Before it Gets Better: Mental Health in South Dakota

Posted by Katy Beem on

This summer, the South Dakota Department of Health reported that last year the number of suicides in South Dakota reached an all-time high. According to that report, the state experienced 192 suicide deaths in 2017 and suicide was the second leading cause of death for South Dakota’s young people ages 15 to 25. The Centers for Disease Control and Prevention reported that suicide deaths in South Dakota increased by 44.5% from 1999 to 2016 – compared to the 25.4% increase seen nationally.


Dr. Stephen Manlove has practiced psychiatry in South Dakota since 1987. After 25 years with Regional Health, he currently directs a private psychiatry practice in Rapid City and coordinates mental health services for Pennington County Jail.

Manlove is frank in his views about the state of mental health care in South Dakota and equally candid about what he sees as the political difficulties that hamstring solutions. “The mental health system in South Dakota is worse than it’s ever been in the 31 years I’ve practiced here,” says Manlove. “It’s slowly deteriorated. A lot of factors contribute to that. But, it’s not impossible to fix it.”


BeforeItGetsBetter_Steve Manlove.jpgDr. Stephen Manlove


All Hands on Deck

“It’s a huge political endeavor to rearrange the money it takes to improve mental health care,” says Manlove. “So, it really depends on how big a deal we’re willing to make it. It’s a big deal to me because I think it’s shocking and inhumane, and reflects the inhumanity of our world, that we have the most suicides ever in our state, and a lot of them are kids, which is really distressing.” Manlove says a commitment to improving the state’s mental health system begins in the governor’s office. “Really, to make anything happen in South Dakota, the governor has to run it,” says Manlove. “The governor needs to get involved with the task force that’s already in place. I’ve also advocated the governor develop a task force that involves both senators, the congressperson, Indian Health Services (IHS), Bureau of Indian Affairs (BIA), and tribal councils to specifically address the IHS issue.”


Removing Stigma

“The illnesses that make people commit suicide are serious, true medical illnesses,” says Manlove. “And all medical illnesses have complex, psycho-social issues. Heart disease does too. And just as all medical illnesses have layers - are affected by what environment you grow up in, what you eat, how much you exercise - mental health deserves to be treated just like other healthcare problems. And like with all healthcare needs, people have a right to decent mental health care. People with mental health issues are so clearly stigmatized because we don’t fund treatment for them, whereas we do with other illnesses.”


Recognizing Geography and Culture

Manlove says reimagining mental health services in the state begins with accepting that South Dakota is unique, geographically and culturally. “There’s hardly a place in the world like it,” says Manlove. “Consultants come in with what works in Atlanta or Minneapolis. But we are a combination of being very, very rural, with an extensive Indian population and interfacing with Indian Health Services. We are a different cultural setting and it’s a whole different picture.”

Manlove suggests rebuilding the mental health system by dividing the state into three or four regions. Each region would be served by its own publicly-privately partnered state hospital, rather than by the Human Services Center in Yankton, the state’s sole in-patient psychiatric treatment center. “Each of those regions could develop their own tiers of treatment that work together, and each of the hospitals could have a continuity of care system that reaches down from the state hospital to outpatient offices. Some pieces are already there; it’s a matter of filling in the blanks. This would provide access to regular outpatient assessments, medication, psychotherapy. One state hospital has never worked for West River. It just triggers recidivism. People get out of Yankton and come back and live here [in Rapid City] without any follow up.”


Funding and Medicare

Manlove says lack of funding is a principal reason for the state’s scant mental health services. “The funding we have is not adequate to get people to come here and practice,” says Manlove. “Specifically, Medicaid needs to be rethought so people can be reimbursed adequately to what they can be paid in other states. We have to improve the reimbursement system so there’s a possibility of making mental health services financially feasible.”


Early Child Bonding for Resiliency

Manlove believes firmly that early childhood development programs offer the earliest form of suicide prevention. “We have to rethink our commitment to early education and having kids ready for school,” says Manlove. “We happen to have a culture where we have a lot of impoverished people having children who don’t have a lot of support or can offer their children a lot. As a result, many of these kids grow up with significant attachment disorders. Those factors lead them to be much more prone to being self-destructive when things are not going well in their lives or when they become depressed.”

Manlove says rethinking how we treat our children is key. “One of my peeves is saying we need more crisis lines, more 211 numbers you can call if you’re suicidal,” says Manlove. “But that’s just parking the ambulance at the bottom of the cliff. We need to move people away from the cliff and you do that through early childhood interventions.”


Stronger Together

In Rapid City, Dr. Manlove is involved with the West River Mental Health Alliance, an organization formed by Regional Health, the Rapid City Police Department and Pennington County Sheriff’s Department. The organization was formed in early 2017, in part, after Rapid City Regional Hospital announced they’d no longer accept patients suffering from mental illness when the hospital is full. In keeping with a state statute, mental health patients are instead sent to jail for temporary holding. Manlove says this alliance, as well as the state’s mental health task force, are encouraging. “I’ve seen more interest than I’ve seen in a really long time,” says Manlove. “And these are people from all different political perspectives: very, very conservative Republicans, very liberal Democrats. But we drive down Main Street and we see the problem. We need to really take care of the things that communities need to take care of - kids and mentally ill people. If we do, we’re going to all do better.”

Before It Gets Better

SDPB’s Multiplatform Discussion on Mental Health in South Dakota


In the Moment

SDPB Radio: Thursday, November 15 - 11am-1pm (10am-noon MT)

What is the current state of mental health in South Dakota? What are our most urgent needs?  Tune in for a live panel discussion featuring:

• Dr. Stephen Manlove, Rapid City Psychiatrist

• Dr. Lee Baugh, Associate Professor of Neuroscience & Associate Director, Center for Brain & Behavior, Sanford School of Medicine

• Thomas Otten, Assistant Vice President for Behavior Health Services, Avera Health

 The program also features intimate interviews with South Dakotans with stories of hardship and hope in the face of depression and mental illness.


South Dakota Focus

SDPB1: Thursday, November 15 – 8pm (7 MT)

A live conversation with members of South Dakota’s Mental Health Task Force Summer Committee, including committee Chair Sen. Deb Soholt.




subscribe to sdpb email updates food blog link image learning blog link image living blog link news and information blog link science and technology blog link sports blog link image

Related content from SDPB Radio - Art

The Enduring Simplicity (And Complexity) Of Michael Hall

In The Moment ... September 20. 2018 Show 426 Hour 2 Michael Hall writes picture books that delight and endure. He's...

Art That Takes You Home

In The Moment ... July 18, 2018 Show 381 Hour 2 Jon Crane creates "Art that Takes You Home." After a tour at...

Renowned Artists Visit Oscar Howe Summer Art Institute

In The Moment ... June 19, 2018 Show 361 Hour 2 Art can be meditation, expression, activism, and escape. It can also...

Eagle Butte Artists Learn Tips To Flourish

Artists who turn their passion into a business venture can find it a challenge. They need to figure out the details...


The Multiple Hearts Of Laura Geringer Bass

In The Moment ... September 20. 2018 Show 426 Hour 2 When 13 year-old Briana's dad dies suddenly, she is faced with...

Read, Baby, Read: What's America's Best-Loved Novel?

In The Moment ... May 22, 2018 Show 342 Hour 1 What's America's best-loved novel? You get to decide. PBS launches...

Author Kirk Wallace Johnson's "The Feather Thief"

In the Moment ... May 1, 2018 Show 327 Hour 1 The centuries-old art of salmon fishing fly-tying has a dark side. It...

Jane Yolen Celebrates #Yolen365 And Counting

In The Moment ... April 26, 2018 Show 324 Hour 1 In March, author Jane Yolen released her 365th book. That means you...


Matthews Opera House Season Preview

In The Moment ... September 26. 2018 Show 430 Hour 2 The Matthews Opera House subscription concert series begins...

Fun Approach To Music Theory

Andrew Rogers – in home music lessons designed for children and young adults. Uses a unique teaching style that...

The Literary Style of Reina del Cid

Reina del Cid kicks off her summer tour with a stop in Sioux Falls at the Icon Lounge. She joins SDPB's Lori Walsh...

Eric Johnson Returns For Black Hills Playhouse Opener

In The Moment ... May 29, 2018 Show 346 Hour 2 Leave the ordinary behind at this year's Black Hills Playhouse Season...


Broadway Choreographer Chet Walker

In the Moment ... April 9, 2018 Show 311 Hour 1 The University of South Dakota Theater Department presents "Cabaret"...

Images of the Past: Stage To Screen

In The Moment ... November 27, 2017 Show 227 Hour 2 A new exhibit at the Old Courthouse Museum tells the story of...

Personalities: From Huron High to Broadway

Singer, actor, and teacher Joseph Mahowald graduated from Huron High School in 1977. He went on to study music and...

In The Moment ... Alex Meyer's Scenic Design

In The Moment ... May 10, 2017 Show 090 Hour 2 Alex Meyer. He's a junior art and theater major at Augustana College...