The signs of trouble should have been obvious long before Robert Bracken shot his son Justin, his brother Richard, his employer Doug Dharmage, and finally himself with a .357 revolver on August 29, 2022.
There was an unimaginable scene of four corpses lying in a North Dakota grain field under blue skies, and the act seemed fueled by towering instability. A formal investigation into the incident continues, and the ultimate motive and circumstances remain unknown.
It was one of two tragedies that happened late this summer, highlighting the need to address mental health and substance abuse issues statewide.
A week after the bracken shooting, near Gackle, Ryan Storbeck hired South African visa worker Johannes Steenberg to run the combine. Storbeck and Steenberg reportedly split 30 packs of beer before starting the combine on a cool, cloudy afternoon, according to the Stutzman County Sheriff’s case report.
Not all cases of behavioral and mental health problems end so tragically. When they do so, they expose enormous barriers to treatment and prevention, including social stigma, the tradition of alcohol in many communities, and too few counselors and other practitioners to meet needs.
Heather Gibbens, a counselor at Evolution Counseling at Devil’s Lake, said many North Dakotans are reluctant to deal with their mental and behavioral health struggles, or those of those close to them.
Gibbens, who is from Kandaw, said stigma can be a real barrier for people seeking counseling in the community they know.
When they finally admitted it was time to reach out, they realized that most providers of mental health, psychiatric, and addiction services have a two- to three-month waiting list. increase.
“That’s why I started my private practice, essentially so I could do things a little differently and reach out to meet people where they are. Many people may not be ready for the services they need,” she said.
“People are very busy,” Gibbens said.
At the Hartview Foundation’s 16-bed residential addiction treatment facility in nearby Cand, 26 people were on a waiting list at the time of the visit, according to operations manager Shari Timms.
“We were packed. It seems like a place with no people moving out, but four people are moving out the next week, so it really depends on the flow in and out,” Tims said. said in October.
According to official records, both Ryan Storbeck and Robert Bracken had histories of alcohol-related arrests and court-ordered substance abuse evaluations.
It is unknown if either ever asked for or received help. Most of the family and friends who were traumatized by the incident were reluctant to talk about the transcript of the story.
Robert Bracken’s daughter-in-law, Rachel Angela Bracken, was never near Robert Bracken, nor did she know what problems he was suffering from.
“I think the whole state of North Dakota drinks the most,” she said. You have to want to ask for help, a lot of people don’t ask for it.”
When contacted, the North Dakota Criminal Investigation Service declined to comment on the bracken case or whether a toxicology report would be issued, saying the investigation was still ongoing.
In addition to stigma, lack of insurance, coverage gaps, transportation distances, and associated costs are other factors inhibiting treatment.
According to Jennifer Spatola, Director of Clinical Services at Heartview, insurance is available in the midst of the pandemic, but treatment for telehealth addiction is not currently covered by insurance.
She said the lack of telemedicine services affects people who do not have treatment available nearby, who lack transportation or who have difficulty finding stable housing.
“A lot of people signed up because it took them an hour just to answer the phone and now their insurance doesn’t cover it,” says Spatola.
Sometimes the barrier is their small-town alcohol tradition.
Gibbens says I often hear clients say, “‘There’s nothing for me to do.’ You always say the opposite of addiction is primarily connection, right? I encourage people to join their communities.” I’d like them to, but there’s nothing they can do,” she said.
“Everybody can struggle with these things,” Gibbens said.
Supatra says it’s increasingly not one or the other when it comes to mental and behavioral health.
“I think 98 percent or 99 percent of people now have mental health and addiction issues, but it used to not,” Spatola says.
Behind the headline-grabbing tragedies is a constant stream of more regular mental and behavioral health problems.
Suicide is the second leading cause of unnatural death in North Dakota, ranking the state 12th nationally, according to the latest data from the Centers for Disease Control and Prevention.
Suicide is also the leading cause of violent death in the state. In 2021, there will be a total of 164 suicides followed by 131 drug overdoses.
These behavioral health deaths far exceed the 20 homicides and 5 accidental firearm deaths in the same year, according to state health and human services. [NDHHS] data.
North Dakota’s alcohol mortality rate is also higher than average, at 18.4% compared to the national mortality rate of 10.2% in the most recent year.  The data was available, according to NDHHS.
Alcohol-related accidental deaths that year were 41, compared with the national average of 28.
A recent NDHHS survey of over 5,800 respondents in August found that between 11.1% and 13.5% said their mental health was ‘poor’ at least three days up to seven days a month. . Another 10.4% to 12.8% said the 8th to 29th of the month are “bad”.
Pamela Sagness, executive director of behavioral health programs at NDHHS, said there are widening disparities in treatment across North Dakota. Scaling up is problematic due to lack of manpower and funding.
“We certainly need more providers,” says Gibbens. “If someone comes through my door, if they need to be somewhere else, I need to help them get there. We need help understanding this process that has rules and regulations for
If some of these disjointed processes had been addressed before, then recent tragedies like last summer could have been flagged when warning signs appeared, experts say. .
Despite these gaps, one area where the department has made some progress, according to Sagness, is through its success in training peer support specialists. These peers are typically people who have beaten addiction, mental health issues, or both.
Over the past three years, NDHHS has trained more than 800 professionals to work on the front lines of health care, especially in rural areas.
“They’re not helping state hospitals. They’re not doctors, but they’re connectors,” Sagness said. “It’s someone you can connect with in your little country country, call in the middle of the night on a Saturday, someone who knows how to access those services.”
According to Sagnes, many trainees come from rural areas. “They saw it in their hometown,” she said. “They saw that gap, or missing piece.”
Additionally, federal funding has enabled NDHHS to build a registry of treatments and providers that began in October.
The directory lists 174 mental health providers, with more to come, Sagness said.
“At least now I can send an email to every mental health provider and say, ‘Now that we have funding, can you tell us how we can close these gaps?’ We can see where the biggest gap is,” she said. “[Before] We didn’t know either. ”
This article is the first in a two-part series on access to mental and behavioral health care in North Dakota.
Here are some resources for those struggling with mental health and addiction.
The North Dakota Farmers Union also provides a resource page for farmers and ranchers dealing with farm stress and other behavioral health issues at https://ndfu.org/farm-stress/.
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