Dem-NPL Candidates Call for Investments in Behavioral Healthcare Amid Pandemic
By Alex Rohr,
Dem NPL- Communications Director
Expanded and Edited,
by Sherry Stevens
Bismarck, ND – On October 8, 2020, a group of Dem-NPL legislative candidates moderated and reported summarily by Alex Rohr Communications Director for the North Dakota Democratic-NPL, “[C]alled for strong investments in behavioral health services and a holistic approach to treatment and recovery that includes Prevention and Early Intervention, Real-Time Services, and Supporting Recovery in every part of North Dakota. An investment in behavioral health improves the quality of life of North Dakotans and also grows the workforce and the economy. The virtual press conference recording can be found on the Dem-NPL Facebook page.
A study from the Kaiser Family Foundation showed that in 2019, more than one in ten adults reported symptoms of anxiety or depression. Now, it’s more than one in three. Further, 13% of adults have reported a new or increased substance use as a way to manage COVID-19-related stress, while 11% reported thoughts of suicide. In recent years, North Dakota’s suicide rate has risen faster than almost any other state in the nation.
Call for Nations’ Collective Contribution in Building a Solid Foundation for Culture-Based Intervention
Lisa Finley-DeVille, Senate Candidate for District 4, was present at the meeting and afterward, offered her insight into the need to bridge the current gap in behavioral health and funding for indigenous programs in respect to all Tribal Nations’ collectively:
“North Dakota has been in a health professional shortage for quite some time. We need to build a solid infrastructure for our rural health care needs, which includes access to cultural-based behavioral health services. Culture and identity have a strong protective factor towards resiliency. It’s so important to know who you are and where you come from. When you lose your identity, you lose yourself. As Indigenous people, we are taught to respect ourselves; this means not using drugs and alcohol. We were taught to respect your body; there is only one you.”
DeVille further stated, “Education and prevention are very important; in fact, it is a part of our cultural teachings. This second oil boom has brought many social issues, including a rise in crime and drugs. For example, within Fort Berthold Indian Reservation, within just this year alone, we have had many overdoses. Part of a solid infrastructure to address the continued harms of crime and drugs means we need more counselors in the school system, one for behavioral health and one to prepare our children for the future. With behavioral health, we are dealing with COVID-19, premature deaths, and family addictions such as gambling, drugs, and alcohol.”
In emphasizing a need to collaborate mutually on dealing with these behavioral issues as First Nations, DeVille stated, “The bottom line here is that we need more funding to commit to building a stronger future through a solid infrastructure for our rural communities. Not to mention, collaboration and partnerships with tribal nations are key. We are all in this together.”
District 24 Sen. Larry Robinson discussed how investing in behavioral health would benefit the public and private sector workforces and the need for support in rural areas. Robinson said:
“When it knocks at your door, it’s a rude awakening, and you quickly find yourself searching for help, and advice, and direction, and support,” Robinson said. “The revolving door aspect of treatment, addiction, and so on has not worked, and we know that, and we’ve learned from that over the last number of years. This is not going to be an easy lift. We know that, but I think there’s increasing awareness across the state, private and public partnerships, private and public sectors that this is an issue that must be addressed. The greater cost would be in not making those investments.” Larry Robinson, reported by A.Rohr, 2020.
Robinson went on to explain an approach needed to sustain the work already started and the importance of education as a tool toward intervention, “I think there are a number of things, and obviously, we know that we’re going to be in a very tight budgetary situation in the 2021st legislative session. However, I feel it’s important that we go in with an open mind. It is certainly important we sustain what we have started, and we’ve made significant progress in the area of behavioral health programs, but I do know there is a lot happening across the state; this social service unification program hopefully, toward a bill that I am providing.” He also explained that although budgets will be tight especially in rural areas, education and intervention is key. “Early intervention is always important – that’s your best money right up front,” he commented.
Tracey Wilkie, a District 16 House Candidate, who has worked for 25 years on the Front Lines of Behavioral Healthcare, said:
“As someone who has worked directly with people going through serious challenges my whole life, I can tell you behavioral health needs a holistic approach and that Prevention and Early Intervention is key to saving lives and livelihoods. These resources include supporting early screening, referral services, expanding local behavioral workforces, and strengthening economic support for families, all even more important as risks arise during the pandemic.” Tracey Wilke, as reported by A. Rohr, 2020.
Caseload Numbers and Access are Statewide Issues
Wilkie also went on to describe particular difficulties on a statewide level, “We have issues of access to programs, and the affordability of programs. We have to be sensitive to aftercare components, and this is a statewide issue. The rural areas in particular, are hard-pressed to access these services. The availability of addiction counselors for example, is a major challenge not only in North Dakota, but across the country.” She commented because of this hard pressed access, people working with the health department and certainly in the area of corrections, are stretched to the max, “With caseloads sometimes double what the industry standards would suggest. This issue is one of critical importance to our state, and the session of our legislature will delve into this in a big way, not only in terms of a health department and human services but again, the impact behavioral health and addiction issues have on all aspects of the state of North Dakota.”
Jackie Hoffarth, a District 18 House candidate and a licensed social worker, discussed the need for real-time services, culturally responsive care, and diversifying the behavioral health workforce. Hoffarth said:
“We need to base funding off what people need and change the way we think about behavioral health, which means person-centered care that helps people set and meet goals they can accomplish today. It’s helping people meet their basic needs, treating them with dignity and trust over the choice in their own lives, and reducing stigma often associated with systems whose approach is often punitive rather than empowering. This is the path to a healthier North Dakota, not only at the individual level, but economically as healthy North Dakotans become productive employees who stay in the workforce and become part of our innovative fabric.” Hoffarth, as reported by A. Rohr, 2020.
Quick Responsiveness to Care and Lack of Care and Underfunding for Person-Centered Care
In elaborating on the need for a quick response to intervention and treatment for those with behavioral health issues, Hoffarth further stated, “No quick access to services is huge. When people are ready to receive care, when they’re in this window of opportunity for behavioral issues, or they’re in a crisis, they need low barrier options. Take, for example, you have a single parent of three school-age children, who has working-class wages, which are not beyond much of the minimum wage, and is (now with treatment requirements) just a paycheck away from being able to pay their bills. Now, if they would have to give up every part of their life for traditional inpatient treatment, they would have to give up work, financial momentum, the ability to care for their children. Hoffarth further believes this is not a productive or effective situation to place a person who is in need of services for addiction or mental illness into, so the call for legislative funding to expand and open these services is immediately necessary.
Hoffarth further went on to point out the difficulties with adequate outpatient care and lack of funding as a primary cause of perpetual substance abuse as the resources are not readily available to patients, “A lack of outpatient options, a long waiting period, underfunded programs that keep people from seeking treatment, and when people aren’t able to access the help that they need. It sees the ripple effect through generations.”
She offered a solution by describing a unique person-by-person assessment of treatment, “We need to base funding on what people need and change the way we think about behavioral health. This means person-centered care helps people submit goals that they the complex today. It helps people meet their basic needs, treating them with dignity and trust over the choices of their own lives and reducing stigma, which is often associated with assistance to the approaches all too often, punitive rather than empowering. This is a path to a healthy North Dakota. We are not going to fix everything in one legislative session, but we do have to change the way that we think about behavioral health, the way we treat it, and certainly the way we fund it.”
A Call for Culturally Responsive Care
“To be active, we also need to be culturally responsive to care, Hoffarth stated. “Now, as a proud Mexican American who grew up with the strength of a family-centered and oriented culture, I know having people who understand my culture builds trust and comfort and care that I receive. Building culturally responsive programming goes beyond just training of staff; it means diversifying the behavioral health workforce, investing in counselors, and social workers who come from those cultures being served. These workers have a deeper understanding of racial and class inequalities, historical trauma, and the current day reaction now that people face. Now investing in Tribal partnerships, having services in one’s first language, and access to the ceremony are just some of the ways in which programs are already moving towards this ‘already inclusive framework’, and we must continue to do that.”
Will Thompson, District 22 House candidate, discussed his personal experience with behavioral health, the need to eliminate stigma, and what that means in terms of setting priorities. Thompson said:
“I believe that mental health issues and substance abuse are going to be some of the greatest challenges my generation is going to face. So, we don’t have time to wait. The legislature instituted an addiction treatment voucher that enabled people who couldn’t afford treatment to get care in their communities, rather than one of the few state facilities. It was a start, but the money ran out this year and right before the most critical time of the year – when the winter makes us feel trapped and the holidays bring challenging times for many people. The program froze during a crisis. We can’t let that happen again.” Will Thompson, as reported by A.Rohr 10/2020.
No Sector or Class is Immune to Behavioral and Addiction-Related Issues
“It’s something we can’t ignore, and it’s important that we do what we can to address the issue now,” Thompson explained. “I think that’s close to the state and all aspects; private and public sectors are trying to maintain a workforce and also trying to address issues of work productivity, recruitment, retention, the middle class. Also, the impact it has on our health department, our human services department, our corrections division, and again, every agency and government institution are not immune to this issue of behavioral and addiction-related issues.”
Stigma in Demonizing People in Treatment or Therapy Needs to Stop
Thompson’s approach to spearheading the problem is to rid social perceptions of stigma-related roadblocks to treatment and therapy as he explains, “It’s important that we stop demonizing people who suffer from these problems. I think we’ve come a long way. My father would always talk about when he was growing up; you didn’t talk about problems like this; you just kept it on the inside. We’ve made steps, but there is still much stigma, and that stigma benefits itself as a lack of resource allocation. Just making this a budgetary priority would be a huge step and a big deal in the fight against that (overall) stigma.”
The Addiction Treatment Vouchers Ran Out Before Covid-19 Hit
Thompson mentioned North Dakota’s historical approach on ‘treatment vouchers’ before the Covid-19 Pandemic, “[A]n addiction treatment voucher program; it enabled people who couldn’t afford treatment, to get care in their communities rather than one of the few the states offer. This was a start, but the money ran out this year and right before the most critical time of the year when the winter comes and makes us feel trapped inside when the holidays come to bring challenges for many people. The program froze in a crisis, and we can’t let that happen again. It’s disheartening to see that health and human resources make up less than 3% of the budget, and only a fraction of that goes to substance abuse and mental health treatment.”
A Kaiser Family Foundation Survey Found in mid-July that 53% of American adults in the United States reported their mental health was negatively impacted by worrying to stress related to Covid-19. In March, that was only 32%.
It’s clear by the statements in this article, and amid the 2020 Covid-19 Pandemic, the state of North Dakota has witnessed a substantial rise in the need for funding on behalf of behavioral health programs to treat North Dakotans’ addiction and mental health issues effectively.
As stated by Senator Candidate, District 4, Ms. Lisa Finley-DeVille, this need of funding allocation and commitment by government reaches also to include the MHA Nation. However, Three Affilated Nation seems to be ahead of the ball in comparison, as It has just this year, and during the Pandemic Season, witnessed the Sage-Coulee Wellness Center Grand Opening in Bismarck as well as the continuation and development of after-treatment housing for families in Bismarck who are recovering from addiction and mental illness to remain closer to home during Outpatient and after-care treatment. Seemingly, those acknowledgments and approaches are being explored and resolved within each segment.
This need has also been foretold and mentioned prior to this ‘Call from State Legislators’ in dedication ceremonial speeches by leaders of the MHA Nation as a necessary approach to maintaining the family unit, while addressing addiction and drug abuse issues suffered by members within the MHA Nation (see Chairman, Mark N. Fox’s Speech in The MHA Times article, titled ‘Grand Opening’ of The Sage-Coulee Wellness Outreach Facility; Volume 32, Number 27, July 1, 2020)