When she decided to earn a PhD in sociology, Teri Fritsma first thought that she’d be a professor. But a few years in, she realized that line of work didn’t really suit her. Academic life has its perks, but she wanted a career with a clear connection to real life.
“For me,” she said, “It is far more satisfying to do work that has a direct, positive impact on people right now, work that can do some good. That’s what makes my life worth living, among other things. It is hard for me to imagine doing anything else.”
With the goal of using her research skills to make a positive impact on people’s day-to-day lives, Fritsma took the public service route, working as a labor market workforce analyst at the Minnesota State Colleges and Universities system and the Minnesota Department of Employment and Economic Development (DEED) before joining the Minnesota Department of Health (MDH) as lead health care workforce analyst.
While academics might have more control over what they study or how they structure their research, Fritsma said she’s never questioned the tradeoff: “For me it is the right thing to do.”
In recent years, Fritsma has focused on mental health workers in Minnesota. Her research has uncovered troubling trends, including Minnesota’s aging psychology workforce, the impact of low pay rates in the industry and the statewide shortage of psychiatrists.
Most recently, Fritsma’s research into the shortage of licensed alcohol and drug counselors (LADCs) in Greater Minnesota helped influence state legislators to add LADCs to a list of mental health professionals eligible for a state-run loan forgiveness program if they agree to work in rural Minnesota for a minimum of three years. Her advocacy also led to increased funding to support pre-licensure internship supervision hours.
Her efforts led leaders at NAMI Minnesota to select her for the organization’s annual Public Service Award, which recognizes a local, state or federal government employee who demonstrates leadership and commitment to improving the mental health system.
Nitika Moibi, supervisor of MDH’s Workforce Analysis program, nominated Fritsma, whose expertise and experience Moibi considers to be, “One of the best-kept secrets in town.”
“You don’t go into state service for compensation,” Moibi said. “You go into it for the satisfaction of knowing your work is making a difference and that you are serving the greater good that benefits all of Minnesota.”
Sue Abderholden, NAMI Minnesota executive director, praised Fritsma’s “incredible work tracking graduation outcomes for students in the mental health fields, mapping pathways to licensure, and quantifying ‘leaks’ along the pipeline.”
Abderholden said she’s appreciated Fritsma’s quick response to her requests for assistance and said that NAMI staff has appreciated partnering with her on the expand loan forgiveness program and LADCs. “As a state employee, she goes above and beyond and we are so pleased to have the opportunity to partner with her.”
For Fritsma, the award felt like a big deal. “It is such a huge honor to me because I care so much,” she said. In her acceptance speech, she talked about her family’s and her own personal experience seeking out mental health care. That kind of care has improved her life, Fritsma said, and she thinks everyone in the state should be able to have the same kind of access.
“To me it seems as obvious as making sure everyone has food, clean water, housing, medical care, and so on. What’s also pretty obvious is that we don’t have enough — not nearly enough — mental health professionals to meet the need, especially now.”
A real shortage
While Fritsma’s research has revealed looming — and current — shortages across Minnesota’s mental health workforce, the greatest need is in rural parts of the state. In recent years, she’s taken her findings on the road, talking to organizations and individuals about the gravity of the situation, and making suggestions about possible fixes.
Lance Egley, a former governor for the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH) and staff development coordinator at Red Lake Nation Tribal Chemical Health Program, said he met Fritsma two years ago, when she presented at a MARRCH conference.
Her research on regional care disparities struck home for Egley, but he said that one number felt particularly significant: “When you get to the frontier areas of the state or even the small towns, there is only one LADC for every 13,576 people.”
Egley, who lives in Bemidji, was well aware that LADCs are few and far between in his part of the state, but he didn’t realize that the situation was quite that bad. Rural communities have been hit hard by the addiction crisis, he said, and people who live in remote communities literally have nowhere to turn when they are in addiction crisis.
Fritsma’s close analysis of workforce trends revealed that even when local colleges and universities are able to graduate trained addiction professionals, many are leaving the region — or switching to more lucrative health care careers. Her presentations suggested that a few strategies could possibly help stem the tide and attract or retain more addiction professionals to the region.
“I realized there was a real connection between rural health disparity and the workforce work that Teri was doing,” Egley said. “We started thinking about where people come from as LADCs and where do they go [after graduation]. We don’t seem to be keeping them all.”
Marti Paulson-Strommen, executive director/CEO of Project Turnabout, a nonprofit addiction recovery services organization with locations in Granite Falls, Marshall and Wilmar, said, “The LADC is the main caregiver of the patients’ treatment. They are the pivot point of our multidisciplinary team.”
Her organization tries to maintain a ratio of 6-7 patients to every primary LADC, she explained. “When you have approximately 200-plus beds you need a lot of primary LADCs.” Recently, that’s become a tall order, Paulson-Strommen said: “In the last year-and-a-half-to-two-years, the shortage has become stronger and stronger. Rural Minnesota is at a disadvantage simply because of remote placement.” It doesn’t help that nearby schools have been shutting down their LADC training programs, she added.
Fritsma’s research has the potential to help shift the outlook for employers like Project Turnabout, Paulson-Strommen said. “Her research makes a huge, significant difference because people don’t realize those numbers until somebody puts them in front of them. That makes all of the difference in the world.”
Impact of the change
The new loan-forgiveness legislation will make LADCs who agree to practice for a minimum of three years in a designated rural area of the state eligible for an annual award of $9,300. That help is “huge,” Fritsma said. “LADCs have never been eligible for loan forgiveness. They are now.”
While Egley doubts that the program will be able to fully balance the workforce discrepancy between rural and urban area of the state, he is optimistic that it will at least narrow the gap: “You can see that the discrepancy we’re starting with is huge. But I think it will make a difference.”
Paulson-Stommen said that such loan forgiveness programs can be “one of the reasons that LADCs choose to stay here.” Her organization is also developing other programs designed to attract and retain mental health staff. “We have really worked hard at Project Turnabout to develop our own program which allows our staff to return to school and further their education. We have tuition reimbursement and we work hard to start to grow our own and get them interested in the LADC program.”
Adding LADCs to the state’s mental health workforce loan forgiveness program will provide a big boost, Paulson-Stommen believes. “I think it is going to play a significant role. Tuition is so incredibly expensive.” Because LADCs make less than other health care professionals, she added, “We need to be able to entice them with other benefits, this being at the top of the list.”
To Fritsma, changes like this are an official recognition that easy access to mental health care, like access to physical health care, is a right that should be afforded to every person in the state, regardless of where they live.
“My hope is that this will move the needle and fundamentally change the dialogue – maybe even the way we compensate mental health providers,” she said in her acceptance speech. “Obviously NAMI has always known this, but perhaps it’s taking a global pandemic for the rest of us to realize that without mental health, there isn’t health.”