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August 2025

Perceptions of Mental Health and Substance Use and Misuse in North Dakota and Minnesota Communities as Identified by Community Heath Needs Assessments.

Avram Slone is a Research Specialist with the Center for Social Research at NDUS with experience in survey research, data analysis, needs assessment, and research dissemination. His primary areas of research since joining the Center have been in public health and child care. Avram has a Master’s degree in Sociology from the University of Kansas.

A community health needs assessment (CHNA) is a systematic approach to identifying and addressing the health needs of a specific community. Typically, CHNAs involve collecting data and engaging with community members to identify addressable health needs and then using the findings to develop plans to address those needs. Between August 2024 and May 2025, the Center for Social Research at North Dakota State University (CSR) collaborated with CommonSpirit Health to conduct CHNAs for the service areas of 13 North Dakota and Minnesota hospitals in the CommonSpirit Health System. CommonSpirit Health is a not-for-profit national healthcare system operating more than 2,200 care sites in 24 states. Every three years, not-for-profit hospitals, like those operating under the CommonSpirit umbrella, are required by the Patient Protection and Affordable Care Act to conduct CHNAs within their service areas in order to identify and better address community health needs. In this case, service areas included the county in which a hospital was located as well as neighboring counties in which the hospital in question is the most readily accessible hospital for a substantial proportion of residents. The communities that participated in these assessments were Baudette, MN; Bismarck, ND; Breckenridge, MN; Carrington, ND; Devils Lake, ND; Dickinson, ND; Garrison, ND; Lisbon, ND; Little Falls, MN; Oakes, ND; Turtle Lake, ND; Valley City, ND; and Williston, ND.

The CSR took a three-pronged approach to collecting the data needed to perform these CHNAs. Data were gathered by means of a digitally distributed community survey, the collection of secondary data from publicly available resources, and a community stakeholder meeting held after the closure of the community survey to discuss its implications and oversights. The CSR developed 12 of the 13 community surveys. In Bismarck, the survey was developed and administered by Sanford Health. Surveys developed and administered by the CSR were individually tailored to each community, and were therefore similar but not identical to one another.

One of the primary goals of these assessments was the identification and prioritization of specific actionable community health needs (Hodur, Schroeder, and Slone 2025 a-m). Although different participating communities identified varied needs for prioritization, there were several commonalities across most communities. Most prevalent amongst these commonalities were concerns about mental health and the availability of mental health treatment, and substance use and misuse and the availability of substance use and misuse treatment. This article discusses the extent to which community respondents are concerned about mental health and substance use and misuse in their communities, as well as the changes that they perceive regarding the severity of these concerns since CommonSpirit Health’s previous round of community health care needs assessments in 2022.

Perceptions of Mental Health

Mental health was identified as a top concern in each community that participated in the CHNAs. Respondents consistently ranked the state of mental health and access to mental health care among their highest priorities. Among the communities that were surveyed directly on general mental health concerns, the majority of respondents expressed being either somewhat or very concerned about mental health issues in their area. In Devils Lake, 96 percent of survey respondents reported being somewhat or very concerned about mental health in their community. Concern levels in other communities ranged from 69 percent in Turtle Lake to 92 percent in Williston. Although the survey conducted in Little Falls did not specifically address general community mental health concerns, 36 percent of respondents in Little Falls indicated that they dealt with mental health issues in their own homes either sometimes or often.

In line with widespread concern about mental health, many respondents also highlighted suicide as a critical community issue. Suicide was also regularly cited as an area of concern, with the majority of respondents in every community indicating that they were somewhat or very concerned about suicide in their community. In Baudette, 92 percent of survey respondents indicated that they were somewhat or very concerned about suicide in their community. The proportion of respondents in other communities who indicated that they were somewhat or very concerned about suicide ranged from 53 percent in Turtle Lake to 88 percent in Devils Lake.

Residents in participating communities expressed not only concern about mental health and suicide, but also dissatisfaction with the availability and adequacy of local mental health services. In Williston, for example, 81 percent of respondents disagreed with the statement that their community had adequate mental health services. In other communities, this level of dissatisfaction ranged from 30 percent in Carrington to 77 percent in Dickinson. Carrington and Baudette (36 percent) were the only communities where fewer than half of respondents expressed dissatisfaction with local mental health services.

Although the surveys conducted in Little Falls and Bismarck did not specifically address general community mental health concerns, the surveys conducted in those communities still highlighted mental health as an area of serious concern. Thirty-six percent of respondents in Little Falls indicated that they dealt with mental health issues in their own homes either sometimes or often. In Bismarck, 70 percent of respondents who felt that their community needed improved access to specific healthcare services cited mental health care as a service that needed improvement.

Perceptions of Substance Use and Misuse

Substance use and misuse were also cited as priority concerns in each of the 13 communities that participated in the CHNAs. In Devils Lake, 97 percent of respondents indicated that they were somewhat or very concerned about substance use and misuse including alcohol, prescription drugs, tobacco, vaping, and illicit or street drugs. The proportion of respondents in other communities who indicated that they were somewhat or very concerned about substance use and misuse ranged from 74 percent in Turtle Lake to 94 percent in Dickinson and Williston. While the surveys conducted in Little Falls and Bismarck did not specifically address general community concerns about substance use and misuse, 29 percent of respondents in Little Falls indicated that they dealt with substance use and misuse in their own homes either sometimes or often and 44 percent of respondents in Bismarck who felt that their community needed improved access to specific healthcare services cited addiction treatment as a service that needed improvement (second only to mental health services).

Changes in Perception Since 2022

Each community, with the exception of Little Falls and Bismarck, was asked to consider whether priority issues had gotten worse, stayed the same, or improved since the previous CHNA was conducted in 2022. In general, community sentiment was that both mental health and substance use and misuse had either stayed the same or gotten worse since then.

The general sentiment in Breckenridge, Devils Lake, and Dickinson is that these mental health and substance use and misuse have grown as issues since 2022. Concerns about the growing burden of substance use and misuse were most evident in Devils Lake, where 76 percent of respondents indicated that substance use and misuse had become a more serious issue since 2022 and only 5 percent indicated that it had become a less serious issue. Growing concern about mental health was most evident in Dickinson, where 62 percent of respondents indicated that depression and anxiety had grown as community issues since 2022 compared to only 9 percent who felt that the issue had improved. In Breckenridge, 52 percent of respondents indicated that substance use and misuse had gotten worse, while only 12 percent indicated that it had improved. Similarly, 49 percent of Breckenridge respondents felt that mental health in their community deteriorated since 2022, compared to only 14 percent who thought that it had improved.

In Williston, Lisbon, Garrison, Baudette, Valley City, and Oakes, the largest proportion of respondents felt that the issues of mental health and substance use and misuse had stayed essentially the same since 2022, or that some aspects had improved while others had not. In Valley City, for example, 65 percent of respondents indicated that they felt that depression and anxiety in youth had gotten worse since 2022, while 51 percent indicated that substance use and misuse had gotten worse. However, 34 percent of Valley City respondents felt that the availability of mental health services in their community had improved as compared to the 22 percent who felt that it had gotten worse. In Oakes, a majority felt that the issue of depression or anxiety had remained the same since 2022 (52 percent) and that the issue of stress had remained the same since 2022 (53 percent). However, a large percent of respondents in Oakes (42 percent) felt that the availability of mental health services had improved.

Carrington was the only community in which respondents indicated that perceptions of both issues had notably improved since 2022. Although 44 percent of respondents in Carrington indicated that alcohol use and abuse had not changed since 2022, 37 percent felt that the issue had improved, compared to only 19 percent who felt it had gotten worse. A majority of respondents in Carrington (51 percent) felt that mental health had improved in their community since 2022, compared to only 11 percent who felt that it had gotten worse.

Wrap up

Although there are other issues that multiple communities indicated as priority health concerns, mental health and substance use and misuse were the most prevalent. Each of the 13 communities that participated in the CHNA indicated that these were areas of particular concern, and when asked, most respondents in most communities indicated that the treatment options available were inadequate. Furthermore, in most communities there is little indication that the communities perceive these issues to be improving.