Assessment identifies mental health, substance use as continuing concerns in Grand Forks community

Oct. 29—GRAND FORKS — Mental health, substance use and transportation are among the top continuing concerns of community members in Grand Forks and Polk counties, according to the most recent

Community Health Assessment

published in Grand Forks.

The assessment, released last week by Grand Forks Public Health, Altru and UND's Master of Public Health program, is the latest in a series of Community Health Assessments conducted every three years since 2013. The assessment has grown into a three-way collaboration between Altru, UND's MPH program and Grand Forks Public Health, and informs public health priorities and action plans for Altru and Grand Forks Public Health.

Mental health, substance use and transportation are public health concerns that were also identified in the 2019 CHA, but other top concerns identified in this year's assessment include health care access, child care access and insurance coverage.

The planning, data collection and data analysis portion of the assessment is completed by UND graduate students in the school's MPH program.

"It's a great opportunity for our students and one that they're able to grow from," said Ashley Bayne, MPH assistant director.

Sarah Larson, an MPH student specializing in Indigenous health, said conducting the research was beneficial professionally, but also helped her get to know the community and see what collaboration for improving community health looks like in Grand Forks.

"These really important public figures coming together to all work toward promoting and serving the general public is a really great opportunity to see what partnership at the public level looks like," she said.

The assessment consists of three components: secondary data from national, state and local sources, a community survey with nearly 400 responses and focus group discussions with community leaders and special populations. Special populations focus groups included new Americans, LGBT individuals, Indigenous people and adults with disabilities.

Secondary data includes information about demographics, risk factors and health outcomes and is collected by other agencies to give an overview of community health, while the survey and group discussions conducted by UND are more specific to the community.

Bayne said across all the components, data told the same story in the community.

"You can use the focus groups to further illuminate the community survey and secondary data, so the themes all really lined up well," said Bayne.

In 2019, substance use, mental health, obesity, transportation, the cost of health care and housing were identified by the Grand Forks Community Advisory Committee as the top six health priorities for the following three years. While official priorities have not yet been selected for the next three years, Debbie Swanson, Grand Forks Public Health director, says based on the data from this year's study, mental health and access to behavioral health services will likely carry over.

While the ratio of population to mental health providers improved in both Grand Forks and Polk Counties from 2019 to 2022, the average number of poor mental health days reported in a span of 30 days in both counties rose. While Grand Forks County's mental health provider ratio improved from 350:1 in 2019 to 280:1, poor mental health days rose from 3.1 days in 2019 to 3.5 days in 2022. In Polk County, the population-to-mental health provider ratio improved from 490:1 to 390:1, but poor mental health days rose from 3.1 days to 4.1 days between 2019 and 2022.

Additionally, in the community survey, around 30% of respondents said access to mental health services in the community is poor. A lack of mental health services and providers was listed as a barrier to health care and a concern respondents face on a regular basis.

"It seems that those issues have become of a greater concern in the community — both access to services and overall mental well being," said Swanson.

Concerns about substance use in the community are also consistent from the 2019 assessment, said Swanson.

Similarities in the results from year to year speak more to how pervasive issues like mental health and substance use are in the community than the success of the continual work to address these issues, said Larson.

"The fact that they are continually being worked on and continue to be pressing issues further validates the need to prioritize these sorts of issues," said Larson. "It's not to say they're not being worked on, but it's just to say that they're so complex that they need to be seen through different lenses and continually prioritized."

This year's CHA also highlighted new concerns among community members. One was how a lack of cultural inclusivity or culturally competent care can be a barrier for some populations in the greater Grand Forks community.

"We had a really nice discussion about how all service providers and health care providers in the community can do better to serve the residents of the greater Grand Forks area," said Swanson. "That is a new discussion, but it's certainly been a theme that has been there in the past in terms of access to care."

After the 2019 assessment, early in 2020, Altru and Grand Forks Public Health created a Community Health Improvement Plan and Implementation Strategy that laid out how they would address the identified community health priorities. However, says Swanson, the COVID-19 pandemic, which started in March 2020, affected both parties' abilities to carry out those plans.

"We never really had a way to very effectively monitor our progress and see how we were doing because all of the entities that have been involved in our assessment and planning work were highly involved in pandemic response," she said.

Some data about COVID-19 is included in the study, like vaccination and infection rates in Polk and Grand Forks counties, but the pandemic's long-term impact on the health of the community is still unknown.

"I think there are some preliminary effects that we can obviously see, but I think there are long term impacts we won't see for quite some time," said Bayne.

Despite COVID-19 being a significant public health event since the 2019 study, Larson said she rarely heard COVID-19 as a primary health concern in focus group interviews.

"It was more peripheral," she said. "Once or twice people might have said COVID exacerbated mental health or substance use, but again, that is an individual perspective and you can't actually draw that full conclusion."

Swanson says near the end of this year, the Community Advisory Committee will officially establish community health priorities for the next three years and publish a full report. From there, Altru and Grand Forks Public Health will put together groups to develop an implementation plan for how to address those priorities.

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