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Those with symptoms of COVID-19 may receive a nasal or throat swab test to confirm a diagnosis. For the growing number of Americans reporting symptoms of anxiety or depressive disorders, diagnosis is a far more complex process. According to a recent study from the Henry J Kaiser Family Foundation (KFF), the number of individuals reporting symptoms for these conditions has jumped from 11% in 2019 to 36.5% in June 2020.

Despite these growing numbers and the millions of Americans already living with mental health conditions, stigma and misunderstanding is widespread. The National Association of Mental Illness (NAMI) adds to their “You Are Not Alone” campaign by promoting the theme “What People with Mental Illness Want You to Know” for Mental Illness Awareness Week, which begins October 4, 2020.

“Major life changes and social isolation have always been triggers for mental health issues. As the pandemic persists, the ongoing stress and uncertainty is magnified,” shared Kari Johnston, LPC-MH, chief executive officer for the Human Service Agency in Watertown, SD. “People may recognize a change in their mental health status; but because of the negative perception, they continue to suffer alone rather than seek care.”

According to NAMI, only four in ten Dakotans with a mental health condition received any treatment in the past year. Lack of treatment can produce a ripple effect and expand to the development of other chronic diseases, substance use, incarceration, homelessness and suicide.

“Largely, people continue to remain uneducated about mental health disorders and mental illness. Warning signs can be difficult to recognize,” added Johnston. “Long-term stress has a negative impact on the health of the individual, their family and their community.

In our agricultural state, many face the additional burdens of long hours, decreased market prices and uncooperative weather. While lack of anonymity and the midwestern philosophy to “pull yourself up by the boot straps” deter care, lack of mental health care services is the biggest obstacle.

To support demand for care, each state provides behavioral health and substance use services through their respective programs. The North Dakota Human Service Center is made up of eight regions and the South Dakota Community Mental Health Centers is comprised of eleven service areas.

“The community mental health system is a vital framework for all behavioral health services in the state of South Dakota.” Johnston added and expands on the program’s services. “While we are each unique, we offer services to those without income or health insurance as well as provide services for those who need help through a developmental transition. We serve all walks of life and are often the touchstone for the individuals we serve.”

All but three North Dakota counties and four South Dakota counties are designated as mental health shortage areas. In order to meet the recommended population-to-provider ratio, North Dakota would need to employ 20 additional mental health providers and South Dakota would require 35. The demand for mental health professionals spans from private practices to school districts. State programs struggle to compete, resulting in staff turnover.

“Those we serve frequently adjust to new providers, both in case management and in psychiatry. People can ‘fall between the cracks’ when there is a transition in staff and this can result in some individuals going without their medications, which can be dangerous for those we serve,” Johnston emphasized.

Community and health stakeholders across the Dakotas have long worked to bridge the gap through phone or text help lines, support groups, chronic disease self-management education and evidence-based intervention programs. The pandemic highlighted the value of these programs and became a catalyst for expanding from limited on-site options to virtual platforms.

In addition, Sanford Health and the University of North Dakota recently teamed up to provide the Behavioral Health Bridge. This series of online modules focuses on common behavioral health conditions related to COVID-19 and promotes behavioral health treatment.

“At some point in life, everyone faces circumstances beyond their control. Trying to manage by turning to alcohol, drugs or other harmful behaviors only makes the situation worse,” Johnston concluded. “Injuries can happen to the mind and the body. A healthy therapeutic alliance is vital to helping everyone live a purpose-driven life.”

Source: Q Insider | September 2020

To further conversation and knowledge sharing, be sure to attend the October TeleEcho Workshop and huddle – Depression in Older Adults – hosted by the University or North Dakota and the Great Plains QIN team. Details below.


Access to geriatric care improves the quality of life for patients and residents in our communities. Great Plains Quality Innovation Network is partnering with the University of North Dakota to improve access to care for patients with complex conditions in rural and underserved communities through the Geriatric and Age Friendly Care TeleEcho™ Series. 

Depression in Older Adults – October 2020

Mental health will be the conversation during our October TeleEcho sessions. We will further the discussion on how mental health and depressions relates to the 4Ms framework and how to incorporate tools and best practices. Be sure to register and attend.

October 13, 2020 [12 p.m. CT] – UND TeleEcho Session
October 20, 2020 – [12 p.m. CT] – Great Plains QIN Huddle

Register for the UND TeleECHO Sessions Register for the Great Plains QIN Huddles