BISMARCK-North Dakota's behavioral health system is too heavily focused on costly residential and inpatient services, a new report has found, while investing less in prevention and early intervention services.

State lawmakers were briefed on the extensive report during a interim committee meeting at the state Capitol Tuesday, April 24. The nearly 250-page analysis was conducted by the Human Services Research Institute, a research and consulting firm based in Massachusetts, for the state's Department of Human Services.

The report found most expenditures in mental health and substance use disorder treatment were used for services delivered in residential, inpatient and long-term care settings in fiscal year 2017.

"There's been conversation about that historically, but we never actually had numbers to say that," said Pamela Sagness, director of the DHS behavioral health division.

Bevin Croft, a research associate for HSRI, declined to ring the alarm bells too loudly, however. She said most other states are in similar situations.

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"When it comes to behavioral health issues, what rises to the top are people who are truly suffering in the moment. And those are people who are in need of very intensive services and supports because, frankly, the system has failed them up until that point," Croft said.

But Jennifer Eberle, the owner of Creative Therapy in Valley City, struck a more dire tone. In a letter to lawmakers, she pointed to recent cuts in Medicaid reimbursement for behavioral health services that have caused practices like hers to cut back on the number of Medicaid clients and decrease staff.

The report laid out 13 broad recommendations, such as developing a "comprehensive implementation plan" and investing in prevention and early intervention. It also praised state and local leaders for efforts to address behavioral health problems in the criminal justice system.

A DHS spokeswoman said the agency contracted for the study at a cost of $160,000.

Trina Gress, vice president of Bismarck-based Community Options, backed HSRI's recommendations but wasn't surprised by the report's results.

"Our system is in crisis and has been for quite a time," she said. "Services are siloed, and the services that do exist are inconsistent across the state."

Sagness anticipated prioritizing a few of the recommendations "that are going to be the biggest contributor to making change."

Fargo Democratic Rep. Kathy Hogan, the committee's chairwoman, called the report a "master playbook" for a wide range of stakeholders, including state, education and corrections officials.

"This is really the umbrella vision that public and private communities will use," she said.