Priority: Mental Health (M)

Priority: Mental Health (M)

Key Data Findings

 17% of all Minnesota adults report Mental Illness in the household.

 Approximately 55% of Stearns County adults consider depression among youth and depression among adults a moderate or serious problem in Stearns County.

 When considering the topics of suicide, difficulty obtaining mental health services, and eating disorders, more Stearns County adults consider these topics no problem or a minor problem as compared to a moderate or serious problem.

 Almost 15% of Stearns County adults have felt sad, blue, or depressed for 15 or more of the last 30 days.

 42.6% of 18-30 year old Stearns County adult males (compared to 4.8%-16.9% in other age groups) rate their overall level of stress as “High”. This is 2.5 times higher to the highest rate for females in the age category of 31-50 at 17.3%.

 Almost a third of Stearns County adults identified a time in the last 12 months when they wanted to talk to or seek help from a health professional about emotional problems but delayed or did not seek that help.

 After saying that they did not go or delayed seeking help from a health professional about emotional problems, the top two reasons for Stearns County adults were “I did not think it was serious enough” (42.1%) and “I was too nervous or afraid” (36.5%). At 10 percentage points less, “The care I needed cost too much” came in at 26.5%.

 One third of all Stearns County 8th, 9th, and 11th grade females have felt sad, blue, or depressed in the last 12 months (17% for males). Stearns County student rates are slightly less than Minnesota students as a whole.

 Approximately 5% of all Stearns County 8th, 9th, and 11th grade students across grade levels and gender indicated that they have attempted suicide at some point in their life, with 10% of the males and 15% of the females thinking about ending their life in the last 12 months. Minnesota rates are very similar to the Stearns County rates.

 From 2009 to2013, there was a 67% increase in the number of persons age 50-64 accessing the PATH (Project for Assistance in Transition from Homelessness) project at Stearns County Human Services. These are adults who have mental illness and are experiencing homelessness.

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ACE

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Table source: Minnesota Department of Health – Adverse Childhood Experiences in Minnesota: Findings and Recommendations Based on the 2011 Minnesota Behavioral Risk Factor Surveillance System (BRFSS). PowerPoint presentation authored by Vincent Felitti, MD and Robert Anda, MD. (Jan 28, 2013) Discussion

 The 1995-1997 Adverse Childhood Experiences Study (ACE Study) was conducted by Center for Disease Control and Prevention and Kaiser Permanentes Health Appraised Clinic in San Diego. The study findings suggest that certain experiences (including mental health) are major risk factors for the leading cause of illness and death as well as poor quality of life in the US. The 10 adverse childhood experiences included in the study were: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, parental separation/divorce, battered mother, parental substance abuse, parental mental illness, and parental criminal background.

 In 2011, the Minnesota Department of Health utilized the statewide data in the Minnesota

Behavioral Risk Factor Surveillance System (BRFSS) to analyze the data looking specifically at the data elements related to adverse childhood experiences. 55% of all Minnesotans report 1 or more ACEs. Among Minnesota adults, there is a strong association between mental health and ACEs. Minnesota adults with an ACE score of 5 or more were 6 times more likely to have an anxiety disorder diagnosis compared to persons with no ACEs. (31% vs. 5%)

2011 Minnesotans (%)

ACE (Adverse Childhood Experience) All Men Women

Incarcerated Household Member 7 7 6

Sexual Abuse 10 6 14

Drug Use Problem, Household 10 10 10

Witnessed Domestic Violence 14 13 16

Physical Abuse 16 15 16

Mental Illness, Household 17 14 19

Parent Separated or Divorced 21 22 21

Drinking Problem, Household 24 22 26

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Ranking of community concerns by Stearns County adults identifying each concern as a moderate or serious problem, February 2013

16. Depression among adults (57.6%) 39. Suicide among youth (38.7%)

19. Mental Illness (55.6%) 41. Difficulty obtaining MH services for adults (38.1%) 21. Depression among youth (55.5%) 42. Difficulty obtaining MH services for youth (37.1%) 33. People not taking MH meds (45.3%) 47. Eating disorders (32%)

37. Suicide among adults (40.1%) BUT, Heart Disease or Stroke ranked at 13 (59.6%) Source: Central Minnesota Community Health Survey, February 2013

Discussion

 Out of a total of 68 community concerns, most mental health related concerns ranked in the bottom half by Stearns County adults.

 A high ACE (Adverse Childhood Experience) score doubles your chance of heart disease.

o Many studies have stemmed off of the original ACE (Adverse Childhood Experience) study. o Source for this statement: Presentation by Jane Ellison (Greater St. Cloud Area Thrive) to the

St. Cloud Area Human Service Council, 2/14/13. Research from 2004, Sep 28. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Authors: Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, Anda RF. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and

Prevention, Atlanta, GA.

 Out of a total of 68 community concerns, Stearns County adults ranked heart disease or stroke at #13.

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Discussion

 The two community concerns related to mental health that Stearns County adults identified as more of a moderate or serious problem versus no or little problem were depression among adults and depression among youth. When considering the topics of suicide, difficulty obtaining mental health services, and eating disorders, more Stearns County adults consider these topics no problem or a minor problem compared to a moderate or serious problem.

28.6% 29.2% 42.3% 43.2% _{40.2% 39.8%} 47.1% 57.6% 55.5% 40.1% 38.7% 38.1% _37.1% 32.0% 13.8% _{15.3% 17.7% 18.1%} 21.8% 23.1% 20.9% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Depression among adults Depression among youth Suicide among adults Suicide among youth Difficulty obtaining mental health services for adults Difficulty obtaining mental health services for youth Eating disorders

Various Community Concerns related to Mental Health

In Stearns county, how much of a problem is...

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Discussion

 36.8% of Stearns County adults have not felt sad, blue, or depressed in the past 30 days.  Almost 15% of Stearns County adults have felt sad, blue, or depressed over half the days of the

previous month. 36.8% 44.3% 5.0% 13.8% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0%

0 days 1 to 7 days 8 to 14 days 15 or more days

Stearns County adults: During the past 30 days, for about how many days

have you felt sad, blue, or depressed?

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Discussion

 The Stearns County adult age group that has the highest group of high stress is 18-30 (42.6%). This is 2.5 times higher than the highest rate for Stearns County adult females in the age category of 31-50 at 17.3%

 Inversely, the Stearns County adult male group with the highest amount of low stress levels is aged 71-100.

 Stearns County adult male age group 31-50 has the smallest amount of low stress at 16.5% and the largest amount of medium level stress.

42.6% 11.4% 16.9% 4.8% 33.1% 72.1% 43.8% 47.3% 24.3% 16.5% 39.3% 47.9% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 18-30 31-50 51-70 71-100

Stearns County adults: How would you rate your overall level of stress broken

down by age among males

(Source: Central Minnesota Community Health Survey, February 2013)

Low Medium High

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Discussion

 Stearns County adult females show a much more even distribution of stress across age levels than the Stearns County adult males. Adult females aged 18 through 50 have approximately the same level of overall stress. After the age of 50, the levels of high and medium stress decrease and the level of low stress increases.

 In the age group of 71-100 the Stearns County females and Stearns County males have very similar distribution of stress. 16.6% 17.3% _12.7% 3.1% 62.9% 61.1% 56.6% 50.8% 20.5% 21.7% 30.7% 46.1% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 18-30 31-50 51-70 71-100

Stearns County adults: How would you rate your overall level of stress

broken down by age among females

(Source: Central Minnesota Community Health Survey, February 2013)

Low Medium High

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Discussion

 Almost a third of Stearns County adults identified a time in the last 12 months when they wanted to talk to or seek help from a health professional about emotional problems but delayed or did not seek that help.

 The full question on the survey was: During the past 12 months, was there a time when you wanted to talk with or seek help from a health professional about emotional problems such as stress, depression, excess worrying, troubling thoughts, or emotional problems, but did not or delayed talking with someone?

Yes, 29.70%

No, 70.30%

Stearns County adults: During the past 12 months, was there a time

when you wanted to talk with a health professional about emotional

problems but did not or delayed talking to someone?

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Discussion

 The top two reasons for not seeking care for emotional problems are related to stigma. The highest reason for Stearns County adults delaying or not seeking care from a health professional for

emotional problems is they did not think it was serious enough (42.1%). The next highest reason was because they were too nervous or afraid (36.5%).

 A little more than a quarter of Stearns County adults who delayed or didn’t seek care from a health professional for emotional problems did so because the care they needed cost too much.

42.1% 36.5% 26.5% 15.8% 12.1% 9.5% 4.2% _3.1% 2.9% _2.5% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0%

Stearns County adults: Reasons for delaying or not obtaining health

professional help for emotional problems

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Discussion

 One third of all Stearns County 8th, 9th, and 11th grade females have had significant problems with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future during the last 12 months. (17% for males)

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Male Female

8th graders 17% 34%

9th graders 20% 38%

11th graders 24% 40%

 Minnesota male and female students as a whole experience problems with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future during the last 12 months more than the Stearns County 8th, 9th, and 11th grade male and female students. Both Stearns and Minnesota students see increased problems as they age, but the Minnesota increase is more than in Stearns County. 16% 17% 18% 32% 33% 35% 0% 5% 10% 15% 20% 25% 30% 35% 40% 8th 9th 11th

Stearns County 8th, 9th, and 11th graders who during the last 12 months

had SIGNIFICANT problems with feeling very trapped, lonely, sad, blue,

depressed or hopeless about the future - by gender

Male Female

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Discussion

 From 1998 through 2007, Stearns County 12th grade females had a lower rate of attempted suicide than the overall state. In 2010, Stearns County had the same rate as the state at 6%.

 From 1998 through 2010, there is a general downward trend for 12th grade females attempting suicide.

 This is trend data to accompany the 2013 Minnesota Student Survey data. The questions were modified in the 2013 version of the survey and there were different grade levels that participated in the survey as well. The data in this graph cannot be directly compared to the new data, but it does present a history in this area of high school student mental health.

8% 8% 9% 4% 6% 9% 9% 10% 7% 6% 0% 5% 10% 15% 20% 1998 2001 2004 2007 2010

Have you ever tried to kill yourself? (Yes, more than a year ago)

Stearns County and MN 12th Grade Females

(Source: Minnesota Student Survey, 1998-2010)

Stearns MN

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Discussion

 Approximately 5% of all Stearns County 8th, 9th, and 11th grade students across grade levels and gender indicated that they have attempted suicide at some point in their life. 8th and 9th grade females are slightly higher than 5%.

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Male Female

8th graders 3% 7%

9th graders 4% 9%

11th graders 5% 9%

 The Stearns County and Minnesota percentages of 8th, 9th, and 11th graders actually attempting suicide are very similar. Stearns County 11th grade females are 4% less than the Minnesota 11th grade females as a whole. 4% 4% 5% 7% 8% 5% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 8th 9th 11th

Stearns County 8th, 9th, and 11th graders having actually

attempted suicide by gender

(Source: Minnesota Student Survey, 2013)

Male Female

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Discussion

 Of Stearns County 8th, 9th, and 11th graders, 10% of the males and 15% of the females have had significant problems with thoughts about ending their life or committing suicide in the last 12 months.

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Male Female

8th graders 9% 18%

9th graders 10% 20%

11th _{graders 10% 15%}

 The Stearns County and Minnesota percentages of 8th, 9th, and 11th graders having significant problems with thoughts about ending their life or committing suicide during the last 12 months are similar. Stearns County 8th and 9th grade females are slightly less than the Minnesota 8th and 9th grade females as a whole. 10% 9% 10% 17% 17% 15% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 8th 9th 11th

Stearns County 8th, 9th, and 11th graders by gender who have had

signficant problems with thinking about ending their life or

committing suicide during the last 12 months

Male Female

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PATH

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Discussion

 Stearns County Human Services is seeing an increase in older adults who have mental illness and are experiencing homelessness that are being seen by the PATH (Projects for Assistance in Transition from Homelessness) project. PATH is a grant Stearns County receives where a PATH outreach social worker connects persons experiencing homelessness to community resources. 95% of all PATH clients have some type of mental health concern or illness. From 2009 to 2013, PATH clients aged 18-49 years has seen a slight decline or remained fairly steady. On the other hand, from 2009 to 2013 there has been 67% increase in the number of PATH clients who are aged 50-64 years. 2013 was the first year when a client who was 75+ years old was served.

158 157 143 146 154 45 67 ₆₄ 76 75 5 4 4 5 7 0 0 0 0 1 0 20 40 60 80 100 120 140 160 180 2009 2010 2011 2012 2013

Stearns County Human Services PATH Clients

PATH=Projects for Assistance in Transition from Homelessness

{generally clients are 75% from Stearns and 25% from Benton}

(Source: Annual Stearns County Human Services PATH grant reports)

18-49 yrs 50-64 yrs 65-74 yrs 75+ yrs Linear (18-49 yrs) Linear (50-64 yrs)

Health Equity assessment

Disparities in access to mental health services affect individuals and society. Barriers to services include: Lack of availability, high cost and lack of insurance coverage. These barriers can lead to other problems such as unmet needs, delayed treatment, and hospitalizations that could have been prevented. Mental illness is still a stigmatized condition by society as noted by 36.5% who were afraid to get treatment.

Community feedback

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Public Health Task Force comments

Public comment during comment period

Comments were received between September 15, 2014 and October 15, 2014. Where applicable, the comments were added into the body of the plan.

Alcohol Awareness Council

 Add Partners: Minnesota Department of Human Services, Minnesota Association for Children’s Mental Health

 Add Resource: Project Know, Understanding Addiction (online resource) - Behavior Health section

ARC Midstate

 Presently one of the biggest challenges we witness is the availability for treatment and care for children and teens who are in need of therapies and/or inpatient treatment including residential services. This is especially true for those who have co-existing developmental or cognitive challenges.

Central Minnesota Mental Health Center

 Add Goal: Maintain and enhance evidence-based training available to law enforcement about mental illness. An example would be Crisis Intervention Training (CIT).

 Additional Partner: Minnesota CIT (Crisis Intervention Training) Association  Add “Dental Access” to the Mental Health Priority Interconnections

o “It's a very difficult need for clients in the system to meet with current resources.”  Add Community Resources: ACT Teams and IRTS

HealthPartners

 Like how we described priority selection

 Add Resource: Make it OK Campaign (https://makeitok.org)

 Consider forming a Center for Community Health as in Rochester: “The Center for Community Health was established by the University of Rochester Medical Center to develop and expand academic-community health partnerships dedicated to improving the health of our academic-community.”

THRIVE

 We feel it is important to consider the needs of New Americans in our area when addressing all the proposed priorities.

 We look forward to future collaboration in relation to early childhood, parenting, and family needs.

Village Family Services, Inc.

 Would love it if all children and adults could undergo trauma informed assessment when seeking treatment.

 Add Resources: Anger Management, Domestic Violence, and Co-Parenting Support Groups, Trauma Informed Support Groups at the Village Family Services

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Focus group identified contributing factors/sub-issues

 Stigma - afraid to admit having mental health concerns, fear of being labeled “crazy” - applies to all cultures

 Access to care – interpreters, transportation, availability, affordability  Affordability of care

 Persons understanding they have a problem

 Identification of mental health concerns for very small children, 0-5 year olds

 Connections with babies - availability of maternity leave, importance of encouraging attachment during baby’s first year

 Aging population - support needed for grief and loss

 Aging population - beware of withdrawal from society, fear and shame, dismissal of the severity of the mental health component

 New Brain Research

 Family won’t allow treatment - parents don’t believe in medicine or getting professional assistance for mental health concerns

 Jails/corrections/prison - End up in the system instead of getting care  Homeless population

 Racial and Cultural Predisposition  Post traumatic stress disorder (PTSD)

 Difficult to navigate the system. Difficult to understand how to obtain funding - Long Term Care and Medical Assistance Waiver funding. Difficult for English speaking Americans, even more so for other cultures and immigrants and refugees.

 Takes a lot of time to get “better” - if there are barriers, one appointment is hard enough - let alone considering months or years of ongoing appointments

 Early intervention is important, Focus on Primary Prevention o Early childhood screening and family screening o Include the family in the treatment

 It is difficult for the Native Americans, Latinos, Somali cultures to understand our mental health profession process.

o Holistic/spiritual component missing

o There is some distrust. There is discomfort or misunderstanding with the term of “Intervention”

o Some things get lost in the interpretation – the direct translation of mental health is uncomfortable

 Mental illness = crazy o Psychiatrists looked upon as weird

o It is important to provide different services based on the different cultures - making sure the client understands with as little fear as possible.

 People not understanding that they do have a say in their mental health services  There is such a wide variation of Mental Health needs

 Our community needs a wide range of services to meet the full range of needs: in-home, skills workers, outpatient, inpatient

 Don’t make people fit into the box - make the box fit the people.

 Must keep the best interest of the children in mind - outside of the money.  ADHD/Autism spectrum

 Anxiety/regulation  Misdiagnosis

 Need for provision of widespread Screening Process

o Just like vision, hearing, or scoliosis screening in schools

o We tend to Only deal with mental health when there already is a problem  Bullying

conjunction with talk therapy  Medical trauma

 Secondary trauma of staff in the medical community, EMS, police, or fire personnel  How to parent when you have a mental illness

 Lack of support groups -Ongoing support to address layers of needs

Focus group prioritization of contributing factors/sub-issues

 Priority #1: Stigma - afraid to admit having mental health concerns, fear of being labeled “crazy” - applies to all cultures

 Priority #2: Our community needs a wide range of services to meet the full range of needs: in-home, skills workers, outpatient, inpatient

 Priority #2: Need for provision of widespread Screening Process

 Priority #3: It is important to provide different services based on the different cultures - making sure the client understands with as little fear as possible.

 Priority #4: Access to Care

 Priority #4: It is difficult for the Native Americans, Latinos, Somali cultures to understand our mental health profession process.

 Priority #4: Lack of support groups -Ongoing support to address layers of needs  Priority #5: System Navigation

 Priority #5: Need to include family in treatment for children

 Priority #5: Must keep the best interest of the children in mind - outside of the money.  Priority #6: Affordability of Care

 Priority #6: Persons understanding they have a problem  Priority #6: Racial and Cultural Predisposition

Suggested action from community dialogue

 Stigma

o BLUR the line between medical and mental health - they are connected o Educate workers first

 Utilize Reflective Practice to help employees have comfort with the topic of mental health

 Educate workers at all levels: Courts, Corrections, Public Health, medical field, teachers, child care providers, peer mentors, state/DHS, insurance companies, community leaders (Elders, church community)

o Educate clients about mental health diagnosis - include the physical and mental aspects - utilize recent brain research

 Individually - medical provider and client  Also Utilize safe group settings

o Some populations can best be educated through community leaders  Spiritual leaders

o Educate students in school

o Expand/Review definition of “Mental Health”

 Include feelings, body language, ability to cope o Change the way we communicate about Mental Health

 Normalize mental illness  Change the message  Know your audience  Pay attention to vernacular

 Use Imagery - have the message come from famous/well known people with Mental Illness

 Get message into schools and General Medical Clinics -people are more comfortable going to these places than to Mental Health clinics

 Teach modules/models on Resiliency, Mindfulness, Self Care, Deep Breathing/Regulation

o Utilize Peer Mentors - make this practice more acceptable  Provide support and social networks

 Have places where people can go to be heard/use group processes o Invest in Community Support Workers

 A great model where people can sit down 1-1 to find out what they need and connect to resources

o Somehow get the word out about what resources are available  Utilize 211

 Identify a way to keep 211 updated  Original identified need: Widespread Screening Process

 Group identified that there actually are already existing screenings available that are being conducted on a widespread basis, but on minimal basis

o Lists already exist through THRIVE and the CommUNITY AMH initiative Resource list.  New need: Identified system to use for persons who screen positive on a Mental Health Screen

o A clearly identified system to refer positive screens would allow the screens to take place more frequently and expand the use to schools and general doctors

 Utilize 211?

o Need a directory or flow chart to identify which tool to use for which population  Perhaps 211 could be used to store this

o Electronic screening options need to be developed for the younger generation o Develop a community based system

 “Our sense of community has been lost”

 Answer the question, “How can we help persons who screen positive?  Need to identify a menu of options - “scaffolding”

 Be cognizant of how each population group is best served  Utilize 1-1 connections

o ARMHS workers, peer mentors

o How can we provide this to the younger populations through technology?

 Get a community group together of persons/agencies who want to do this ongoing screening and follow-up to start the process.

Similarities to national, state, and other local planning processes

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2020

This is a topic area in the Health People 2020 looking at Mental Health and promoting it as well as availability of treatment for mental illness and better understanding of mental illness as a society. [Mental Health Status Improvement and Treatment Expansion]

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2020

Goals include: (1) People in Minnesota at risk for or who live with chronic diseases receive the right care in the right place at the right time. (2) People in Minnesota have access to information about the burden of chronic diseases and injury, their associated risk factors, and best practices to address them.

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Community health issue identified as Mental Health Services.

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 Housing: A full range of housing is available for all community members.

 Economy: Our community has an increase in employment and median income levels.  Safety: All people feel secure and free from crime.

 Wellness: Our community will create sustainable environments that encourage healthy choices and support well-being.

 Transportation: All people have access to, from and within the region by means of public and other modes of transportation.

 Community engagement: All people feel ownership in local government, connected to the larger community and involved in social networks.

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Stearns County Goals

Using the Control and Influence Matrix, Mental Health is an Area to address.

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Objective M1.1: Make mental illness more visible.

Suggested strategies

a. Implement policy and system changes that support mental illness treatment and services.

b. Develop more mental health services at the primary care level using advanced practice mental health specialists.

c. Implement programs that foster healthy relationships and positive mental health. i. Assure persons living with mental illness provide input into programming. ii. Assure culturally appropriate programming is available.

d. Implement the MakeItOK Campaign in the Stearns County area.

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Objective M2.1: Provide parental education on promoting positive mental health in young children.

Suggested strategies

a. Support Evidence-based programing for services that serve families such as Healthy Families America and Nurse-Family Partnership.

b. Provide resiliency training for professional and community members.

Objective M2.2: Provide mental health resources throughout the life span.

Suggested strategies

a. Increase depression screening at critical times in life (i.e., adolescence, post-partum, senior). b. Assure referral practices are implemented after all depression screenings.

c. Maintain and develop additional community mental health resources (i.e., one number to call for mental health access services).

d. Work with local businesses to identify local resources that address mental health. e. Assure age appropriate resources are available (i.e., phone apps, telemedicine).

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Objective M3.1: Explore ways to increase the capacity of primary care providers to provide mental health services.

Suggested strategies

a. Explore further collaboration between primary care providers and psychiatrists.

b. Explore the use of technologies to increase collaboration between primary care providers and psychiatrists.

c. Provide and educate primary care providers on evidence-based strategies to initiate early interventions for persons experiencing mental illness.

d. Convene payers and providers to address and improve reimbursement around mental health treatment.

Objective M3.2: Explore ways to increase the number of psychiatrists, specifically pediatric psychiatrists, practicing in the Stearns County area.

Suggested strategies

a. Increase education to college students about the field of psychiatry and pediatric psychiatry. b. Explore the use of economic incentives to attract psychiatrists to the Stearns County area.

Objective M3.3: Explore ways to increase the use of advanced practice professionals (i.e., advanced practice Registered Nurses or Social Workers) in mental health.

Suggested Strategies

a. Support policies that would promote loan forgiveness for providers practicing in underserved areas. b. Promote policies that incentivize persons of all cultures to pursue a mental health professional

degree.

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M4-M13:

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Objectives and Strategies have not been developed for the following goals, but they are additional goals for the community to consider:

 Goal M4: Increase awareness of resources to address mental illness.  Goal M5: Conduct mental health screenings across all ages.

 Goal M6: Increase the number of advocates to help people navigate the system to help people identify the next steps after the first “no” (i.e., no we can’t get you in for another 5 months, no we do not take your insurance, no we do not have a pediatric psychiatric services).

 Goal M7: Increase community awareness on maintaining mental health.

 Goal M8: Increase social activities for senior populations to increase social contacts to decrease isolation.

 Goal M9: Decrease stigma of utilizing senior living communities/arrangements.

 Goal M10: Maintain and enhance evidence-based training available to law enforcement about mental illness. An example would be Crisis Intervention Training (CIT).

 Goal M11: Increase the capacity of the community to serve children and adults on the Autism Spectrum.

 Goal M12: Increase the capacity of the community to serve children and teens with co-existing developmental or cognitive challenges along with mental illness in need of therapies and/or inpatient treatment including residential services.

 Goal M13: For children, youth, and adults experiencing mental health challenges, create, maintain, and enhance promising and evidence based services such as TXT4Life, PBIS (Positive Behavioral Interventions and Supports), JDAI (Juvenile Detention Alternatives Initiative), and CTI (Critical Time Intervention).

Measurements for success

Measure Source Baseline 2019 Target

MM1. Reduce total number of adults who do not receive mental health consultation Central MN Community Health Survey – Question 7 2013 – 22.4% did not or delayed talking to a health professional about emotional problems 2018 – 18% did not or delayed talking to a health professional about emotional problems MM2. Reduce total

number of people who did not receive or delayed receiving care because they were nervous or afraid

Central MN Community Health Survey –

Question 8f.

2013 – 36.5% of those who did not receive or delayed care did so because they were nervous or afraid

2018 – 30% of those who did not receive or delayed care did so because they were nervous or afraid MM3. Reduce total

number of people who did not receive or delayed receiving care because they did not think the problem was serious enough

Central MN Community Health Survey –

Question 8h

2013 – 42.1% of those who did not receive or delayed care did so because they did not think the problem was serious enough

2018 – 35% of those who did not receive or delayed care did so because they did not think the problem was serious enough MM4. Reduce the total

number of children in Out of Home Placement that are placed in a residential treatment center

Stearns County Human Services Internal Report

2013 – 26 residential treatment center placements 2018 – 20 residential treatment center placements

Individuals/Agencies responsible for implementing strategies for Mental

Health priority

 Stearns County Human Services Department

Existing community assets and resources

 Intensive home visiting programs (Early Head Start, Healthy Families America, Nurse-Family Partnership)

 School District school counselors

 St. Cloud Area Trauma Response Initiative at the St. Cloud Police Department  Greater St. Cloud Area Thrive, a collaboration addressing children’s mental health

 Mental Health Providers offering Circle of Security, a relationship based early intervention program for parents and children

 Clara’s House, partial hospitalization program for children with mental illness  United Way Success by Six

 United Way 2-1-1

 St. Cloud Area Human Service Council

 Project Know, Understanding Addiction (online resource) - Behavior Health section

 ACT (Assertive Community Treatment) Teams and IRTS (Intensive Residential Treatment Services) through the Central Minnesota Mental Health Center

 Make It OK Campaign (online resource)

 Anger Management, Domestic Violence, and Co-Parenting Support Groups, Trauma Informed Support Groups at the Village Family Services

 Lutheran Social Services Resiliency Program for Children

 Minnesota State Advisory Council on Mental Health and its subcommittee on Children’s Mental Health, 2014 Report to the Governor and Legislature

 Mental Health Workforce Development Steering Committee

 Stearns County Human Services, Public Health Division programs, WIC and Child and Teen Checkups  Minnesota Statewide Suicide Prevention Plan

 Report and Recommendations on Strengthening Minnesota’s Health Care Workforce from the Legislative Health Care Workforce Commission

 Preeminent Medical Discovery, Education, and Workforce for a Healthy Minnesota Final Report from the MN Governor’s Blue Ribbon Commission on the University of Minnesota Medical School

 Gearing Up for Action: Mental Health Workforce Plan for Minnesota Report from the Minnesota Health Workforce Steering Committee

Potential partners

 Stearns County Human Services: Public Health Division, Family & Children Services Division, Community Supports Division, Community Corrections Division

 Sherburne County Health and Human Services  Stearns County: Attorney’s Office, Sheriff’s Office

 Law Enforcement: St. Cloud Police Department, other Stearns County community Police Departments  Minnesota Department of Health

 Minnesota Department of Human Services

 Minnesota Association for Children’s Mental Health

 Minnesota Department of Economic and Educational Development  Minnesota Psychological Association

 Local policy makers

 Reach-Up, Inc., Head Start Early Head Start  Resource Training and Solutions

 Universities/Colleges

 St. Cloud State University Child and Family Studies Department  Sauk Rapids/Rice Early Childhood Programs

Caritas Mental Health Clinic, Catholic Charities Young Learners Program, Center for Psychological Services, Child and Adolescent Specialty Care [CentraCare Health Plaza], Clara’s House,

HealthPartners Behavioral Health, ISD 742/St. Cloud School District Triage System, Lutheran Social Services, Pinecone Family Counseling, Four County Crisis Response Team, St. Cloud VA Health Care System, and individual therapists, psychologists, social workers, and counselors)

 Health Care Clinics  Hospitals

 Health Plans: Health Care Home Coordinators  Emergency Rooms, Behavioral Access Nurses  Schools

 Child Care Choices  St. Cloud Area YMCA

 Boys and Girls Club of Central Minnesota  Anna Marie’s Alliance

 St. Cloud Area Crisis Nursery  New Beginnings

 ARC Midstate  Rise

 Goodwill Easter Seals  United Way

 Community Non-Profits

 National Alliance on Mental Health  Parish Nurses

 Minnesota CIT (Crisis Intervention Training) Association  HealthForce Minnesota

 Rural Assistance Center

 Families for Depression Awareness (Massachusetts Non-profit)

Stearns County community health priority interconnections

 Parenting skills

 Lack of physical activity  Poor nutrition

 Tobacco use by women  Alcohol use

 Integration of newly arrived persons  Financial Stress