Clay County Public Health

Report date
August 2016

What has been most instrumental to your progress?

Routineness. ReThink Mental Health (RMH) has five active workgroups; crisis, recovery, treatment, prevention, and promotion. The first four existed before the Bush funding began. There had been two community sharing events and two organizing summits the years prior to funding to identify needs and build momentum. Many stakeholder attended. Much work was done to begin to generate ideas for solutions. RMH, however, was dependent on a leadership team who wore many hats in the community to coordinate this is initiative. Because RMH did not have the full time leader that could dedicate a significant amount of his/her time to coordinating the initiative, its groups and its activities progress was limited. As a result of hiring a full-time manager coordination has improved. Workgroups have established more routine meeting schedules. This keeps RMH issues more "top of mind" preventing tasks from falling "off of mind." With regular meetings it was possible to re-engage many who had become stagnant and to identify those who wanted to take an active role in the "action" of change.
Goal setting. Each work group intentionally sought out actionable ideas from its long list of needs. The treatment group, for example, of its many identified needs established a goal to identify a common suicide language and community suicide screening tool. It has now been hosting meetings with key stakeholders to present the Columbia- Suicide Severity Rating Scale and to answer questions as it encourages them to adopt the tool. The prevention workgroup has piggybacked on the State of North Dakota's new legislation requiring all K-12 school staff to complete 8 hours of continuing education on mental health every two years. RMH quickly got behind a powerful training, "Trauma Sensitive Schools" that was approved to fulfill the continuing education need. It established a goal to expand the knowledge of trauma beyond schools to childcare, juvenile justice, after school programs, child protection, primary care physicians, etc. and to seek ways to institutionalize such trainings for these sectors. The training has been adapted for these other sectors. Active members of the workgroup have become approved trainers. The keynote presentation at the annual summit was on trauma.
Relationship building. By having a full-time leader and by re-engaging stakeholders via routine meetings we have strengthened existing relationships and been a conduit in establishing others. RMH has helped establish a semiannual event for behavioral health-related collaboratives to share what they do. We discovered there are 10+ related, but different, behavioral health initiatives. Many don't know what each other is doing. The Recovery workgroup is beginning a quarterly Recovery Roundup for the recovery community to share what each other are doing. There are many aspect to long term recovery, sober housing, knowledge of self care, understanding financial management, meaningful employment, etc. These topics and many more will be addressed in the Roundups helping those providing recovery services to serve their clients better. It has been our experience that the networking that occurs at these intentional events, often results in improved professional connections that expand understanding and mental health in our community.

Key lessons learned

There are so many needs and complex systems to address mental health as well as varied strategies to address it from treatment to prevention that it is easy to become overwhelmed. It is easy to get mired in the negatives; to focus on all of the problems at the expense of developing solutions. In the last year RMH has evolved to generating ideas for solutions and beginning to trial those solutions. The treatment workgroup listened to its participants when they nudged the group to narrow its focus in the short term to specifically address a tangible need. It has done that by working toward a common community suicide screening. The crisis workgroup has narrowed its focus to the sharing of information between agencies at a time of crisis and to improving the ease of access of information about community resources for behavioral health information and referrals. Wee have learned that it is important to "do." Even small changes can serve as the tinder that helps ignite a fire of change.
"Mental health" is perceived by so many to mean "mental illness." The case for a public health-led focus on mental well-being and prevention is strong and growing, yet the default narrative in ours and most communities is that of focusing on mental health treatment, treating those who are ill. With all of its importance, we will not "treat" our way out of our current health care challenges. One does not visit a heart surgeon to ask about an exercise program to prevent heart disease. Changing the narrative to one of mental well-being that can benefit all of us has been challenging. Our defaults are so entrenched in treating those already diagnosed that we don't often give true consideration to what promotion and primary prevention can do to help people and save money. RMH has lots of work to do to continue to shift the narrative to one focusing on and building individual strengths and social supports to aid them when times are difficult; to build compassionate communities that are resilient and support individuals not blame them and shame them.

Reflections on inclusive, collaborative or resourceful problem-solving

Inclusive and collaborative have been most important. The Well-being and Promotion workgroup was established at the beginning of the grant (the other four were already in existence) because there was no representation from early or higher education. Both were perceived to be vital if we hope to change the culture in schools and child care to build individual strengths and a collective culture that will help us remain well when difficult times come. The treatment group has been a true collaboration of many, not limited to health care providers that vie for the same patients, payors that want to ensure they are paying for the best possible care, and first responders. Collectively, each has taken varying roles (e.g. facilitator, educator, implementer, student) to help advance to goal of a community-wide suicide severity screening.

Other key elements of Community Innovation

A collective humility and selflessness have been prominent. It is amazing how much gets done when know one cares who gets credit. The program manager has no formal mental health training but has been warmly welcomed by those that do. RMH stakeholders have repeatedly engaged with each other in a manner that strongly indicates a desire to do what is best for the people of Cass and Clay counties regarding mental health and well-being.

Understanding the problem

As we strive to improve the systems, policies and partnerships to improve mental health and well-being and its care all at a better cost, it has become more clear which needs, if addressed, have the greatest opportunity to make an impact and which ones are most reasonable to pursue. We have listened to our stakeholders and watched their actions and as a result put time and effort into helping establish a community suicide screening. We have found certain sectors to be more ripe for change. For example, North Dakota State University (NDSU) has trained each of its teacher education professors on trauma-informed schools as a result of its work with RMH. NDSU also sends a contingent of five professors to the monthly well-being workgroup meeting. We will continue to work with them while harnessing what we have learned from that experience to apply to the two other local universities. Higher education is highly impactful because it reaches future professionals before they are practicing. RMH has evolved to looking as far upstream as possible to impact systems that affect individual and community mental health and well-being. RMH will continue to look upstream for opportunities.

If you could do it all over again...

I would have spent the first 2-3 month interviewing more stakeholders asking what they thought RMH could and should strive to accomplish. I would have interviewed the mental health and well-being staff at the Minnesota Department of Health (MDH). There are key individuals who really know the mental health world well who would have been able to help identify impactful and realistic solutions earlier. We interviewed some but could have done it more thoroughly. I would have sought out regional experts like MDH immediately. The health promotion part of RMH may have developed sooner and more rapidly with some consultation with MDH.

One last thought

The community innovation grant has allowed our communities to begin to build capacity and make positive change while continually seeking opportunities to sustain. We have discovered partners who are willing to lead. We have had partners share their resources (e.g. staff time, meeting space, and money). Without this grant to support a dedicated project manager it would be very difficult to identify the many opportunities, to fully engage multiple workgroups, and to ensure forward progress in sustainable, systemic change.