Editor’s Note: This story is the second in a two-part series on access to mental and behavioral health care in North Dakota.
BISMARCK, ND — Claire Bullis could have given up. Most of the others had already done so. She almost did too.
For years, Bullis worked her way through the tangle of anxiety, depression, post-traumatic stress disorder and anorexia, in and out of institutional care and treatment centers.
Finding a community where she felt safe enough to talk about her mental health journey, at Lighthouse Church in Fargo, was one of the first steps on her road to recovery. Another was to share her experiences and provide support to others going through similar challenges in life.
Bullis is one of more than 800 trained and certified Peer Support Specialists in North Dakota as of 2018. They act as sounding boards, life coaches, confidantes, and non-judgmental partners to those who struggle daily with mental health issues and behavioral.
Peers across the state are increasingly filling the gaps in a health care system that is struggling to keep up, especially in underserved rural areas, where staff and facility shortages are felt most acutely.
Breaking down the barriers of stigma, finding and providing social connections through support groups, and helping others, allows peers to help those in recovery and continue on their own recovery journey, they say.
“I’ve found that the more I interact with people, and the more I talk to others, and I’m like, ‘How’s life today?’ — more has been really helpful,” Bullis said. “It’s almost a kind of validation to a certain degree. There for so long, I never thought I would get out.”
Since gaining a greater understanding of his own challenges and successfully tackling them, Bullis has now become someone others can turn to.
“It’s almost a bit of a shock sometimes to think, yeah, I made it, and now I know how to get through it in a healthy way, and I can share that,” she said.
normalizing the conversation
Kristy Johnson, a peer support network manager for the state Department of Health and Human Services, who is also recovering, said about 170 of the 800 trained and certified peers now work in state-funded programs.
Others provide peer support by working with private entities or institutions not funded by the state, or are staff from hospitals and clinics that have integrated peer support into their services.
“We’ve gained more acceptance and the peer-to-peer opportunities have grown a lot” now that Medicaid and Blue Cross Blue Shield cover peer support as a reimbursable service, Johnson said.
That professionalization of North Dakota’s peer support system may be one of the most important factors in its long-term success, program developers say.
Specialists are now paid for the support they provide. The training process included two levels of certification, and within the initial two-year certification period, specialists must follow up with at least 20 hours of continuing education.
One of the leading advocates for peer support is First Lady Kathryn Burgum, who has helped spearhead the annual Recovery Reinvented event since 2017. The event brings together people recovering from addiction to share their recovery stories.
Burgum, in two decades of recovery from alcohol abuse, anxiety and depression, said she believes the first step forward for both affected individuals, families and communities is to normalize the conversation about these health challenges.
“The fastest, easiest and cheapest way to remove the stigma is to talk about it,” Burgum said.
“All of you can make a difference wherever you live or wherever you are in your life simply by talking about how the disease of addiction is affecting you,” he said.
While more people have come to understand that addiction is a disease, the general perception and the health care system have not necessarily caught up, Burgum said.
“The treatment centers are on the outskirts of the city in a separate building elsewhere, there is no addiction wing of the
It’s not the addiction wing of the hospital, it’s a back room somewhere and it’s not treated like a disease,” he said.
In Williston, peer support specialists like JoLyssa Kringen and Josh Korner are fighting an uphill battle trying to normalize the conversation about behavioral and mental health.
They said they hope to provide support in a community where there is little access to treatment for those seeking recovery.
“Williston doesn’t have a treatment center, we don’t have sober living, so we’re missing areas,” Korner said. “Sometimes it’s a bit of a battle here, because in order for people to get treatment, you have to drive them.”
The nearest treatment facility is 45 miles away in the city of Watford, Korner said, adding that there was much more support in that community to build the infrastructure for recovery.
Korner, who has overcome his own demons related to drugs, alcohol and prison time, said he feels his role is to help close the gaps that exist in a system where stigma is rife, punishment is the norm and where people often do not receive the help they need to treat their illnesses.
“That’s one of the most important things we can do, is stand up for these people, help them regain their trust, help them discover that they’re not just a number and that they really matter,” he said.
“Recovery work is my passion,” Korner said. “This is what I’m supposed to do.”
Kringen’s own problems began at an early age. At 14, she began experimenting with painkillers to deal with social anxiety and other issues. At 18 she was a full-blown heroin addict. After six years of addiction, followed by prison time, she was finally able to break the downward spiral. From there, peer support became a natural path.
Like Korner, working as a peer support specialist helps Kringen reach out to those who need help, but also attend to their own recovery.
“It’s unbelievable,” Kringen said. “It’s so nice to be able to help people and not have to provoke myself or my own sobriety. You are helping them in a safe place.”
Reaching people in rural communities across the state is a major hurdle seen by peer support specialists. Things like telehealth have helped a bit, they say, but electronic communication only goes so far, especially if insurance doesn’t cover it or only allows for a small part of the treatment.
“It’s very hard to get to those rural areas,” said Tara Gilbert, a peer support specialist at Lighthouse Church in Fargo, and another former addict.
“If we’re crying out for behavioral health services in places like Bismarck and Fargo, in rural communities, they’re screaming very quietly, because they don’t have enough voices to speak for them. So who is going to be the voice for them?
Gilbert said it will take people stepping up in smaller towns and communities to talk about their trauma, to talk about how they feel, to create a greater level of comfort and openness about the challenges that affect them.
Kringen knows how difficult it is to return to a community where an addiction first manifested itself. There are challenges faced by critical friends and family and challenges coming into contact with people she used to be with in the past, putting his own sobriety at risk.
“I had to change my thinking about it,” he said. “I felt more proud of my sobriety than caring what people thought.”
For Bullis, much of the work needs to start at the family level, he said, before changes at the community level can really take place.
“I don’t know if it’s a North Dakota thing, I’m sure it’s a Midwestern thing, but it’s like when a person has a problem, we hide it,” she said. “We hide it well, because we don’t want anyone else to know, because what does that reflect on us?”
- Resources for those seeking help with statewide mental and behavioral health issues are available in the DHHS Directory:
- The North Dakota Farmers Union also offers a resource page for farmers and ranchers dealing with agricultural stress and other behavioral health issues in
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