Mental Health Advocates Talk About the System That Has Not Yet Been Built

 

Four mental health advocates discussed together the state of mental health in Minnesota — past, present, and future. The following article is edited from an hour-long conversation between (pictured above left to right): Comfort Dondo (executive director, Phumulani Minnesota African Women Against Violence), Pahoua Yang (vice president of community mental health and wellness, Wilder Foundation), Shannah Mulvihill (executive director and CEO, Mental Health Minnesota), and Sue Abderholden (executive director, NAMI Minnesota).

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Minnesota Women’s Press: Let’s explore the state of mental health in Minnesota up to 20 years ago. What did it look like?

Sue Abderholden: We didn’t have a mental health system; we still don’t. It’s not broken — it was never built. Most [mental health] institutions closed by 1980. The biggest shift we saw was that you used to have to go to the county to get services, and when they ran out of money, you were put on a waiting list. Around 2006 and 2007, a lot of services moved to Medicaid and Minnesota Care, so [mental health care] became viewed as part of the health care system.

Comfort Dondo: I’ve been in Minnesota for 22 years. There was a shift from an institutional type of mental health service provision to more community-based. There are attempts to build it, though there’s a lot of work that has to be done. In my community — African immigrants — there’s a huge stigma around mental health, even just seeking services.

Shannah Mulvihill: There’s increased recognition that there are different ways to address mental health needs across the spectrum, [like] beefing up work in crisis response so that we can help folks avoid inpatient, and building out additional services after discharge from inpatient care. There is growing interest in more upstream approaches to help people avoid crises in the first place.

Pahoua Yang: When I moved back to Minnesota in the early 2000s, we were talking about the workforce shortage and issues with licensure. It has been disappointing that we’re having the same conversation that we had 20-plus years ago.

SA: When I came to NAMI in 2001, no one was really talking about children’s mental health. It was part of the child welfare system and child protection. There’s more focus on children’s mental health now than 20 years ago.

SM: We’re thinking about it very strategically. The rising needs have prompted us to look more broadly across the system and think through who’s not getting the services. There are a variety of populations largely missing from our mental health services, like BIPOC or rural communities, who have almost no access to treatment or services.

PY: Over the last 20 years, there has been a better understanding that just because a certain population is not showing up in the system, that doesn’t mean people don’t have needs. It means we are probably not reaching them, or we have built something that doesn’t make sense for them. From a provider lens, the Affordable Care Act has done an incredible amount for people who were underserved, or who were afraid of the stigma of having a mental health label.

CD: In the 2010s, there was an opioid addiction crisis, and there was a lack of connection with the intersectionality [of addiction] and mental health. There’s been a lot more awareness. I continue to see measures to treat co-occurring disorders, and not criminalizing one or the other. The telehealth expansion during Covid-19 is also a step in the right direction. After the pandemic, a lot of people started talking a lot more about mental health.

MWP: You’ve all touched on improvements in the mental health space. Are there any others that you want to highlight?

SA: We are at the beginning stages for services and treatment to be more culturally informed and responsive. We haven’t gotten as far as we should go, but it’s a start.

CD: We’ve seen an improvement in increased funding for school-based mental health programs, although I think there’s still more work to be done.

PY: I have appreciated the growing understanding that representation reflecting our changing communities matters, not just in our providers, but in our leaders who are running, organizing, and changing systems. The investments that our state legislators have made in workforce development in rural communities and in diversifying the workforce have been critical.

MWP: Let’s talk about your wish lists for the future of mental health. What changes would you like to see?

CD: I would love to see [acknowledgment that] what causes disease is mostly isolation. We hosted over 15 healing circles in our community with the support of NAMI, and a lot of what I kept hearing was people describing ailments like depression, but also a lot of loneliness and feeling disconnected from communities and one another. So for me, I envision leadership that understands that connection.

SM: For me, it’s continuing to utilize peer support, and ensuring that we have a solid training and certification process for peers to support families with children who have mental health conditions, as well as youth peers to support other youth. It can also help us address the workforce shortage and lift the burden on the rest of the workforce.

Another piece is the flow of folks going through emergency departments and ending up stuck there. That is especially the case for children. The emergency department can often escalate what’s happening instead of de-escalating it.

Also, building out care on both sides: what else can we do to help folks avoid use of emergency care and inpatient care? Another big topic continues to be the tragic intersection between mental illness and the criminal justice system. The number of people who end up in jails or prisons rather than getting the care that they need is an atrocity, so continuing to look at diversion programs and mental health courts. How do we make sure that [incarcerated people] are getting care, getting screened, and getting their medications?

SA: My favorite thing these days is voluntary engagement, when the county sends out a peer specialist who works to engage people in treatment voluntarily for 90 days. Also, working with the families to help their loved ones. We’d be intervening earlier, so people don’t end up having interactions with the police.

PY: I want to encourage all of us to dream big. We have a legislature that has given us bipartisan support. We have a network of providers, advocates, and our Department of Human Services working together. We’re sitting in different seats, and we are bringing different lenses, which means it complicates the conversation. But that also means we get a better result. I want to continue to see additional investments so that we can build out the system that Minnesotans deserve. 

 

I have worked in service to children over the last 20 years. It is obvious to me now: everything impacts a child’s mental development. Attachment and emotional regulation are all as vital to development as it is to understand when a baby starts to recognize faces and colors. This is a unique time in Minnesota to really think about how we transform treatment of our children’s mental health. This includes recognizing diagnosed disorders that children are experiencing as well as adding to the medical model that guides how we treat mental illness. Emotional well-being requires a public health approach.

— Twanna Anderson, Minnesota Association for Children’s Mental Health

 

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