M Health Fairview teen model treats drug addiction and mental illness together

Robin Geist knew her daughter Jay struggled with mental health, but it wasn’t until the 17-year-old started self-medicating with increasing doses of marijuana that she knew they needed to try a different approach.

Because of Jay’s history of childhood trauma, Geist explained she had “been on different medications for certain mental health issues” but that as her senior year in high school approached, the teen felt like her prescription medications weren’t helping anymore. So, Geist said, Jay started experimenting with marijuana.

“Then she started using marijuana in vape carts,” she said. “She became really dependent on them and was having major mood swings. In an attempt to feel better, Jay ended up feeling much worse.” 

Those bad feelings extended to home and school, Geist said. Jay’s grades and attendance were suffering, and her social life wasn’t much better. “She started hanging out with certain crowds where they weren’t very responsible. She went downhill the whole way around,” Geist said. “At home, she was very depressed, hiding in her room. It just wasn’t good.”

Though Geist knew something had to be done to help her daughter, it was Jay herself who actually made the change happen. She talked to a drug counselor and therapist at her high school, who told her about M Health Fairview’s Adolescent Co-Occurring Intensive Outpatient Program in Elk River, where teens went to specialized treatment during the day while earning school credit, then went home to be with their families at night. The program was designed to treat participants’ mental health and substance use issues at the same time.

The school counselors reached out to Geist and Jay, who said she was all in on participating in the program. “She was tired of feeling the way she was feeling,” Geist recalled. “She said she wasn’t feeling like Jay anymore. She could see herself spiraling. She saw this was an opportunity to dig out of the hole she was in. She wasn’t happy Jay — and she didn’t like that.”

In September, M Health Fairview relocated the IOP program to nearby Princeton Medical Center. Programming is offered year-round, with Princeton Public Schools staff offering classes during the day so participants can keep up academically during the school year. 

Jay chose to enroll in the program over the summer so she could focus exclusively on her mental health and substance use and return to school in person for her senior year. “She had fallen so far behind, it was either summer school or treatment,” Geist explained. “We all decided that the best option for Jay to get back on track was to do this over the summer.”

Jay’s focus and determination paid off, her mother said. She graduated early from the 12-week program, and when school rolled around this fall, she was armed with coping strategies that made her feel confident about going back without relapsing.

“She completed all of her assignments and she was really active in the group therapy sessions,” Geist said. “She really put in the work.” By the end of the program, Geist said, Jay “wasn’t using anymore, and she was still on board with getting clean and sober. We’re feeling confident about her continued success at this going into the future.”

Not all Northland IOP participants are as focused and committed as Jay, said Neil King, lead psychotherapist in the Princeton program. “There are times when we have clients that get here and they don’t want to do treatment,” he said. “Maybe they disagree with the recommendation to come to treatment in the first place. Maybe they don’t realize that they need help.”

For most young people struggling with co-occurring mental illness and substance abuse, change doesn’t come immediately, King said, but when it happens, the impact is significant. “It is always gradual change over a long period of time,” he said. “We try to teach them that they are taking baby steps: every week things are getting better. After 8-12 weeks, they look back and see that there has been a drastic change.”

Unique focus on treating co-occurring disorders

For Jay and Geist, the most appealing part of the co-occurring IOP program was its comprehensiveness. “The attraction for her to join this program is the [mental health] therapy part included in it,” Geist said. 

Because the staff focused on Jay’s mental health as well as her addiction, her mother said, “They were really able to help her in such a short period of time. At the beginning, she had her doubts. She was scared and didn’t know what to expect. But it was her decision to follow through. She wanted to be there and she did the work.”

Northland’s focus on co-occurring disorders among adolescents sets it apart, said Nicole Herlofsky, M Health Fairview manager of outpatient clinical programs. While many programs focus on teens’ mental health or their substance use, few tackle both at the same time.  

“I’m pretty sure we may have been the first agency in the state to start offering this integrated dual-diagnosis treatment for teens,” Herlofsky  said. “I know we were one of the early ones.”

It’s a small program, serving up to 10 young participants at a time. The IOP format, with the educational support, helps make it work for teens. 

The program also offers a rolling admission policy so teens can start at any time of the year without losing ground. “Kids are always starting and finishing as we go,” Herlofsky said, “which is really nice because sometimes kids aren’t super-excited about going to treatment. It is nice to have kids start alongside kids who are a little further along in the process. They can see someone else’s progress.”

Initially opened in Elk River in 2000, the program was created in response to an outbreak of suicide and drug use among young people in the community, Herlofsky said. “Community members and parents reached out to Fairview to bring in more services,” she said. “The dual-diagnosis program grew out of that.”

Mental health and addiction services for young people are harder to come by outside of the Twin Cities metro area, and for many families, driving long distances to get care for their teens can feel like a hardship. This program, while small, helps to fill a hole and make mental health and addiction care more accessible.

“When you get outside of the metro area there’s not much for adolescent mental health,” Herlofsky said. “We are the only program in this part of the state that focuses on co-occurring issues for teens. To have this kind of service accessible — a day program, where they go home at night — makes participation less of a hardship for everyone.”

Teen drug addiction and mental illness isn’t limited to big cities, Herlofsky said. In smaller towns like Princeton and Elk River, she explained, “We are seeing teens struggling with addiction to fentanyl and other opiates. Often people are thinking it is an adult problem or a big-city problem. But we are seeing that it is absolutely an adolescent problem and it’s a problem out here. We are seeing kids as young as 14-, 15-years-old who are addicted to opiates.”

The IOP format is a good structure for teens, Herlofsky said. While some young people need to spend at least some time in residential treatment to reset and relearn healthy habits, most young people are better served if they can stay at home in the community with their families. 

“If we can help kids stay at home, stay connected to their school, they have a better chance at success,” she said. “We try to have a very strong family component to this program. We know that the home environment is so important.”

During the school year, the structure of the Princeton Adolescent Co-Occurring Intensive Outpatient Program takes on a clear structure, he said. 

“We have a 12-week rotating curriculum. The content changes every week,” she said. “They get here at eight in the morning. We do a community group check-in: The clients come in, tell us about their day, tell us about how things are going at home. Then they fill out a diary card to keep track of their mental health symptoms.” 

After community group, King said, participants spend two hours on school work, supervised by a Princeton Public Schools paraprofessional: “After school, we get a lunch break and then we do group therapy for the last two hours of the day.”

This reliable schedule provides young people in the midst of great change and adjustment with something structured to cling to, something they can rely on in a world that has too often felt unreliable and unpredictable.

“We often see young people who live in this triangle of anxiety, depression, ADHD,” King said. “These are the big co-occurring disorders. Often a lot of our clients have experienced trauma in some capacity. Everything we do here is from the trauma-focused perspective. We want to show them they can trust, can rely on us, to give them the tools they need to heal.” 

‘She came out of her shell’

Geist believes that for Jay — and the rest of her family — the dual-diagnosis IOP program was a success. While the combination of mental health concerns and drug use had put her in a bad place, now — with a summer of intensive outpatient work under her belt — Jay’s back to being the smart young woman her mother remembers.

“The Jay that she is now is the Jay she was a few years ago,” Geist said. And her mother says she even sees that the program has helped Jay to make progress on issues that will help her down the road, in other parts of her life. 

“Certain things that she would normally dwell on and pick at or really focus on the negative, she’s made the decision that it’s not worth her time,” she said. “She seems so much more centered. She came out of her shell.”

The program stresses the importance of family therapy in participants’ healing, Geist said. This means that she was required to take part in weekly family therapy sessions led by King.

“Neil did a great job of not being one-sided,” Geist said. “There were times I was struggling to communicate what I was trying to say and he’d present it in a way to Jay that worked, like ‘I think what your mom is trying to say is this.’ His guidance helped us narrow down the problem.”

This work wasn’t always easy, Geist said, but in the end it paid off. “We had some hard discussions in family therapy as well. Whereas before it would have been lashing out or blaming, we were taking accountability for the role we played as well as communicating effectively. It helped us deepen our connections as a family.”

While being back at school — the place where Jay’s addiction was sparked and fed — can be challenging, Geist said so far Jay has been able to use the coping skills she learned in the program — combined with some key life changes — to stay on the straight and narrow.

Andy Steiner

Andy Steiner is a Twin Cities-based writer and editor. Before becoming a full-time freelancer, she worked as senior editor at Utne Reader and editor of the Minnesota Women’s Press. Email her at asteiner@minnpost.com.

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