In behavioral health lingo, it’s often referred to as social detox. It’s meant to occur in a medical facility, but more often than not, there’s no such place to hold the intoxicated individual. They end up instead in a jail cell for 24 hours.
“That is a clinical level of service,” Pam Sagness, Director of North Dakota Behavioral Health said to a group of stakeholders in Williston on Tuesday, Nov. 26. “And not one jail in North Dakota is certified to offer that. We don’t talk about that, and people die in jails because of that.”
It’s just one of many shortcomings in behavioral health care across the state in North Dakota communities, one that Sagness says the state is trying to eliminate.
Sagness was one of three state officials traveling to Williston on Tuesday to talk with community stakeholders and caregivers about efforts to improve both early intervention and access to treatment for behavioral health care.
With her were Chris Jones, executive director of the North Dakota Department of Human Services and Sara Stolt, transformation manager of the North Dakota Department of Human Services.
Sagness said the state has historically only been able to offer services when there is a diagnosis.
“I’ve actually had to look at parents and say, ‘I’m sorry, your kid is not bad enough yet,’” she said. “If you think about that, there are so many ways that is not OK. But it’s the system I was trained in. There are no services without a diagnosis.”
Half of all people with mental illnesses or substance use disorders are diagnosed by age 14, Sagness added. But the state spends just 1 percent of its behavioral health care dollars on youth outpatient services. The amount it’s been spending on prevention is also very low.
“Does that connect?” she asked. “Are we investing where we need to, to see the outcomes we’re looking for?”
There is a substantial gap between the age a symptom first appears and actual diagnosis and treatment.
That’s a missed opportunity, Sagness said.
“Why are we investing only in deep-end services if we know early intervention has better outcomes?” she asked. “We wouldn’t do that for a physical ailment. We wouldn’t be OK with that.”
Then, after people get treatment, there’s been inconsistent connectivity to other programs that could help people remain on track. In addition, many of the people have had to leave their homes, potentially losing their jobs and housing to get the treatment they needed.
‘A broken system’
“We have a broken behavioral health system, and we need to address it,” Sagness said, adding. “I want to thank the legislators who are here today. This is the most important session that’s ever happened to change the behavioral health system.”
Among the many changes — there are 20 or so in all — will be statewide behavioral health crisis services in all regions of the state.
“In the past, we tried to do it as a public-private partnership,” Sagness said. “We had difficulty even finding a provider that wanted to offer it.”
The program is only in one community so far. It has not been rolled out to Williston yet.
“It’s going to roll out in each community individually and will be different, so I don’t want to talk about specifics here,” Sagness said.
Crisis services will hopefully link up with a certified peer support specialist. These will be individuals who have been there. They will be trained to help guide people through the behavioral health care system, helping ensure that patients know where to go next in their recovery process.
Another area that is getting a lot of attention is improving the access and delivery of services to youths. Too often, they’ve have had to bump into the criminal justice system first.
Figuring out how to change that will involve many conversations between the education community and the behavioral health care sector.
Some of those conversations have already occurred, Sagness added, and there was one heartening thing that quickly became clear.
“In the room, we realized that often we were saying the same thing, just with different words,” she said.
Educators talk about a multi-tiered system of support, while behavioral health care experts say continuum of care.
“One important distinction to make, however, is that behavioral health care does not equal special education,” Sagness said. “Children with behavioral health issues do not necessarily have any form of academic failure or failure to thrive in the classroom.”
While the two populations may overlap, the differences become clearer when you think about desired outcomes. For special education, the goal is generally about academic proficiencies and life skills. For an abused child, the goal is more like healing and wholeness.
Sometimes children with a behavioral health issue get labeled as just “naughty,” Sagness said. But their behavior can also be a symptom of profound trauma and abuse occurring at home.
“Our schools are not equipped generally with people able to diagnose this,” Sagness said.
But cross-training may help to address the gap, Sagness suggested, and help youths access programs that can help them earlier than has been occurring.
Each school, going forward, is going to have a designated resource officer to receive information from the Division about behavioral health care. Then when a child needs behavioral health services, there is someone familiar with what’s available.
Another change that’s being made is expanding the Free Through Recovery program, which, while not a clinical program, does provide care coordination and peer supports. That will no longer be restricted to just the prison population. Williston has seven providers for that program, and dozens of participants, Sagness told the Williston Herald.
The age limit for the substance use disorder voucher is also being expanded. It will now extend down to age 14 instead of 18.
So far, 3,556 individuals have received services with the help of the SUD voucher, which was established in the 64th legislative session to address barriers to treatment.
The division receives about 186 applications for the voucher each month, and there are 22 providers so far approved to provide services using the voucher. Summit Counseling in Williston is so far the only provider approved for that in Williams County.
The vouchers will pay for methadone, where Medicaid will not. Methadone is considered a best practice for opioid treatment.
Facilities whose patients succeed on performance metrics can also qualify for additional reimbursement from the SUD voucher.
Expanding the SUD voucher and opening up the Free through Recovery program provides vital funding to reach underserved populations.
With more funding, health care providers have more incentive to step up and provide services to populations that may not be able to afford care on their own.
“These things are not going to appear magically on July 1,” Sagness added. “We need providers who can supply the services. We have done the first step, which is making sure there is a sustainable service model. But we need providers. We need you all to go back and talk about it. What are the opportunities to expand community services for behavioral health?”
Sagness also told the Williston Herald that Division has sat down with behavioral health care providers to ask what it would take to get them to locate facilities in the west.
“It came down to reimbursements for the services,” Sagness said.