Editor’s note: This is part two of a two-part report from the Hibbing Daily Tribune that looks deeper into the shortage of in-patient beds for Iron Range teens experiencing mental health issues and what happens when they’re sent across state for treatment.

HIBBING — A 16-year-old boy suffers a painful break-up. In the days that follow, his posts on social media take on an increasingly depressed tone. He tells a friend during class that he has nothing to live for and is going to kill himself. His friend reports him to the school counselor, who immediately calls him in and determines he’s at risk for self-harm. The teen is referred to the district psychologist, who performs a depression screening that reveals that he has a plan to kill himself. The teen’s parents are contacted. A school resource officer transports him to the nearby hospital for a professional assessment in the emergency department, where the doctor determines the teen is at high risk for suicide.

For years, the Iron Range families suffered silently as scenarios like this played out among area youth. Hibbing has no in-patient mental health beds for people under 18 years old and few exist in the surrounding area. That means a teen experiencing a mental health crisis could be transported an hour and a half drive 75 miles southeast to Essentia Health-Duluth. More than likely, that facility will be full. The next possible stop? A three-plus hour drive 195 miles south to the University of Minnesota Fairview in Minneapolis. Or, perhaps, a four hour drive 200 miles southwest to Fargo, N.D. It could even be to a three and a half hour drive 193 northwest to Thief River Falls, a town that is about five square miles and a little more than half the population of Hibbing.

It will all depend on the number of beds that are available in a state where mental health services are too few and families are forced to rack up costly travel bills as they traverse long distances in hopes of supporting their struggling loved one.

Youth treatment in Duluth

Inside the blonde brick Miller-Dwan building of Essentia Health in Duluth is an adult in-patient unit with 38 beds and an in-patient adolescent unit with 14 beds. Diane Holliday-Welsh is the operations administrator for behavioral health and emergency medicine at Essentia. She’s been with the company for more than 25 years and told the Hibbing Daily Tribune in an interview last month that the adult unit is almost always full while the adolescent unit, which typically serves ages 5-17 years old, maintains about 95 percent capacity.

“There’s a shortage of inpatient beds throughout the state, and I’m not sure why others don’t offer them,” Holliday-Welsh said. “When you look at geography, we’re one of the few child adolescent in-patient programs. The closest in Wisconsin is close to Eau Claire, and the other is in the Twin Cities. So we really do serve a large geographic area.”

Between July 2018 and June 2019, Essentia Health admitted 3,343 youth patients (compared to 10,000 adults for that same time period). Youth coming in tend to stay for two to three weeks. The treatment team consists of one psychiatrist, nurses, behavioral health technicians, therapists, occupational therapists and a pharmacy team member. Patients spend the majority of their day in therapeutic interventions or activities. In one group program, they learn how to manage stress and environmental factors through Dialectical Behavioral Therapy (DBT).

“They focus on mindfulness-type activities that allow them to not let behavior get in the way of their functioning,” Holliday-Welsh said.

Yet their biggest challenge seems to be the “transition of care,” meaning what happens once a youth is discharged. Holliday-Welsh explained that staff look for resources that will help support the youth and their family once they’re back home — but this depends entirely on what is available in their home community. Understanding the lack of rural services, Essentia is looking into implementing “tele-medicine” in their Virginia clinic. This would give patients access to a psychiatrist through a screen. “We can’t recreate a tele-bed, but at times, if the individual can be safe at home, the more we can build out-patient services,” Holliday-Welsh said. “Then that person doesn’t have to leave their community. ...We’re working very diligently on the expansion of child adolescent psychiatry services to Virginia. For someone at a high level of risk, if they have someone who can be part of their safety plan and we're confident in that, then they can be in outpatient.”

Youth treatment in Thief River Falls

In the northwest corner of the state in a town of around 8,000 people sits Sanford Thief River Falls Behavioral Health Center. The 16 bed in-patient facility serves a mixed population of people ages 13 and up, including Iron Range teens who occasionally get transferred here when closer facilities are full. They, too, are often at capacity, and Senior Director Dr. Kevin Ballard told the HDT in September that in the last five years, more and more young people coming in have cited social media bullying as a trigger for their mental health crisis. That, and “heroine is back,” he said.

Physician Dr. Trent Barstad agreed, noting another trend they’re seeing, “Fifteen years ago, you wouldn’t have seen as many people who self-harm.”

Manager of Nursing Inpatient Heather Bregier told the HDT that in the last five years, they admitted between 75-215 youth annually, with a spike in 2017 that came back down last year. The average length of stay is eight days, and from January to the start of September this year, they admitted at least seven Iron Range teens. They also tend to see “a lot” of adolescents from St. Louis County but also from all over Minnesota.

A teen who is transported to the facility is seen by a psychiatrist and a psychologist, who work together to collect information about mental health history, medication history and what triggered the crisis. They create an individualized plan for treatment and discharge. The teen soon enters structured programming with daily group therapy and other activities to teach relaxation, mindfulness, daily living skills, goal setting and healthy coping skills. This occurs between daily visits with the psychologists and psychiatrists, a combination that Ballard says gives them a “step-up” in terms of treatment.

Barstad explained that about five years ago, staff at Sanford recognized the shortage of beds throughout the state and sent people down to the state legislature, lobbying to increase their unit from 10 beds to 16 beds. They were successful and opened the 16 bed unit they run today.

But as they are taking in more people from all over Minnesota, a new issue is apparent. “Getting them here is never a problem, but getting them home again is a challenge,” Barstad said. “Especially if they don't have a good support system.” This means “creative” coordinating with the county, social workers, transportation services and extended family to get these teens back home. Even then, Barstad said the concerns may linger. “When you don’t have good social support systems for the minor, that makes it the most challenging,” he said. “If there isn’t a good case manager or community support, it’s hard to send them back where they’re not going to be retriggered.”

Looking forward

Last year, County Commissioner Mike Jugovich worked with the nearby City of Buhl, about 12 miles northeast with a population of 1,000, to try to entice North Homes Children and Family Services of Grand Rapids to construct a 26-bed facility for youth at Buhl’s former Martin Hughes High School. For 18 years and until it’s closure in June 2016, the building had housed KidsPeace-owned Mesabi Academy, a juvenile correctional facility, which employed more than 130 people. Sen. David Tomassoni, of Chisholm, also jumped on board, calling for $5.5 million in Fiscal Year 2020 to build a “stabilization unit for children 10 to 18 years old experiencing mental health or child welfare trauma.” However, Jim Christmas, CEO of North Homes, opted instead to add on 20 beds at its existing Community Mental Health Center in Grand Rapids, according to an article in the Duluth News Tribune. He also called for the construction of a new 32-bed facility right next door. That’s 52 more beds in Grand Rapids, a city in Itasca County just 35 miles southwest of Hibbing with a population of around 11,000.

The move, Christmas told the DNT, would help “fill a much-needed shortage of psychiatric care facilities for children aged 11 to 18 in the region,” and address the large number of youth being placed out of state.

Though no company seems ready to sweep in and build a much-needed in-patient facility on the Range’s ore-rich lands, it’s an issue that is gaining acknowledgement on city and county wide levels. Groups like Thrive Range have formed to provide free suicide prevention solutions in a county that has one of the highest rates of suicide per capita in the state, with the cities of Hibbing, Virginia and Ely suffering 2.5 times the state and national average. Perhaps more groups will form. Perhaps organizations like NAMI Minnesota (National Alliance on Mental Illness) will continue to partner with locals to bring more free mental health workshops here. And perhaps more outcry will eventually lead to a healthcare company moving in to help curtail the crisis while adding jobs in Minnesota’s northeast region.

•••

If you or someone you love is considering suicide, text RANGE to the crisis text line at 741741, call the Suicide Prevention Lifeline at 800-273-8255 (800-273-TALK), visit thriverange.org, or visit American Foundation for Suicide Prevention at afsp.org.

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