BISMARCK, N.D. -- North Dakota has long dealt with a shortage of access to mental health care in rural areas. But efforts are ramping up to make sure treatment is available in hard-to-reach places.

The University of North Dakota and Sanford Health are carving out a multi-phase project designed to provide more resources at a time when more people are feeling stress due to the pandemic.

Andrew McLean chairs the psychiatry department at the UND medical school. He said early efforts included a web page with helpful tips, along with phone assessments. He said future phases could involve a more robust way of ensuring that patients can visit with a provider virtually - potentially closing gaps in some areas.

"As you go into the western part of the state, whether it's mental-health providers or whether it's addiction counselors, there's a particular issue of finding providers there," McLean said.

But he warned there are still a lot of unknowns surrounding the next phases, including whether insurance companies would still allow exemptions for virtual visits as they have during the COVID-19 crisis. McLean also suggested more talks are needed on who would take charge in setting up a reliable portal for such services across the region.

McLean said he anticipates the demand for telemedicine for mental-health issues still will be around after the pandemic. But as the planning takes shape, he said they know they will always be up against a key barrier.

"I think we're never going to grow enough behavioral-health providers. So, I think what we'll be seeing is there will be a need for the ongoing virtual care - whether that will come from within the state if we have enough people to do that, or some of the companies from outside," he said.

Even before the partnership, McLean's team placed an emphasis on training resident psychiatrists in providing services for rural areas as another way of addressing service gaps. North Dakota's mental health-care needs became pronounced when the state saw a 57% increase in suicides between 1999 and 2016, which topped the nation.


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Boulder and Broomfield County residents can now access mental health services the same way they can access urgent medical care.

Dr. Nadia Haddad, medical director of mental health services with Mental Health Partners, said all too often, people can't get help unless they are already connected with an outpatient provider, and many have months-long waiting lists. She said if people have to wait for care, their situation can get worse, and what might have been a manageable issue can turn into a crisis.

"They are going to the emergency room or going to a psychiatric hospital. And so what we're trying to do is fill that gap so that people can get connected with services when they need it, on a walk-in basis," she said.

Mental Health Partners, a community mental health center serving Boulder and Broomfield counties for 60 years, recently launched UrgentPsych Mental Health and Substance Use Urgent Care. The walk-in program provides immediate, in-person support for urgent mental health and substance use needs for anyone, regardless of their ability to pay, whether or not they are an existing client, or speak English. For more information about the 24-hour facility in northeast Boulder, call 303-443-8500.

Mental Health Partners' new Intensive Family Services program provides in-home therapy for K through 12 youth with disruptive behaviors who are at risk of being placed in foster care or the juvenile justice system. The urgent care facility is also available to people of all ages.

"That's another really challenging part of seeking out services. Care for children and adolescents is often even more challenging to find. There are fewer child psychiatrists out there," she said.

Both new programs were created in part to get people the services they need to avoid hospitalization. But Haddad said when people do reach a point where they need 24/7 monitoring and daily visits from a medical provider, it is essential that people can access hospital-level care.

"The vast majority of people who are dealing with mental health-related issues do not require hospitalization. If we can change people's trajectories earlier, we can prevent mental suffering, and they may not have to go through the hospital," she explained.


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This is National Library Week, honoring the many roles that libraries play in their communities.

In central Texas, a pilot program is using the public library system to expand mental health services in rural areas.

Residents in four counties can get assistance at their local public library through the Libraries for Health program.

Trained mental health peer specialists evaluate clients and refer them to clinics for additional help if it's needed.

The program is funded through the St. David's Foundation, working to advance health equity in Central Texas.

The foundation's Senior Program Officer Abena Asante said the initiative works in tandem with the mental health community.

"It's in no way taking the place of clinical-directed psychologists," said Asante. "It's just one community response in addressing the lack of mental wellness resources in rural communities."

Asante said libraries are trusted and accessible gathering places for people living in rural areas. The libraries tailor programs to meet specific local needs based on feedback from the residents.

Data collected during the 3.5-year pilot program will be used to evaluate its success. The nonprofit Via Hope trains the peer specialists who work in the libraries.

Dr. Sandra Smith, vice president of Via Hope, said the staffers use their own life experiences to help them relate to the clients.

"They have to have had a mental health challenge at some point in their life," said Smith. "We don't ask them any specifics about that, we don't ask diagnoses - it's a self-disclosure."

The Libraries for Health program operates in eight libraries in Bastrop, Caldwell, Hays and Williamson counties. If successful, it could be implemented in other parts of the state.





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The Centers for Disease Control and Prevention reported one in 36 children around the U.S. has autism spectrum disorder. Rates are much higher than a decade ago and support organizations hope Wisconsin communities do more to make individuals feel welcome, including adults on the spectrum.

April is Autism Acceptance Month. Not only do advocates want to empower those with a diagnosis to live their fullest possible lives but they also ask those around them to learn more about it.

Katie Hess, executive director of the Autism Society of Greater Wisconsin, said there are some key practices to keep in mind.

"Really, what we're looking for is for people just to be open-minded and patient, and understanding," Hess explained.

Acceptance does not happen only at home or school. Workplaces also are encouraged to foster more inclusiveness, with nearly 60% of people with autism now employed after receiving vocational services. Their advocates said they have many strengths and asking them about their needs creates a better environment for them.

Symptoms of autism can vary widely for each person on the spectrum, including how they interact with others. Hess noted whether individuals are considered "high need" or "low need," having the public pay more attention to the evolution of this disorder is vital.

"We're learning new information all the time, so certainly reach out to your local chapter, your Autism Society," Hess urged. "Ask questions."

Her chapter will soon begin offering a training program to organizations about how to become more autism friendly, including being able to identify a person on the autism spectrum and how to best offer ways to help if they disclose their diagnosis.


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