Mental Health America of North Dakota
Report date
February 2019
What has been most instrumental to your progress?
MHAN believes that the Community Innovation Grant was successful in that it allowed MHAN to flesh out the unique perspective it had---the consumer and family perspective---to mental health services in North Dakota. Simultaneously the grant aided MHAN’s ability to be an independent information resource for consumers and families, agencies, policymakers, and the community at large. Together, MHAN was able to utilize its documentary as a rallying point for consumers and families to see themselves as the experts of their own experiences and the services that they need and do or do not receive. That energy was cultivated when MHAN sought to find out what the experiences of consumers, families, and professionals were in having consumers and families access mental health services with a survey. But MHAN has also brought in resources to educate itself and pertinent stakeholders on North Dakota’s legal responsibilities as well as past efforts to reform mental health services in North Dakota. A culminating activity in that effort were the statewide convenings and information presented to policymakers after the release of the Human Services Research Institute report in the summer of 2018.
MHAN believes that its perspective, the consumer and family perspective, was essential to its success. A primary reason for that was that it was an untapped niche, even if it was an obvious niche. In 2013 and 2014, when the Behavioral Stakeholder Group and Schulte Consulting, LLC were conducting parallel investigations of the status of the mental health system in North Dakota, scant attention was given to ensuring that the sources of information utilized adequately represented the consumer and family perspectives. In fact, tokenism was rampant, with one individual being expected to provide the consumer and family perspective. This also hampered the ability for more substantive recommendations to be provided in the resulting reports. With the use of this grant, MHAN was able to become a public face representing the views of the most important stakeholders in addressing the mental health systems crisis: the consumers and families themselves.
Key lessons learned
MHAN discovered that activating consumers, families, and professionals was not as difficult as we had once perceived. For many years--decades even-- individual members of MHAN recalled that it was difficult to gain societal buy-in and activism from many segments of the population, be they consumers or professionals. However, given a moment in which not only was the state dealing with a mental health crisis, but was having problems adjusting to the boom and bust cycle of the energy sector as well as a groundswell of attention paid toward addiction, MHAN was able to build a grassroots movement. MHAN’s message resonated because it was seen as more authentic to concentrate on the experiences of those who received services. When consumers, families, professionals, and policymakers saw the MHAN documentary, a problem affecting thousands of North Dakotans became tangible and demonstrated the life-long impact of decisions made by state agencies and policymakers. MHAN noticed that those who viewed the documentary were more willing to become engaged in advocating for change and improving society’s perception of mental health.
Reflections on the community innovation process
Both “increasing collective understanding of the issue” and “generating ideas” were instrumental in making the grant successful. MHAN routinely shared information it or other stakeholders had to policymakers, state agencies. It also attempted to create policy solutions to a number of the problems identified in the mental health system. Each could happen at any point in time. In some ways, MHAN’s self-assessment about how much institutional knowledge it had was incorrect. Through the historical research, we discovered that we had little knowledge we had about government activities throughout the state’s history. To use the Community Innovation diagram as an example, the state of North Dakota regularly went through a rinse/repeat cycle of embarking on steps 1-3, but rarely, if ever testing or implementing solutions. Even still, if the government did implement solutions, it would also self-destruct many of those solutions, eventually ensuring a renewal of the Community Innovation process. Over time, MHAN had shared that information with policymakers and state agencies. Some of the recent progress that has been made was as a result of pointing out the historical failure to act.
Progress toward an innovation
MHAN believes that we are potentially on the cusp of achieving actual community innovation. Historically, North Dakota never truly addressed providing its citizens proper access to community-based mental health services. Some decades were better than others, but it is unlikely that North Dakota had ever met the benchmarks set by the Olmstead decision. However, with MHAN’s presence, the continued decline of the mental health system, and the release of the HSRI report in 2018, we have seen more substantive progress in pending legislation than we had in many years, including a 1915(i) State Plan Amendment to the state’s Medicaid Plan. The North Dakota legislature is also becoming more persuaded to break-up the existing government monopoly on mental health services. Yet, we know that these legislative and agency proposals have not been evenly embraced by state agencies or branches of government. While there are champions in each institution, those institutions have been reluctant to share that vision for reform. History has also shown us that we should be cautious in believing change will occur or remain once instituted.
What it will take to reach an innovation?
MHAN does not have the capability to test and implement solutions. As a result, MHAN relies on government agencies and policymakers to complete the community innovation process. Therefore, MHAN will have to continue doing the work that it had begun in 2015: increasing the collective understanding of the issue and generating ideas to solve those issues. MHAN will continue to research the history of mental health services in North Dakota and acquire data about its current state. MHAN will advance its consumer and family-driven narrative that, “Every North Dakotan will have access to the right service – whether it be preventative, treatment, or recovery; at the right time – when the service is needed; and at the right place – as near his or her home as possible.” In many ways that vision is not revolutionary, nor is it derived from outside the North Dakota mental health system. That vision was almost entirely crafted by the state agency charged with overseeing mental health services for North Dakota—in 1976. MHAN will continue to ask that the North Dakota mental health system uphold its own values and goals and meet the expectations of the Americans with Disabilities Act.
What's next?
Given that achieving a Community Innovation relies on policymakers to implement solutions MHAN will have to await the conclusion of the session in the spring of 2019 before identifying any next steps. Until then, MHAN will continue to educate and inform policymakers as planned about the ideas that could be implemented to end the mental health crisis (including, and perhaps most especially the 1915(i) State Plan Amendment to the state’s Medicaid Plan). MHAN will continue to remain vigilant in arguing that if the state experiences a budget shortfall, behavioral health services must be kept from further budgetary reductions.