Editor’s note: This is a special two-part report. The first part is below, the second part is further down the page.

Chapter 1: What’s The Issue?

There is a mental health crisis across the nation, and that includes children’s mental health.

According to the Centers for Disease Control and Prevention, suicide surpassed homicide as the second leading cause of death for teens ages 15 to 19 in the U.S. in 2017.

The North Dakota Department of Health reports a total of 33 young people under the age of 19 died by suicide between 2019 and 2021.

The state ESSENCE Surveillance System estimates over 1,200 kids ages 5 to 18 attempted suicide in that same time frame.

And according to the Youth Risk Behavior Survey, 36 percent of high school students in the state felt sad or hopeless nearly every day, for almost over two weeks, causing them to stop participating in some of their usual activities during the year before the survey.

So, what measures are being taken in North Dakota to combat this crisis? And could they be doing more?

“Behavioral health must continue to be a top priority. We’ve gotta keep expanding critical behavioral health services. Need to reach those in need sooner, and closer to home,” said Gov. Doug Burgum in the 2022 State of the State address.

Child psychiatrist Dr. Kevin Dahmen is one of many mental health professionals in North Dakota who agrees wholeheartedly with Burgum’s statement, and is desperate to find a solution to better support our kid’s mental health.

“The kids are our future,” Dr. Dahmen said. “Our state’s in a unique spot, we’ve got a lot of extra funds that are available.”

An increase in mental health challenges among kids is a trend that has not gone unnoticed by mental health professionals in North Dakota.

“There seems to be a dramatic increase as far as the need for services,” said Dr. Dahmen. “I mean just the last five, seven years or so it seems like there’s a lot more kids that are requiring inpatient stay.”

But North Dakota is struggling to provide access to therapists, psychiatrists and social workers, and as Dr. Dahmen emphasized, even a lack of facilities to treat our kids.

“There’s been a dramatic decrease as far as the overall placement opportunities that we have with the kids,” said Dr. Dahmen.

The state hospital, which closed its adolescent wing in 2012, is one of the facilities Dr. Dahmen is referencing.

The state hospital was a safe place for youth who posed a danger to themselves or others and required stabilization.

Now kids have to wait in emergency rooms, sometimes for days, until they can be placed in one of three in-patient psychiatric hospitals in the state for youth.

Once a child is stabilized, but continues to require longer, more in-depth treatment, they are often referred to a residential treatment center where they receive psychiatric and psychological services, and individual and family therapy.

There are just three residential treatment centers in the state, and just like every other treatment center in the state, “We’re always full, and we always have a waitlist,” stated Bryan Winterberg, the executive director at Pride Manchester House in Bismarck.

Pride Manchester House is the only residential treatment center in in North Dakota to serve kids under the age of 10.

With only two other residential treatment facilities in the state, Dakota Boys and Girls Ranch in Minot and Prairie St. Johns in Fargo, a child can wait as long as two months to get in.

“Once we have a child leave our facility, they have completed treatment successfully and are ready to go the very same day, we have another one from our list come in,” said Winterberg.

Those three residential facilities provide intensive, in-patient treatment help for youth with serious emotional and behavioral problems.

They also serve kids from across the state, but Winterberg says that placing kids far from home is often not ideal because successful treatment really needs to involve the family.

In the second part of this story, we will talk further about the challenges facing kids who have no place to call home, and what mental health professionals say is needed to better serve all of our kids.

Chapter 2: What Needs To Be Done?

Just imagine being a kid, spending months working to overcome a mental health crisis.
The darkness has lifted, you are thriving, and the future looks bright – or does it?

Earlier, we shared with you the many challenges mental health professionals when trying to help our kids.
Now, we hear more on what they say needs to happen in order to better serve their mental health needs.

Staffing shortages, a lack of facilities, insufficient funds – the barriers to addressing the youth mental health crisis are endless.

Another question often encountered when kids enter treatment facilities for mental health is where they will go upon discharge?

While a number of kids who are admitted to facilities like Manchester House are released to family, not all kids have family, or a place to call home.

In the past, these kids would often transition to a Quality Residential Treatment Facility (QRTP).

Then in 2018, the federal government enacted the Family First Prevention Services Act, with the goal of increasing the number of kids who can remain safely at home with family.

Mandy Ferguson, a registered nurse at Pride Manchester House, explained that in North Dakota, the goal was to place fewer kids in QRTPs and more kids with foster families.

“North Dakota tried it out, and it’s not working very well, because we had to close down a lot of our facilities,” explained Ferguson. “They want to try to keep the kids out of facilities and more in homes, which is challenging because some of our kids just aren’t able to maintain in a home, they have a lot of very high needs.”

Staff at Manchester House yearn for a wrap-around approach when it comes to discharging kids from residential treatment, especially for kids who don’t have a place to call home.

Winterberg says most young people do fairly well in the program, but when there is no foster home for a child to go to upon completion of the program, the outcome can be drastically different.

“That’s when those youth get that sense of hopelessness,” Winterberg shared. “They kind of actually regress. A lot of times we’ll go back to maybe four months ago when we were just starting some of the treatment.”

Ferguson said, “The hardest part is like they’ve worked so hard themselves, and you know, with us, and then just have it all come crashing down because there’s no place for them to go. It’s really sad.”

The typical length of time spent in a residential treatment center is six months, but Ferguson says some kids stay upward of 10 or more months when they have no foster placement.

Eventually, they have to leave, but where do they go?

Winterberg says they don’t always know.

It’s an occurrence Dr. Dahmen has also witnessed countless times.

“I’ve talked with social services all the time,” Dr. Dahmen shared. “They’ve even had the position where the social services had to have the kids stay in the office overnight, with them so that they can– they had no other opportunities, there’s no foster homes, there’s nowhere else to have the child go. So with the social workers, it’s… I feel really sorry for them.”

Dr. Dahmen says it’s crucial that North Dakota increases the number of services and emphasizes the importance of coordinating those services and agencies.

“Extra counselors in school, we need some group homes that are back, we need a state hospital that’s functioning at this point, we need a clear transportation system,” Dr. Dahmen explained. “Again, if we cannot serve a child in this hospital, to make sure that all the needs are met at this point. And then smooth transitions, again, between the different levels of care.”

Those resources all require money, but many don’t see that as an issue in North Dakota.

“The state has excess amount of funding,” Dr. Dahmen stated. “In other states, again, there are a lot more services available, we have a budget surplus. I mean, what do we need to save up or to have a balloon up even more about spending it on the kids, I mean they need the services.”

And finally, family therapy and preventative services.

“It costs a lot less money to do the primary care services than it does to try and pick up the pieces that in the long run,” said Dr. Dahmen. “Having integrated services at all the different levels, smooth transitions between the different levels is the way to go.”

“I think that we have, we have a desire,” Winterberg said. “And we have the ability to do well, I think it’s just coming down to the appropriate resources.”

Staff at Pride Manchester House say their dream would be to build a larger facility with more beds, more employees and a gymnasium, and with that to broaden and offer more services.

KX News will follow up with more on what the state and North Dakota schools are doing, and are hoping to do in the future, to address the crisis.