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Published February 09, 2013, 11:00 PM

Task force looking to shore up gaps in area mental health care

FARGO – West Fargo police had repeated encounters with a man whose mental illness caused him to cycle in and out of custody and treatment.

By: Patrick Springer, INFORUM

FARGO – West Fargo police had repeated encounters with a man whose mental illness caused him to cycle in and out of custody and treatment.

Over a recent 18-month period, officers dealt with him 24 times. The longest gaps were periods when he was hospitalized or in treatment.

Because of his poorly regulated mental condition, his physical health deteriorated over time and now the man, who is in his 40s, is in a nursing home.

Although an extreme case, there probably are several thousand people in Cass County with mental illness or chemical dependency who repeatedly must be dealt with by police officers, jailers and emergency room staff, according to a senior police official in West Fargo who serves on a task force dealing with the problem.

Police often become involved when family or friends don’t know where else to turn, said Mike Reitan, assistant chief of police in West Fargo.

“As a last resort, they call the police department because they don’t know who else to call,” he said, adding that officers know some of these people on a first-name basis through frequent contact.

“More often than not, that person is released in a short period of time,” and the pattern repeats itself when the condition goes untreated, Reitan said. “Then it becomes cyclic.”

The Cass County Justice and Mental Health Collaboration is an effort to do a better job of coordinating interventions for people with mental illness and chemical dependency who are frequently encountered by law enforcement officers, paramedics and emergency rooms.

As a result, more police officers, paramedics and others who deal with these cases have received certification and training in crisis intervention techniques.

Also, all inmates at the Cass County Jail now are screened for mental illness, and many of those flagged with possible problems are evaluated by a clinical social worker on staff.

More than 3,000 inmates were flagged for follow-up last year, and more than 2,000 were evaluated, jail figures show.

“We get a lot of the mental health people in custody here,” said Lynette Tastad, the jail’s clinical mental health coordinator.

Despite collaborative efforts, many agree that a remaining gap is the lack of an evaluation and observation center available around the clock for crisis interventions involving mental illness or addictions.

As a result, some people end up being held beyond the 24-hour maximum allowed by law for mental health evaluations, a period some officials say should be extended.

Also, hospital emergency rooms end up having to deal with mental health or addiction crises when other alternatives aren’t available.

At Sanford Medical Center, for instance, the emergency rooms handle seven to nine patients daily with behavioral health concerns, said Jane Taber, emergency department director.

Besides crisis cases, indigent patients without health insurance often end up at the emergency room for more basic mental health services.

“They are frequent fliers, and they hit our emergency room a lot,” said Andrew Larson, Sanford’s director of mental health.

“The emergency room is probably not the best place to present for basic mental health needs,” he added.

North Dakota’s mental health services would be reviewed in an interim legislative study backed by Sen. Judy Lee, R-West Fargo, and Sen. Tim Mathern, D-Fargo.

“There’s just a lot of recycling of some of those people,” Lee said, referring to people with mental illness or chemical dependency who repeatedly come into contact with police officers, paramedics and emergency rooms.

Schools also report a significant increase in children with behavioral health needs, Lee said.

“From lots of different places this need is evident,” she said. “How do we address this? How do we make sure there’s availability, access and affordability of services?”

Mental health advocates applaud the proposed study.

“It’s long overdue,” said Susan Helgeland, executive director of Mental Health America in North Dakota. “We need to look at the whole system. We’re deeply concerned about the people who are falling through the cracks.”

Maggie Anderson, interim executive director of the North Dakota Department of Human Services, welcomes the legislative review.

“This is an important study,” she said in a prepared statement. “It will help identify behavioral health needs in the state – in both the public and private treatment systems.”

Gov. Jack Dalrymple has recognized those needs in his 2013-15 budget recommendations, which include enhancements to behavioral health services to meet growing capacity, Anderson said.

The governor’s recommendations included

$2 million in additional funding for regional human service centers, including a 16-unit transitional living facility in Fargo, and six additional staff positions at Southeast Human Service Center to manage developmental disability and mental illness.

The executive budget also proposes an eight-bed transitional living facility in Devils Lake, and a 10-bed long-term mental illness facility and four-bed mental illness and chemical dependency crisis residential treatment center, both in Bismarck.

Mental health services throughout the state are strained, Helgeland said, with population growth in the west from the oil boom and spillover effects in the east.

Inpatient psychiatric services no longer are available in Dickinson and Williston, and those patients must be treated elsewhere, Helgeland said.

“The impact has been huge,” she said.

Mathern said jails are being used to warehouse people who are mentally ill and are not receiving treatment.

“This is an issue of too many people in the corrections system who should be receiving behavioral health services,” he said.

Because of the lack of adequate community-based services, Mathern added, some patients sometimes are shuttled back and forth to the State Hospital in Jamestown.

“This shouldn’t be happening,” he said. “There just aren’t enough services,” adding that psychiatric services are especially scarce in western North Dakota.

Readers can reach Forum reporter Patrick Springer at (701) 241-5522