Youth in Crisis: Dickinson grapples with lack of behavioral health services
Dickinson PressFeb 16, 2019
When a patient's needs are greater than those that could be treated with weekly visits to a facility, they may need to receive inpatient and residential services. These facilities treat patients with significant mental health issues or significant drug use.
Inpatient services are services in which the patient stays in a facility 24/7 to receive care in a hospital setting -- a psychiatric residential treatment facility. It is typically short term.
The next step down from that is the therapeutic residential treatment facility. The care is less intensive, but is longer-term and takes place in a more relaxed environment.
Badlands
Youth in crisis
There are no crisis beds in the area for youth.
The North Dakota Behavioral Health System Study stated that: "Stakeholders noted that crisis services for children and youth are particularly lacking, and over a quarter of those who visited an emergency room for a behavioral health issue during the study period were under age 18."
The counselors at
They said the district has psychologists, but they are tasked with other things.
"They're looking at evaluating to see if kids have learning disabilities, those types of things, and they're helping with educational plans for those kinds of students, so their time is really just taken doing that kind of evaluation," said school counselor
So instead, they send the students to CHI's emergency room.
"That's a severe situation where they're maybe talking seriously about suicide," said
There they would be assessed and if determined that they are in fact in a crisis, arrangements are typically made for them to go to a residential treatment facility.
Youth not in school can also go to Badlands for assessment.
Private options
There are some private residential treatment facilities available to youth in the area, such as Home on the Range, but
"There's been problems with screening, which means related to certain behaviors, they may not be able to get into that facility," he said.
She said the more complicated a child's or adolescent's behavioral health issues, the harder it is to get them services.
The North Dakota Behavioral Health System Study released by the
"If we don't have the proper services in place through our human service center, some of those people won't get the service they need 'cause they simply can't afford it, and that's a hard reality," she said.
Hjellming said the costs can be "astronomical and not feasible for most people."
"Insurance will only cover the treatment part of it," she said. "There's still a responsibility for room and board. ... That's where the cost becomes prohibitive. That could be
Since there are only a couple of private options for adolescents needing inpatient treatment, many adolescents are sent to the eastern part of the state to
The counselors at
Problems with out-of-town care
Sending youth out of town for treatment presents its own challenges.
"Some parents don't have the ability to drive their child to
Hjellming said that having these services close to home instead of hours or even states away is better for their treatment, especially those leaving for drug rehabilitation.
"So you get all better, you're not using drugs because you're not hanging out with the same people that you hang out with, and you're not near the dealers that you know," she said. "You're in a place where you focus on treatment. What do you think is going to happen when you just say OK you're done; you're successful; you've finished; you can go home now? And you haven't done any of that stuff to mitigate the triggers in their own communities. They're just going to start using, immediately."
Roemmick said she also thinks it is helpful for an adolescent's treatment to be closer to home.
"Family visits, family therapy, I think that's definitely better if the parent can be involved in that," she said. "That's often a component of their treatment."
The distance from their families can sometimes be hard on youth seeking treatment.
She said her son has reactive attachment disorder, but he was not tested here for it, as he missed the appointment.
"(
Trouble with access
It can also sometimes be a struggle to get adolescents admitted to those far away facilities.
"Two years ago, we deflected over 400 patients regionwide that we were unable to treat," he said. "We changed that to (where) last year, we weren't able to treat around 45 patients that we couldn't admit because of capacity."
He said it is still an ongoing issue whenever the population increases.
When those places are full, it puts the youth and local mental health workers in inappropriate situations, Brown said.
"Some of these counties, smaller counties, if there isn't a place for ... youth to go right away, a lot of times they end up having to spend time with them, watch them, either right at the county facility or hotel or whatever," he said. "Again, time consuming, cost consuming. It's just not therapeutically appropriate."
Solutions
Organizations are taking steps to alleviate the problem and provide much needed services.
They're looking to CHI and Badlands for help.
"I know (
Prairie
"It takes a lot of community resources to bring patients from the region to
He said the biggest obstacle to opening the facility is reimbursement by Medicaid. For an institute of mental disease (IMD) to receive funding from Medicaid, it must have 16 or fewer beds. Herman said he thinks the community needs more than that.
"We could open up a program now up to 16 and get our Medicaid reimbursement, but my belief is that between the child and adolescent and adult beds, 16 isn't enough, and then we'd be looking at just a population where it's just kids or just adults, to stay under that 16," he said. "That's only meeting part of the need in the community."
The federal government does offer an IMD exclusion that would allow them to get that funding, but the state must apply for it.
"We're trying to work with this year's legislature around filing a waiver to exclude us from that IMD so we can get reimbursement, 'cause to start a new program and not get paid for it is very difficult," he said.
Hjellming said she thinks the state spends so much time focusing on getting adults treatment that juveniles are often on the back burner.
"You should be putting your money into the kids," she said. "Those are the people that you're most likely able to mold because of development and those are opportunities so that they don't get so far into usage that we're just treating them from adolescence until their elder years because of addiction. I would like to see a kind of rearrange of how we fund those services with front loading kids and secondary adults."
___
(c)2019 the Dickinson Press (Dickinson, N.D.)
Visit the Dickinson Press (Dickinson, N.D.) at www.thedickinsonpress.com
Distributed by Tribune Content Agency, LLC.