Tahran 1

As a Licensed Professional Clinical Counselor (LPCC) for over 10 years now, Amy Tahran has had
her share of both fulfillment and distress over her career.

Amy currently works for the South-Central Human Service Center in Valley City. She is
responsible for performing diagnostic assessments on clients with mental illness and addiction issues,
planning courses of treatment, conducting risk assessments, and directing care for the entire Center.
Previously, she has held positions as a high school guidance counselor (which she sheepishly confesses
she’s glad to no longer be doing), worked both on the sex offender residential treatment unit and as a
general therapist at the North Dakota State Hospital for a total of seven years, and recently operated a
private practice in her hometown of Valley City for several years.

As we conversed through the computer screen, I could clearly see the compassion and
excitement in her eyes, and it was obvious that she was a good fit for the field. Her hair was dyed blonde
but it was gracefully fading to gray, maybe as she grappled with whether or not to let it go all the way.
She’d think about the questions for a time after I’d ask them, and then she’d answer quickly, but
passionately.

Her life’s path took a hard turn in the direction of the mental health field when, around 2004,
she worked as a member of the direct care staff of the State Hospital. In this job, she was able to witness
the work that clinicians and psychologists were doing in treating their patients, and this inspired in her a
“desire to do more, to learn more” (A. Tahran, personal interview, September 10, 2021) so that she
could become one of those professionals herself. She finished her education in 2010, with a bachelor’s
in English and a graduate degree in counseling.

There is much she enjoys about her current job and the field in general. Primarily, of course, her
fulfillment comes from watching her clients get better and “being a part of their recovery; that’s the
whole reason of doing it.” She says, “When you have somebody call you later and tell you how great
they’re doing, that’s just awesome, and it makes up for all the ones that slip through the cracks.”

She is not without her gripes, however. Obviously, there’s only so much she can do for her
clients, and it hurts her to watch so many of them succumb to old habits. It’s also emotionally taxing.
But her biggest frustrations stem from institutional issues.

One of the biggest needs that isn’t being filled right now is that of transitional living for the
mentally ill.
Tahran 2

Currently, there is massive public support to treat drug addiction in the United States, and that’s
fantastic. As a result of this support, there is also plenty of resources for substance abusers, including
residential treatment programs. These programs allow a place to stay for time frames usually ranging
from one to three months, allowing enough time to cleanse the system of the drugs, establish good
habits, and create a network of support for those suffering from addiction. With little exception, people
that need help with drug addiction can get it, and if they want to get better, they are offered the
resources to do that.

The story is far different when it comes to mental illness. In North Dakota, any place offering
residential treatment requires that the individual applying for it has a substance use disorder. If the
individual does not have a drug addiction alongside a mental illness, there are no effective rehabilitation
options for them. This boggled my mind.

As it is right now, the only option these victims of mental illness have during a particularly bad
episode is the State Hospital, which offers short-term treatment usually lasting between 24 hours to 2
weeks at most. This at least removes them from most of their ability to cause harm to themselves or
others, and can just start to begin a process of recovery and treatment. But these short time frames are
not long enough to accomplish what makes residential treatment so much more effective.

Of course, the clinicians at the State Hospital would like to be able to treat their patients with
more care and see them get better. But the funding just isn’t there. They’re forced to transition people
out as soon as possible in order to make more space for the next one. And instead of making more
room, a lack of funding has caused the Hospital to close two whole units in recent years, each unit
consisting of around 20 beds. This, in a time when mental illness is at an all-time high and shows no
signs of slowing down.

Amy makes sure I know that it’s not entirely a bad thing that the State Hospital is incentivized to
transition patients out. In the past, people would become dependent on the Hospital, and wind up living
their whole lives in treatment with no desire or incentive to attempt to lead a normal life. There was an
attitude that the severely mentally ill could simply not be rehabilitated, and this is clearly wrong. But, at
the same time, there are people routinely being transitioned out of the institution that could pose a
serious threat to themselves and their communities.

So, Amy says, it becomes a “sad, hopeless, cycle, where people are transitioned out and months
later are admitted again for the same reasons.” And there’s simply nothing the professionals can do
Tahran 3

without more resources. The clinician and patient can make a plan of treatment before the patient is
released, but there’s no way to keep the patient accountable and ensure that they continue treatment.
And there’s certainly not enough time to make the treatment a habit, or establish those relationships
that make recovery possible, or even instill basic life skills that a lot of mentally ill people lack.

So, after a short stay, patients are transitioned out, and most of them skip out on continuing
their treatment, fall back into their same crowds and triggering environments, and they either hurt
someone and go to jail or are readmitted months later, continuing a hopeless cycle.

Amy has more than enough first-hand experience with this in her decade in the field, and since
it’s such an institutional problem, there is little she or her coworkers can do. One of the scenarios that
still sticks out to her is when a dangerously suicidal patient came to her, and the total helplessness of
the situation:

“Imagine the frustration of seeing someone suicidal, who has a plan, and who is in desperate
need of psychiatric treatment, and the state hospital is out of beds. If the state hospital is out of beds, so
is everywhere else. What do you do? And that is real. That has happened. You send them home and you
hope and pray to God that they’re there when you check on them in the morning.” (A. Tahran, personal
interview, September 10, 2021).

Things shouldn’t be that way. We’ve ended much of the stigma of drug addiction. Now we must
do the same with mental illness.