Behavioral Health in North Dakota

Gary WolskyBy Gary Wolsky, President/CEO
The Village Family Service Center

In January of this year, the North Dakota Legislature hired Schulte Consulting to examine North Dakota’s behavioral health system. Concurrently, a North Dakota Behavioral Health stakeholder’s group was convened to make sure everyone was at the table. Representing the nonprofit sector, The Village is honored to be a part of this group which includes public and private behavioral health providers, policymakers, educators, consumers, and state officials from corrections, and the judicial and executive branches.

All organizations and systems require periodic makeovers in regards to policies, procedures, and organizational structures, and I see the Legislature’s actions as positive steps toward improving the behavioral health systems in the state. This represents the most thorough review of this topic that has been done in many years.

The “Schulte Report,” released in July, points out many shortfalls in our behavioral health system. Before I get into those findings and recommendations, let me share some information and history about the North Dakota Department of Human Services (DHS), the department affected by the findings of the report.

The DHS is one of the largest, most complex and far-reaching units of state government. The department’s budget exceeds $1 billion, and DHS oversees many programs necessary to the well-being of our residents. The department was last “overhauled” in the 1980s. Prior to that, DHS had an executive director and a board of citizens called the Social Service Board of North Dakota that provided oversight and accountability to the programs, as well as represented the needs of the citizens when necessary. It, of course, wasn’t perfect but served our citizens well for many years. Our current system, which emanated out of that change, has also served us well.

But the recent and final report by Schulte Consulting reflects the fact that the department may be due for a tune-up. Of course, as with any consultant’s effort, much of the report seems to be clearly on track, while some needs greater evaluation. However, there are a couple of themes that are worthy of noting, and in one way or another, these topics will impact many of our readers and many of the state’s citizens who need these services. The document delineates 51 strategies to implement change in six areas: service shortages, workforce expansion, needed insurance coverage changes, needed changes in the department’s structure and responsibility, improved communication, data collection and research.

It also identified five areas that require further study: transportation, judicial matters, definition of core services, tribal partnerships, and advocate training.

One of the themes/recommendations is to “privatize” some of the services now provided by the Department of Human Services to private agencies. Some other states have done this to a greater or lesser extent and it is certainly worth looking into.

In my experience, it is generally much easier to hold a private agency accountable for outcomes, etc. compared to a governmental unit. A cautionary note, however, it has been a clear trend over the last four or five decades for private agencies to become more and more dependent on government funding. Before government became so huge and central to the provision of human services, we were more reliant on churches, United Ways, etc. While this wasn’t perfect, it surely kept a closer relationship between who was paying the bill and who was benefiting from the services. While there may be nothing fundamentally wrong with an ever-expanding role of government, it clearly changes the sense of who “owns” both the private agency and the services it delivers. All these things may be subtle, but ultimately quite influential.

An aside: The Village’s reliance on government to support our programs amounts to 27 or 28 percent of our annual budget. We are very proud to partner with both county and state governments to support programs that are immensely successful in working with high-risk kids. The rest of our budget is reliant on a multitude of diversified income sources ranging from insurance companies: United Ways: and corporate, family and individual donors, etc. Our business plan reflects the fact that we are truly owned by the individuals and communities we serve. We continue to believe this is an appropriate role that is consistent with our history and important to our continued success.

I realize that to a lot of people, subjects such as this are as exciting as watching paint dry. If you’re in that group, you quit reading some time ago. Those of you who have a reason to continue will understand the gravity of what is being discussed in terms of our future ability to provide adequate services to our citizens.

While the report indicates our state’s mental health system needs attention, there is some very good news embedded in this process. In this region, we are blessed to have so many folks with a strong work ethic and a passion for what they do. This surely includes the folks who work at the Department of Human Services.

And I think due to the excellent work of both the Legislature and the stakeholder’s committee, the professionalism and thoroughness of our consultant, and a growing awareness that some change is truly necessary, now may well be the time to take steps to improve North Dakota’s behavioral health systems. I’ll keep you posted.

P.S. George and Arline Schubert, dear friends of The Village for a number of years, have compiled an engaging account of North Dakota history in their book,
“A Child From the North Dakota Prairie.” It gives the reader a personal glimpse of one family’s survival through difficult circumstances as it relays the tumultuous life of Beulah Margaret Kensler (1916-1983).

If you are interested in purchasing a copy of the book, email: georgeschubert54981@yahoo.com.

The opinions expressed in this column are strictly those of The Village Family Service Center CEO. They do not necessarily reflect the views of the organization, staff, or boards of directors.

Filed Under: Opinion

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