Imagine a student at a rural school, or an inmate in a local jail suffering from mental illness, but there is no psychologist or therapist nearby and available to help them deal with whatever issue is affecting him or her. Now imagine that student or inmate sitting down in front of a computer screen, a cell phone or a tablet device, and having a completely secure and well-transmitted conversation with a professional who might be on the other side of the county, or the other side of the state, but who was available to help.

That’s precisely what Carlton County and other members of the Arrowhead Telepresence Coalition - a coalition of Carlton, Cook, Lake, Koochiching and St. Louis counties - have been doing. The group is utilizing “telepresence connectivity” (think screens) to link community behavioral health providers with schools, jails, rural hospitals, law enforcement, tribal providers and others to improve access to services so there can be better outcomes.

Newsletter signup for email alerts

“As a collective coalition, we want to match wherever people might be presenting a mental health issue, make it as simple as just a phone call away,” explained Dave Lee, director of Carlton County Health and Human Services, which acted as a “laboratory” for the telepresence initiative. “Instead of having you come to us, we’ll find creative ways to come to you.”

They are winning awards for those efforts. Recently the Arrowhead Telepresence Coalition (ATC) won the county category for the 2016 Local Government Innovation Awards from the University of Minnesota’s Humphrey School of Public Affairs, an award which recognizes the creative ways counties, cities, townships and schools are making Minnesota better and doing things differently. ATC also received a 2016 County Achievement Award from the Association of Minnesota Counties.  

The combination of a growing mental health problem, a shortage of providers and a rural population without easy access to transportation was the challenge the combined counties - which cover 23 percent of the state between them - needed to overcome.

Rather than hire a boatload of new therapists when there’s already a shortage, they tried to use the resources that already existed more efficiently, with the help of a company called Vidyo, which Lee says offers the most advanced telepresence system in the world.

By counseling or assessing over the internet, location or travel time is no longer an issue, or an expense. And, while it may feel strange in the beginning to not be physically face-to-face with a client or a therapist, Human Development Center psychotherapist Amanda Radtke said people get used to it.

“If these services were not available, we would see people falling through the cracks and being unable to access the resources they need and potentially end up in life-or-death situations,” Radtke said.

Stacy Englund, an outpatient therapist at the Range Mental Health Center, said she loves being part of the ATC project. She was quoted in a video developed by the Humphrey school as part of the award.

“I actually have worked in a lot of different rural areas, in schools and I feel like it’s really a challenge for a lot of kids to be able to access mental health (services),” she said, adding that her productivity has actually increased since she’s been doing ITV therapy. “When I have an opening, no matter where I’m at, I can just use my laptop and I can access that and see students wherever they’re at and wherever I’m at.”

It’s made a huge difference at the Carlton County Jail since it began in 2014, according to Jail Administrator Paul Coughlin.

“Prior to that, we would have an inmate who would present with a mental health need and have to go to the ER,” Coughlin explained in the same video. “Once they were at the ER, they would more times than not be transferred to a hospital in Duluth, where the psychiatry services were. That was very cost prohibitive to the jail, because we had staff as well as security issues during that transport.”

The jail uses “telehealth” for mental health treatment as well as Rule 25 assessments for chemical dependency, which can help someone get addiction treatment more quickly if needed.

Now they’re saving money and time, and the services hopefully will help some people get treatment and overcome the challenges that landed them in the criminal justice system.

Telepresence isn’t new to Carlton County, Lee said, explaining that the county looked at ways to utilize it 10 years ago with isolated seniors and then kept expanding how it was used over the years. Then the advances made by Vidyo made the technology perform better while also being much more secure - but it was very expensive. Carlton County was working with people in Texas and Georgia to access Vidyo, but then Lee had a conversation at a conference with two employees of the state of Minnesota, which was also utilizing Vidyo for its own residential facilities such as the Minnesota Sex Offender Programs in Moose Lake and St. Peter.

Long story short, Carlton County and the Arrowhead Health Alliance got licenses from the state for Vidyo and became a “learning lab” for doing mental health through telepresence.

“In some places local government works because they communicate and don’t have political barriers,” Lee said. “They collectively own the problem and want to fix it. We’re a good size here to innovate … but then those efforts can be replicated across the region, just like they were with Text4Life,” he added, referring to the highly successful suicide prevention program developed in Carlton County that offers text messaging with counselors, something today’s young people often respond better to. That program is now happening all across the state.


Carlton County and the Fond du Lac Band of Lake Superior Chippewa were jointly recognized with a Circle of Excellence Award from the Commissioner of the Minnesota Department of Human Services for their School Linked Mental Health partnership.

Through the use of therapists from Fond du Lac Behavioral Health and Carlton County Public Health and Human Services, youth in three Carlton County school districts and the Fond du Lac Ojibwe School have increased access to mental health therapy in the school setting.

“What it means to be school-linked mental health is that we have licensed mental health counselors who go into the school as therapists,” explained Julia “Bunny” Jaakola, behavioral health coordinator for the Fond du Lac Human Services Division, in a state video. “The parents are really appreciating this because we live in a rural area where transportation is an issue. Sometimes the parents aren’t very well engaged with the school personnel and school-linked makes that barrier fade, so the therapist is working with the parents with the children and helping the child have more success in school.”

Other schools utilizing the school-linked mental health program include Wrenshall, Esko and Carlton. Lee said the program is expanding to other schools as well.

Fond du Lac school-linked mental health therapist Joseph Curran said he loves the program because it “brings the clinic to the child.” They don’t have to leave school and wait in a lobby for an appointment, missing two hours of their school day.

“We can get them seen in a culturally-based therapeutic intervention in 45 minutes and back to class instead of a two-hour removal from school,” Curran said in the video.

Lee said the school-linked program “dovetails” with the tele-mental health initiative too, because they can have a therapist at Esko, but if a student elsewhere needs services, they can connect via the telehealth network.

“We want to absolutely minimize the speed of response,” he said, noting that they can bring in additional resources via telehealth as well, perhaps someone from the crisis team in Duluth, for example.

Wrenshall School District Superintendent Kim Belcastro called the program “exceptional,” noting that the small size of the school means they “work very hard to have strong partnerships with different organizations to help us meet the needs of our students.”

Lee said partnerships and leaders who are willing to take risks are the keys to the success of both of the programs recently recognized by the state and other organizations. He is proud that Carlton County and its willing partners, in particular the Band of Lake Superior Chippewa, are being recognized for their innovative approach to the increasing mental health issues in the area.

“You need the leadership of the County Board and Fond du Lac, plus the involvement of other regional partners,” he said. “You have to be willing to take the risks and be willing to fail, because what we’re doing now is not working, it’s not solving the problem. We need to experiment more, do research and development, take risks where we might fail. Because we also might come up with better approaches to provide needed services to the public.”