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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INDIANAPOLIS - More women and young people have faced behavioral-health challenges since before the pandemic, according to a new report. Nationwide, teen suicides have jumped 26% since 2014, according to the study from United Health Foundation, and anxiety among children also has been on the rise.

Dr. Jen Money-Brady, a Indiana School Counselors Association board member, said many counties in the Hoosier State don't have enough mental-health services for adults or children. In schools, she added, counselors do their best but often have so many students they need to make referrals, and wait times can range from six to 18 months.

"That's just really, really difficult," she said, "when you're thinking about a student who really needs help and can get help from their school counselor in little bits, but can't get really long-term support that they need."

The study compiled more than 100 measures of health, from physical to emotional, social and behavioral health determinants. It found only about one in five kids gets the recommended minimum physical activity of at least 60 minutes a day.

The report also noted that fewer children are getting developmental screenings and child well-visits. Indiana ranks 45th among states for developmental screenings and 33rd for wellness visits.

Dr. Ravi Johar, chief medical officer at UnitedHealthcare, said a nationwide shortage of doctors is contributing to the dip in the number of kids in waiting rooms.

"We know there's decreased access to pediatricians and to women's health-care professionals," he said, "so maybe telehealth will be able to help with some of those things."

Access to health insurance also can be a barrier to care; more than 7% of Indiana children are uninsured, and nearly 12% of women.

CARSON CITY, Nev. -- Nevada scored a D-plus for children's mental health, according to a new report from the Children's Advocacy Alliance.

Researchers evaluated the Silver State on a series of mental-health indicators including depression, substance abuse, developmental disorders, suicide and access to care.

Dr. Tara Raines, Kids Count Initiative director at the Children's Advocacy Alliance in Nevada, said the biggest problem is access: The state faces a huge shortage of pediatric mental-health providers, especially within the juvenile-justice system.

"We need more psychologists," Raines argued. "We need more treatment centers for kids with severe mental-health disorders. We need more psychiatric social workers. We need more child psychiatrists."

The report gave Nevada an F-plus grade for percentage of children receiving mental and behavioral care, noting in several counties, families have almost nowhere to turn when a child develops mental illness.

A 2020 report from Mental Health America ranked Nevada worst in the nation for prevalence of mental illness and low access to care. It found 71% of youths in Nevada who experienced major depressive episodes never got treatment.

The bottom line, she said: Nevada needs to aggressively recruit more providers, as soon as possible. Raines would like the state to fund more slots in nationally accredited child mental-health training programs, especially in southern Nevada.

"We know that people tend to stay where they get licensed," Raines observed. "If we can recruit trainees to come here for internships or for post-doctoral fellowships, the likelihood of them staying on afterwards to become licensed in the state of Nevada is incredibly high."

The report authors also call on the state to require mental health screenings for all kids, and reexamine school discipline to focus more on prevention.

CLIVE, Iowa - This week, more attention is being paid to the struggles of people living with mental-health conditions. In Iowa, parents are telling their stories in hopes of inspiring other families to speak out.

Between now and Saturday, groups around the country are observing Mental Illness Awareness Week. Mary Neubauer of Clive has become an advocate in recent years, after her son took his own life in 2017.

More than a decade ago, he was diagnosed with Post Traumatic Stress Disorder, depression and major anxiety. She said the family made a sincere effort to be open about what happened.

"In hindsight," said Neubauer, "it was our way of saying, 'Do you see this? Do you see the impact that mental illness had on this beautiful boy's life?'"

She said leading up to his death, it was hard to find enough resources in Iowa to treat her son's conditions, so that's been another focus of the family's advocacy.

And while the state has taken steps to build resources, including creating a children's behavioral-health system, Neubauer said she worries that access issues remain, especially in rural areas.

For the general public, Neubauer added there are still opportunities to overcome any lingering stigma about mental health issues.

"We all need our mental health and our physical health to truly be well," said Neubauer.

The awareness week comes on the heels of an annual fundraising event for the Iowa chapter of the National Alliance on Mental Illness. This year's "NAMI-Walks Your Way Iowa" saw roughly 500 people in attendance, with more than $140,000 dollars raised.

Organizers say a key element is getting more stories out into the public, so other families struggling with a diagnosis don't feel isolated.