FARGO — As North Dakota continues to fill gaps in mental health services that many agree have reached crisis levels, there’s wide agreement concerning one of the groups most in need of care: children.

A leading mental health advocate complained that behavioral health care for children hasn’t yet been made a priority as officials have been striving to close service gaps.

Carlotta McCleary, executive director of Mental Health America in North Dakota and a spokeswoman for the North Dakota Mental Health Advocacy Network, recently told a legislative committee that “enormous” gaps in services for children remain unmet.

Despite years of effort, it’s not clear whether the number of children with mental health conditions who are being served by the state has increased significantly, McCleary told members of the Acute Psychiatric Treatment Committee.

The committee is studying whether to build a new State Hospital, possibly with additional treatment beds at other locations in the state, and will report its findings for consideration in the 2023 legislative session.

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One of the most serious gaps in mental health services is the lack of residential treatment beds for children who are in need of crisis response, McCleary told legislators.

It’s difficult to know whether the state has been able to serve more children over time, she said.

“We’re not really clear on what the numbers are of children being served,” McCleary said in an interview with The Forum.

National figures estimating prevalence suggest 18,000 children in North Dakota can be expected to suffer from serious mental disorders. But McCleary’s reading of state data places the number of children receiving mental health services from the state between 400 and 800.

One problem has been a lack of support for treatment partnership programs that started in the 1990s but since have dwindled, she said. “We certainly lost some momentum,” she said. “We really had great outcomes with that program,” which helped children receive a holistic range of services.

More recently, McCleary said, a program to use Medicaid funding to provide home and community-based services for people with disabilities, including those with substance use disorders as well as adults and children with mental health conditions, has fallen far short of hopes.

North Dakota officials estimated 11,500 residents could benefit from the program, but so far only 24 have been served since the program began earlier this year. The problem: eligibility criteria so strict that most fail to qualify for assistance.

“You’re disqualifying a lot of people that we hope to serve,” said McCleary, who called the program one of the state’s most significant steps in closing mental health service gaps when it launched in January.

The state is aware of the eligibility problem and is trying to get federal permission to make it easier to qualify. If permission is granted, many more should receive help, said Pamela Sagness, director of behavioral health services for the North Dakota Department of Human Services.

The Medicaid support for home and community-based services will help to expand the behavioral health workforce, one of the main barriers to providing services, especially in rural areas, Sagness said.

“Without funding, it’s hard to get workforce,” she said.

As with adults, children require a full range of services. At the most acute end of the scale, they require hospitalization for brief periods, but also need residential and community-based services, McCleary said.

“If you could stabilize children in the community … you could lessen the need for out-of-home placement and hospitalization,” she said. Also, she added, by treating mental illness in children, the state can avoid the illness progressing and becoming more acute in adulthood.

A building on the grounds of the North Dakota State Hospital in Jamestown. Forum file photo
A building on the grounds of the North Dakota State Hospital in Jamestown. Forum file photo

The superintendent of the State Hospital has recommended a modern replacement hospital with 75 to 85 beds. The Mental Health Advocacy Network supports that recommendation, McCleary said, along with eight to 10 treatment beds in western North Dakota, which has the state’s most dire lack of services.

Jenn Faul, a licensed clinical social worker who manages a grant program to increase access to pediatric behavioral health care in North Dakota, said the state is in the midst of “retooling” many of its programs, including those offered in partnership with schools.

“The state has been doing some of those prevention and early intervention programs,” she said, but agrees that wide gaps remain.

Because all but North Dakota’s five most urban counties have shortages of health care professionals, one effort to better serve the behavioral health needs of children involves training pediatricians and other primary care providers in screening so children can be referred for help, said Faul, who works at Sanford Health in Fargo.

Once problems are identified, children can be taught coping skills that will help to keep their conditions from worsening. “We can absolutely change the trajectory” through early intervention, she said.

Mental health screening now is being done in more schools around the state, but there is a need for standardized screening, Faul said.

Telehealth services, which are not new but got a big boost in acceptance from the pandemic, can be a “game changer” in serving rural communities, she said.

Psychiatrists and counselors don’t have to be based in North Dakota, Faul said, but can be helpful as long as they understand the culture and resources available in the state.

Collaborations and partnerships in many forms will be the key to closing service gaps, she said. “It’s absolutely going to take a village to raise these kids,” she said.

The legislative committee hired the Schulte Consulting to study the state’s acute psychiatric care needs. The concerns McCleary has raised about gaps in children’s behavioral health services are widely shared, Sagness said.

“There’s clear awareness that children’s mental health needs to be addressed,” she said. The state is continuing to build a delivery system and fill gaps in services. “There’s a lot of work being done,” Sagness said.