Mental Health America of North Dakota CI Report – Interim

What has been most instrumental to your progress?

The statewide convenings were critical to our work. North Dakota’s biennial legislative session required a retooling of our initial goals, but also helped maximize our impact. Disability Awareness Day at the State Capital building allowed us to bring in Renee Schulte, who was with us in a meeting with the Governor’s office and an evening panel discussion about progress made since the Schulte Report and the Behavioral Health Stakeholder’s Report. Later in the session we invited Lewis Bossing to present at a luncheon for policymakers at the state capital, the Consumer Family Network (CFN) Conference, and an evening social regarding North Dakota’s legal responsibilities for mental health services. At the conclusion of the legislative session, we also met with the newly-appointed Director of the Department of Human Services to introduce ourselves, our mission, and establish a path forward to ending the mental health crisis. The information that Mental Health Advocacy Network (MHAN) has been able to provide informed policymakers and became a critical discussion point throughout the session.

Without building on the work completed in the “Let’s Hear it from the People” grant, the information that MHAN could provide policymakers and other stakeholders would have been significantly limited. In our survey, nearly 500 consumers, families, and professionals responded that there were significant gaps in mental health service delivery. The MHAN documentary “A System in Crisis” utilized consumer and family voice and experiences to showcase both the depth of the current mental health crisis as well as what positive impact a fully supported system of care can have on individuals and families. “Let’s Hear it from the People” was unique and valuable in comparison with previously disseminated materials in that it did not merely concentrate on the “inputs” and concerns of service provider professionals, but rather the people utilizing services themselves and how the crisis is impacting their lives. Being able to share that information at our statewide convenings allowed consumers and families, professionals, policymakers, and the public at large to see the human face of mental health care and the current crisis and to take on ownership for shaping the dialogue in the future.

Research will grow in importance in the year ahead. At the start of the grant period, MHAN felt that North Dakota had consistently failed to create a vision for what mental health care ought to look like in the state. We sought to find out whether that was the case, uncover how the previous generation built the existing mental health system, and if we could pinpoint a time and reasons for the decline in the state’s mental health system. Historically the state had lacked a cohesive vision for mental health services, but there were moments where planning and execution were in sync. We also discovered starting points for the crisis as well as potential causes. We also uncovered a historical analogy that can motivate policymakers to protect and shore up state and federal resources for human and mental health services. This research has substantially educated us, given us specialization in the field, and fully defined the crisis we are in. We think this research component will become an important part of moving forward in our work toward creating a unified vision for North Dakota’s mental health system.

Key lessons learned

During our initial grant period, we thought we could hold convenings in four regions of the state as well as two additional convenings statewide. What we did not fully appreciate, however, was the sheer number of logistical concerns that would arise from having a legislative session during the same time frame. North Dakota holds legislative sessions once every two years for roughly 80 days. In policy circles, all efforts seem to revolve around the legislative session, tying many active stakeholders to the capital city from January until May. In interim session years, our initial activity goals would have been realistic, whereas during the general session it was not.

The general legislative session did alter our plans, but we discovered that with the right approach, we were perhaps far more successful than we would have been in optimal conditions with our original activity plan. The legislative session funnels key stakeholders and policymakers to a central location for months, and during that time, key decisions are being made that would shape the outlook for the mental health system for the biennium and beyond. It produced a captive audience, because we were able to connect information with all policymakers and a larger number of consumers and families than originally anticipated. The results, though subtle, were nothing short of astounding. We had a perceptible increase of buy-in from policymakers. Most importantly, policymakers were publicly acknowledging in hearings that a mental health crisis existed and recommended changes needed to happen, lest the state face the prospect of litigation.

Reflections on inclusive, collaborative or resourceful problem-solving

The element most valuable to MHAN has been inclusiveness. Prior to this grant, the key reports the state had been grappling with were from the perspective of “inputs,” service providers, or professionals in the mental health field, rather than individuals and families receiving services and their outcomes. Our perspective and information dissemination was providing a unique view—one with a consumer and family focus to give face to the ground-level impacts of this crisis, thereby making it harder to ignore.

Other key elements of Community Innovation

While perhaps included in any or all elements of the Community Innovation Process, MHAN believes that it is the increased specialization we and other stakeholders acquired as a result of this grant that has been especially valuable. Just as informed consent is a virtue in all medical decisions, we believe as consumer and family stakeholders that informed decision making extends to shaping the design and function of the mental health system as a whole. For MHAN members it was the exposure to presentations and reports such as Lewis Bossing’s legal obligations for the state of North Dakota, Renee Schulte’s report, as well as our own original research that helped us better understand the depths of the crisis as well as how to produce a fully supported system of care. But this also extends to other stakeholders such as policymakers, who have only recently been informed as to what their legal obligations are to the citizens of North Dakota. Our policymakers are reliant on others for quality information, and unless an individual or entity supplies that information, they are not acting with informed decision making.

Understanding the problem

The grant’s original research component has added more clarity to the systemic need identified in our grant. The research has allowed us to generally pinpoint when the crisis started to develop and identify potential causes of that downward trend. By being able to identify causes, we may be able to recommend potential solutions to the existing crisis. Policymakers frequently seek historical analogies by which to frame how to approach a given issue. Through our history research, we are also able to provide information regarding an analogous scenario by which policymakers made positive decisions for mental health service delivery during economic downturns, which eventually led to a mental health system of care that was more responsive to the needs of the community.

If you could do it all over again…

In retrospect, MHAN underestimated the potential for a shift in agency imperatives, priorities, or vision and were caught off-guard as a result. MHAN has had to come up with new strategies to try to foster a unified vision of mental health service delivery; prioritizing different actors and their concerns in order to promote the consumer and family perspective on mental health services.

One last thought

MHAN believes there is great potential in eliminating the mental health system crisis. Across the country and in North Dakota, there is enormous bi-partisan concern for the well-being of behavioral health services. Opioid addiction, other substance use issues, and mental health services have risen in the public profile in recent years. So too has criminal justice reform. North Dakota, along with many other states, has expressed bi-partisan alarm at the rising prison population, the cost of that population on state budgets, and how a lack of behavioral health services are frequently at the root of the problem. It is no coincidence that North Dakota has advanced a pilot program for offenders with behavioral health needs to receive behavioral services and divert them out of correction system. It also provides services to inmates with behavioral health needs once they leave the correction system to reduce their likelihood to re-offend.