PIERRE — People looking for mental health care in South Dakota have limited options.
If they’re in a mental health crisis, only half of the state’s residents have access to 211. If they’re involuntarily committed to determine whether they’re a danger to themselves, they often end up in a jail cell, and if they need a mental health assessment, they may need to travel 200 miles to the nearest professional.Show Full Article
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After two years of studies on mental health services spanning across five task forces, state lawmakers found the state’s current options are disjointed. They’re also usually the most expensive services available, according to Sen. Deb Soholt, R-Sioux Falls, who has been spearheading the work.
That’s why lawmakers are looking at a legislative package of eight bills and two resolutions aimed at providing mental health care in a more seamless fashion.
“It’s one thing to talk about it, it’s another thing to look at: What can we meaningful do to change it?” Soholt said.
So far, the changes are moving forward. The proposals in the legislative package have been sailing through the Legislature with mostly unanimous support to expand the 211 help line statewide, allow people to stay closer to home during the involuntary commitment process and boost the ability for virtual mental health services in the state. A couple of the bills have already been signed by Gov. Kristi Noem.
Lawmakers acknowledge the work being done this year means mental health may not be a primary focus in future sessions, but they also know the problems won’t be entirely solved.
This is just the “tip of the iceberg” of mental health needs in the state, said House Minority Leader Jamie Smith, D-Sioux Falls.
Here’s a look at what this year’s bills are aiming to accomplish.
access to 211
Residents in only half of South Dakota counties can call 211 if they need mental health help.
More than 2,300 calls about suicide were made to the service in South Dakota last year. Lawmakers want to expand 211 to the remaining 32 South Dakota counties, and they have been considering Senate Bill 2 to provide $375,000 to pay for it.
Expanding the 211 system statewide is a moment when legislators can put their words into action about mental health, Soholt told her fellow senators before they passed the bill on Feb. 24.
“When we are No. 6 per capita in suicide in the nation, we’ve got to start putting together some infrastructure that makes sense,” Soholt said.
When South Dakotans call 211, a person answers in a call center in Sioux Falls. They are trained in deescalating people who are considering harming themselves, and three-quarters of the people are stabilized by the end of the call, according to Soholt.
Calling 211 also gives people another option to 911 when they’re in a mental health crisis, said Senate Majority Leader Kris Langer, R-Dell Rapids.
“People know what happens with 911, especially in rural South Dakota,” Langer said. “We have law enforcement that shows up and lots of flashing lights, and all of sudden, all of your neighbors are concerned about what’s going on, which is good, but can be bad in certain situations. People are hesitant to use that.”
The goal of the 211 expansion is to keep people as close to home for mental health services as possible. That’s where the expansion connects to other bills in the legislative package that provide places that are closer to home when they are in a mental health crisis, Soholt said.
“This is about developing a new fabric of infrastructure that will help to support mental health access,” Soholt said.
Between last year and this year, the state will have spent about $850,000 on expanding the 211 system statewide. That spending isn’t popular, Soholt said, but the state needs to fund programs that make sense if officials are serious about “changing the mental health trajectory” in the state.
“We can’t just have this patchwork of things that don’t fit together and nobody can find it,” she said. “Everybody’s stumbling around and end up in the wrong place, which is the most expensive.”
people close to home, not in a jail cell
If a person in a mental health crisis is going through the involuntary commitment process to determine whether they are a danger to themselves, they need to be held in somewhere that isn’t home or a jail cell, Soholt said.
But right now, there’s only three regional facilities where a person can be housed during the involuntary commitment hearing process. All three, in Sioux Falls, Aberdeen and Rapid City, are in-patient psychiatric hospitals.
State officials want to keep the person in their area because they’re trying to not disrupt the person’s support system, Soholt said.
Senate Bill 4 opens the state’s criteria for a facility that’s not in-patient to be designated a regional facility where someone can be held during the process.
“The passage of Senate Bill 4 will keep them closer to home, closest to their service providers, closer to their natural supports, saving our very limited in-patient psychiatric beds to be used by those needing the highest level of care,” she said.
It’s companion, Senate Bill 5, gives immunity to the mental health professionals at those regional facilities. The bill recognizes that managing involuntary commitments at an out-patient facility comes with a risk and there needs to be immunity for civil liability, said Sen. Maggie Sutton, R-Sioux Falls.
virtual mental health services
Soholt laid out a scenario: A sheriff with an iPad wants to bring a mental health team virtually into a home to assess someone in a mental health crisis instead of putting the person in their vehicle to bring them to either jail or a hospital, which are currently the only two options.
“This is like an ambulance, a mental health ambulance, coming virtually into the home,” Soholt said.
House Bill 1005 lays the groundwork for that to happen. In Sioux Falls, a crisis team is available for in-person visits to a home and in those situations, 90% of people are deescalated to the point where they can remain in their homes and avoid being hospitalized or jailed, she said.
It’s companion, Senate Bill 1, allows those going through an involuntary commitment hearing to have a virtual assessment instead of law enforcement driving the person 200 miles to mental health professional.
“It’s a way to provide the most qualified person in every corner of our state,” Soholt said.
Legislators also studied access to broadband in South Dakota and it’s estimated that by 2023, broadband should be widespread enough in the state so that a majority of residents can have access to virtual care, according to Soholt.
Additionally, lawmakers are tweaking the involuntary commitment process. House Bills 1009, 1010 and 1011 ensures notices are provided to the appropriate parties in a county when there’s a failure to comply with an outpatient treatment order and clarifies language about mental health profession evaluating people to determine whether they are a danger to themselves.
Soholt told the Sioux Falls Argus Leader that she’s “excited” about the point legislators are at in the two-year process, and legislators are proposing a third year of study on mental health services in South Dakota.
This time the task force will focus on creating a regional approach to mental health services to provide more local access, which will free up access to the Human Services Center in Yankton by decreasing transfers to that facility.
Legislators want to focus on providing more access and better outcomes by allowing actions, such as communications and health care reimbursements, to take place that aren’t currently happening, said Rep. Michael Diedrich, R-Rapid City.
“We’ve found there’s a huge bottleneck at the HSC in Yankton. We’ve found that there are potential collaborations and resources available in communities,” Diedrich said.
Legislators are also directing the state Department of Social Services to consider implementing peer support services, which is a mental health model of care involving people who have experienced mental illness and substance abuse help those recovering from it.
health focus remains
Legislative leaders say that mental health may not be the main focus of future legislatures, but it will continue to be in lawmakers’ awareness.
Senate Assistant Minority Leader Jim Bolin, R-Canton, said it will especially be a focus during stressful times for the agriculture community.
House Majority Leader Lee Qualm, R-Platte, noted that there’s more work to do, including getting telehealth into the rural schools because they can’t expect to have school counselors on staff.
“Mental health is such a huge issue. It’s certainly not going to go away any time soon,” he said.
Soholt said she has already watched barriers about mental health services start to break down between the judicial system, educational system and the health care system. She said she dreams about residents having virtual access on their phone when they’re in trouble, and that’s possible in South Dakota.
“My vision is that the stigma of mental health has dissolved and that people, when they’re starting to experience something, seek care, seek help, seek support and that it is available in a way that is seamless and easy to understand and easy to follow,” she said. “We don’t have that right now.”
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