Has North Dakota found the answer to addressing its gap in mental health services?
Supporters say certified community behavioral health care clinics, open 24/7 and providing routine and acute services, would help to alleviate the dire shortage of community mental health services.
BISMARCK — North Dakota has a recognized gap in community mental health services that can lead to those in crisis languishing in jails or hospital emergency departments instead of getting needed treatment.
The resulting human toll includes people lost to suicide and other “deaths of despair,” as well as lost productivity, according to mental health advocates.
One proposal for addressing the problem: establishing what are called certified community behavioral health clinics, which must meet stringent standards for offering acute services 24 hours a day, seven days a week, for children and adults.
The certified community behavioral health clinics are in use in at least 46 states, including Minnesota, and have a track record of reducing hospitalization for the acutely mentally ill, according to proponents.
“The impact is dramatic around the country when these have been put in place,” said Sen. Tim Mathern, D-Fargo. Mathern served on an interim committee that studied the community clinics.
In Oklahoma, behavioral health hospitalizations decreased by 40% in areas served by the clinics, he said.
“It isn’t just about therapy,” but also monitors patients to ensure they are taking their medications and are able to access supportive care and services, Mathern said.
“It’s all of those ingredients that have been proven to help people stay well,” he said. “That’s the rationale for this model.”
The North Dakota Legislature has advanced two bills that would establish pilot certified community behavioral health clinics, with one favoring private organizations filling the role and another that would designate regional human service centers to provide the services.
Senate Bill 2012 , a funding bill for the North Dakota Department of Health and Human Services, would authorize the department to designate three of its eight regional human service centers to seek certification as community behavioral health clinics.
Also, subject to funding, the bill would allow the department to hire up to 50 full-time staff members for the behavioral health clinics.
Separately, Senate Bill 2128 would provide an appropriation for a certified community behavioral health clinic grant program, allocating a $1 million grant to a private entity.
Pamela Sagness, executive director of behavioral health for the North Dakota Department of Health and Human Services, testified in support of the community clinics, which she said provide a “comprehensive range of mental health and substance use services.” They must “serve anyone who walks through the door, regardless of their diagnosis and insurance status,” she said in written testimony.
Community behavioral health clinics that are certified by the federal government are supported by enhanced Medicaid funds, allowing them to serve patients without health insurance.
The certified clinics ensure access to “integrated, evidence-based” substance use disorder and mental health services and meet “stringent criteria regarding timeliness of access, quality reporting, staffing and coordination with social services, criminal justice and education systems,” Sagness said.
Also, she said, eligible clinics receive “flexible funding to support the real costs of expanding services to fully meet the need for care in their communities.”
Carlotta McCleary, executive director of Mental Health America in North Dakota, said the community clinics would help significant unmet needs in the state.
“There’s a lot that they do that we don’t have here,” she said, including continuous service availability and serving people regardless of their ability to pay.
By her estimate, based on national incidence figures, North Dakota has more than 30,000 adults with serious mental illness and more than 18,000 children with serious emotional disturbances — both categories that are entitled to treatment, McCleary said.
The state’s human service centers fall far short of those numbers, last year serving 5,482 adults and 1,701 children, with only 935 adults and 135 children receiving case management, which the community clinics provide, she said.
“They only serve those who are most severely ill,” McCleary said. “There’s drastic need out there. I think this is going to make a big difference in how we’re delivering mental health care in North Dakota.”
Michael Dulitz, opioid response coordinator at Grand Forks Public Health, said pilot certified community behavioral health clinics were established in 2017 in East Grand Forks and Crookston in Minnesota.
Private organizations, he said, could be better positioned to serve the role of the certified clinics.
Privately run behavioral health clinics would be welcome, Mathern said, noting that Altru Health has expressed interest in providing the service in Grand Forks.
“They have leadership that’s attentive,” he said.
There are more than 500 certified community behavioral health clinics around the country, and the model has received support from both the Trump and Biden administrations, he said.
Staff at the state’s regional human service centers, with some additional training, should be able to meet the standards required for certification, Mathern said.
“There’s some criteria that are quite demanding,” he said. “It’s going to take retooling present staff. You’ve got to be open 24/7. You’ve got to change the way you do things,” such as offering wraparound services.
To do that, community partnerships will be important, he said.
If pursued, a shift to certified community behavioral health clinics would be the biggest change in mental health service delivery in North Dakota since the 1960s, when the population of the State Hospital in Jamestown was greatly reduced, Mathern said.
The State Hospital once treated thousands of patients, but starting in the 1960s, most patients started to get treatment in the eight regional human service centers, he said.