Mental health reform hits the shallows

A four-year-long effort to reshape North Dakota’s mental health services may be shipwrecked in the shallows at the Legislature.

Money is tight.


A four-year-long effort to reshape North Dakota’s mental health services may be shipwrecked in the shallows at the Legislature.

Money is tight.

There’s institutional resistance.

And there’s stigma attached.

The effort began in the 2013 session, when the Legislature ordered a study. This was completed in July 2014. The 2015 session sent the project to an interim committee to craft bills that would be presented this year.

The early going has been rough.


Last week the State Senate rejected the idea of removing the State Hospital from the constitution, one of the proposals advanced by the interim committee. Closing the hospital would have required a public vote; if passed, it would have cleared the way for a system of regional mental health centers.

The proposal got only three votes – but it as a bipartisan vote, two Democrats and one Republican voted in favor of the idea.

Changes in certification and licensure for mental health professionals ran into trouble last week, too. Governing boards pushed back against changes the interim committee had recommended.

Legislators may move ahead with one portion of the plan, renaming mental health. Occurrences of the phrase in state law would be replaced with the phrase “behavioral health.”

That’s aimed at the stigma associated with mental health, state Sen. Judy Lee of West Fargo explained. She chairs the Senate Human Services Committee, and she presided over the interim study committee as well.

Lee said she plans to concentrate on what she called “workforce issues” in mental health. The field is “quite turfy,” she explained. “There are a lot of silos. We need some skywalks between the silos.”

She said professionals with certification in specific fields should be able to work in other fields with proper training and supervision – but perhaps without another certificate.

This would increase the number of professionals that would be available to provide services at specific locations.

Both Lee and Sen. Tim Mathern of Fargo said the state urgently needs to provide services in a more accessible way. This would include teleconferencing for therapy sessions, both suggested.

Mathern is the Legislature’s most vocal advocate for sweeping change. A former counselor, he served on the interim committee studying the issue. He was the most vocal backer of closing the state hospital.

Refusing to do it sets back care, he said.

“It’s an illusion,” he said. “The illusion is that since we have the state hospital we have addressed the problem. It lets us believe we care.”

Lee’s approach is more incremental. She voted against closing the state hospital, and she’s pushing for funding of adolescent treatment facilities and more beds for crisis cases.

Even these small steps may be in danger because of funding cuts.

Human service programs take about a third of the money allocated from the state general fund, roughly the same amount spent on public schools. The general fund is built mostly on taxes paid directly by North Dakota citizens and businesses. When money from other funds, especially federal funds, is added, spending on human services surpasses spending on public education.


Behavioral health is an important part of the human service budget, about 6.6 percent according to testimony given the House Appropriations Committee last week. Rosalie Etherington, who is superintendent of the state hospital and chief clinics officer for the Department of Human Services, said the state’s eight human services centers served about 37,000 clients in 2016. That number is about 5 percent of the state’s population.

In an interview, Etherington said the department hopes to expand services especially in under-served areas and in response to emergencies such as the opioid crisis. Other priorities are expanding the workforce and creating more training opportunities.

As for the bigger question, whether the work of the last four years will result in more and better delivery of services, Etherington said, “It’s likely too early to tell.”

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One thought on “Mental health reform hits the shallows

  1. —That’s aimed at the stigma “associated with” mental health

    Oooops, bad aim: You aim at the people proffering a prejudice, you do not join them in so doing.

    Harold A. Maio, retired mental health editor

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