North Dakota Comprehensive Behavioral Health System Analysis

Conducting an in-depth review of North Dakota's behavioral health system

We are working with the North Dakota Department of Human Services to understand community behavioral health needs and existing services, provide recommendations for closing gaps between community need and current resources, and supporting implementation of systems change activities.


We recommended a number of activities the state can implement to support individuals’ recovery in their homes and communities—including evidence-based approaches such as peer support, telebehavioral health, supported housing and employment, and integrated physical and behavioral health services.

  • Systems Design
  • Data Collection and Analysis
  • Technical Assistance and Training

Our Approach

Our goal is to support the state to sustain a behavioral health system that focuses on the health and wellbeing of the whole population to prevent mental health and substance use problems before they occur, identify and intervene early when behavioral health issues are present, and provide person-centered, trauma-informed, culturally responsive, and recovery-oriented services and supports to those with behavioral health–related needs.

Using various quantitative and qualitative data sources, we examined the service provision across the categories that constitute an optimal behavioral health service system.

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Social Determinants of Health

This work is informed by the social determinants of health, which are the social and environmental conditions in which people live. Roughly 10% to 20% of health determinants—including behavioral health determinants—derive from medical care, while social, behavioral, and environmental factors account for the remaining 80% to 90% of health outcomes. A well-functioning behavioral health system incorporates a continuum of social support services that includes employment, housing, and self-help, alongside clinical treatment.

Our Recommendations

Our recommendations focused on ways the state might strategically examine utilization patterns and need for services to ensure people receive the right level of care at the right time. Such strategies will allow the state to disinvest from costly and undesirable institutional services and reinvest funding upstream to promote population health and prevent and reduce the need for intensive behavioral health services.

Read the press release

Follow-Up: Setting the Course for Transformation

Since we completed our analysis, we've begun supporting the North Dakota Behavioral Health Planning Council to engage in coordinated, data-driven system transformation activities based on the recommendations from the study - an effort known as the North Dakota Behavioral Health Plan.

Working with stakeholders - including service users and families, advocates, providers, administrators, and other North Dakotans - we're helping the state set its course for ongoing system monitoring, planning, and improvements in the long term.

The HSRI study is a major milestone that outlines the next steps all our key partners need to work on over the next five years.

Kathy Hogan

North Dakota state representative and chairman of the interim Human Services Committee


North Dakota Department of Human Services

How can we help?

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