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North Dakota lawmakers get report on ‘crisis’ in behavioral health services

BISMARCK - The ball is now in the North Dakota Legislature's court to fix what a consultant identified as major gaps in behavioral health services, including a "crisis" in the western part of the state, where population growth has more people see...



BISMARCK – The ball is now in the North Dakota Legislature’s court to fix what a consultant identified as major gaps in behavioral health services, including a "crisis" in the western part of the state, where population growth has more people seeking treatment from providers struggling to find workers.

Renee Schulte of Des Moines, Iowa-based Schulte Consulting LLC delivered her final report Tuesday to the Legislature’s interim Human Services Committee after conducting five public hearings and 35 face-to-face meetings with various groups and individuals across the state and taking input from more than 400 people in public conference calls.

Schulte gave lawmakers the bad news first, saying many of the challenges facing North Dakota are self-imposed: choosing a poor essential health benefits package for Medicaid, not applying for Medicaid waivers to help with the chronic mentally ill and refusing to spend state funds on services.


“It’s not because you don’t have the resources,” she said. “It’s because of the decisions made.”

While services are poor across the state, the situation is dire in the west, she said.

Cost of living, lack of housing and other challenges in the Oil Patch make hiring nearly impossible in the lower-paid service areas, the consultant found. The increase in population also is “significantly” adding to the mental health crisis, not only from more people seeking services but also the difficulty of the issues they bring, the report stated, citing more intravenous drug use, sex trafficking, physical assaults and domestic violence.

“Your western part of the state is really in a crisis,” Schulte said. “You do not have the services you need there.”

The good news, she said, is that the state has the resources and expertise needed to turn things around.

The report outlines 51 strategies for making changes in six key areas: service shortages, workforce expansion, insurance coverage, communication, data collection and research, and the structure and responsibility of the state Department of Human Services.

“You guys are fully equipped to deal with this crisis,” she said.

The report’s implementation plan lists 37 steps, at least 16 of which would require action by the Legislature and another five that could require it. Among the recommendations is boosting funding for adult and youth substance abuse services including detox, estimated by the consultant to cost $2 million to $10 million, depending on the funding source.


The report also recommends ways to address the “extreme shortage” of workers in behavioral health areas, including easing the state’s reciprocity requirements for workers from other states and creating an oversight system for licensing boards.

North Dakota’s Legislature meets every two years, and the plan calls for legislative action in 2015, 2017 and 2019, in addition to steps already in process by DHS and the Legislature.

“A system change of this size is not something that you can do overnight,” Schulte said.

Sen. Tim Mathern, D-Fargo, said time is of the essence.

“There are people dying all the time from a lack of health care services in behavioral health,” he said.

The committee also received a complementary report from a stakeholders group consisting of public and private behavioral health providers, policymakers, educators, consumers, and officials from corrections and the judicial and executive branches.

Rod St. Aubyn, representing the group’s steering committee, urged lawmakers to adopt the report’s recommendations in bill drafts for the 2015 session. He cautioned that the potential exists for a lawsuit over behavioral health issues, not unlike the federal class-action lawsuit that forced reforms in North Dakota’s system for the developmentally disabled in the 1980s.

“We strongly recommend that this does not collect dust,” he said.


Rep. Chuck Damschen, R-Hampden, chairman of the 17-member committee, said, “We look forward to trying to implement as much as we possibly can – at least as much as we can agree on.”


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