucky to find someone who prefers the rural life.
Ness said despite the slowdown they haven’t really seen much change in their workload. Most clients are people who were not just in North Dakota for work. Either they’ve permanently relocated to the state or they’re longtime residents.
Knowing the demand is going nowhere and staffing issues were not going to be resolved anytime soon, Gotvaslee and Ness looked for other ways to address problems in a model now being replicated across the state at “sister” clinics, such as Jamestown and Minot.
“We were the pioneers,” she said.
They now have a system that allows for walk-in clients a few days a week. This provides an immediate analysis, and needs can be prioritized.
Gotvaslee compares it to an emergency room, where someone with a life-threatening injury can be treated before someone with a bad case of the flu.
“We’ve been creative in how we serve our clients,” Gotvaslee said.
Among the priorities are intravenous drug abusers, pregnant women, serious mental illnesses, people who are a danger to themselves and others, and children.
Those cases they address as quickly as possible.
The center has a psychiatrist who visits weekly from Bismarck, and they use “telemedicine” so he can meet clients remotely through teleconferences.
The less serious cases can be scheduled for more distant appointments, and since they aren’t in crisis they are much more likely to keep those appointments.
Not only has the system cut down on no-shows and allowed the system to reach a lot more of the demand, it lowers costs to the public.
People with untreated mental health issues end up unemployed or caught up in the criminal justice system, especially untreated addiction.
Steve Hall, manager of the probation and parole office in Minot, said the positive impact on the open access system to his clients has been “overwhelming.”
“The open access is a way to triage people coming in the door,” he said.
Therefore his clients are much more likely to meet the conditions of their probation.
The Williston center also provides referrals to what they call their “community partners,” the private clinics throughout the community.
As with the public-sector services, these private clinics, such as the Northland clinic in Ray, are using non-traditional approaches to provide behavioral health services in rural areas.
The Center for Psychiatric Care was started in 1993 in Grand Forks, and they now have clinics throughout the state, including Tioga.
The provider has been in a partnership with Tioga Medical Center for about three years and recently moved into the old clinic when the hospital began using its newly built clinic.
Tom Peterson, CEO of the company, said they’ve seen their workload “plateau” with the slowdown, but rural behavioral healthcare was a challenge well before the boom.
“We are going out of our way to help people in rural areas,” Peterson said.
The clinic has three part-time psychologists and three part-time psychiatrists who visit Tioga on a regular basis to serve their clients.
This approach, Peterson said, is the “model of rural behavioral healthcare.”
Like Northwest Human Service Center, the clinic also uses telemedicine.
Peterson said most of their clients work full-time, have children they care for, and are addressing routine issues.
This includes help with depression, anxiety, PTSD, attention disorders, and grief issues.
“They just need specialty care in that area,” Peterson said.
Most often, such clients would have to go to Bismarck and possibly wait months to see anyone.
He said Northwest is vital to addressing the area’s mental health care needs, and they handle serious issues like schizophrenia.
Peterson said the clinic does treat serious mental problems but not nearly in the numbers the Northwest Human Service Center does.
The clinics in the Center for Psychiatric Care system, like the one in Tioga, also provide a lot of help for children and the elderly.
Peterson estimated they provide services to about 80 percent of the nursing homes in the state -- most of them in small towns like Tioga.
The biennium session is going to be a struggle for an ever shrinking amount of dollars. With bi-partisan support for mental healthcare services in the rural parts of the state, providers probably won’t see their budgets cut.
More resources would be helpful, but until more professionals enter the field of behavioral health and substance abuse treatment, much of the problem won’t be solved.
Gotsvaslee said it’s easy to see why the legislature has been so supportive and understanding. Mental healthcare is something that touches just about everyone.
“You hear people say, ‘those people’ when referring to the mentally ill. Those people are our spouses, our siblings,” she said.
For the time being the rural needs will be met by emulating and expanding the innovative rural programs the private clinics and public centers have implemented.
That’s where resources are going to go a long way to getting rural residents the care they need.
“We look forward to working with our legislature to find solutions,” Ness said.