Latest / The Mental Health Evolution / Ep 52: Pessimism Is Not a Strategy with Marcus Schmit

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Ep 52: Pessimism Is Not a Strategy with Marcus Schmit · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick podcast
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network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about
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what's changing in mental health and why it
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matters.
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I'm your host, Rachel Harrison, inviting you into
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honest conversations with people from all perspectives in
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the field, clinicians, tech founders, investors, insurance companies,
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and all the folks in between.
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Let's explore what's working, what's not, and what's
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next.
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Hey, everyone.
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Thank you for joining us today on the
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Mental Health Evolution podcast.
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I am just excited to talk to you
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about what this episode with Marcus Schmidt with
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NAMI of Minnesota was all about.
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If you have been noticing in the news,
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Minnesota has had a lot of things happening
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there, a lot of different traumatic situations, a
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lot of stress on their Medicaid system and
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their support net in particular.
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And this conversation with Marcus was really inspirational
1:07
to hear not only what he is leading
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with NAMI in that place, but what people
1:14
are stepping up and doing as he talks
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about Minnesota is a neighborly place.
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And he talks a lot about action steps
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that we can do in all of our
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communities to support mental health when funding goes
1:27
away.
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So I hope you enjoyed this conversation as
1:31
much as I did.
1:32
Take a listen.
1:33
Welcome back to the Mental Health Evolution podcast,
1:37
where we talk about how the landscape in
1:40
the mental health industry is rapidly evolving.
1:44
Today, we are joined by Marcus Schmidt, Executive
1:47
Director of NAMI Minnesota.
1:50
NAMI, if you're not familiar, stands for the
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National Alliance on Mental Illness.
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Listeners to our show may remember that we
1:58
spoke with Sue Abderholden, Marcus's predecessor at NAMI
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Minnesota earlier this year.
2:04
That was a wonderful conversation.
2:06
So when we came across Marcus's interview on
2:08
NPR, Minnesota Public Radio, we reached out and
2:12
asked him to join us to update us
2:14
on the work of NAMI Minnesota and specifically
2:16
on what the Medicaid funding cuts mean for
2:20
Minnesotans, which, as you will hear, is very
2:22
much applicable to what's happening in many states
2:25
across the country.
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NAMI Minnesota is the state's largest mental health
2:30
advocacy organization.
2:32
They work every day with families and individuals
2:35
living with mental illness, fighting to make sure
2:38
the systems that support them stay intact.
2:41
Marcus came to this role after years leading
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Hearth Connection, a nonprofit focused on ending long
2:47
-term homelessness, and he has spent his career
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at the intersection of public policy and some
2:52
of the most vulnerable populations in Minnesota.
2:56
Marcus, welcome to the show.
2:58
Thanks so much, Rachel.
2:59
It's a pleasure to be here.
3:00
We are really glad to have you here.
3:02
And before we get into the policy, I
3:04
want to start with a simple question.
3:07
What does NAMI Minnesota actually do day to
3:10
day and what does it mean to be
3:12
the largest mental health advocacy organization in the
3:15
state?
3:16
So the NAMI Minnesota team is doing incredible
3:18
work across the state to provide education, support,
3:21
and advocacy.
3:23
We do that a few different ways.
3:24
Through our education, we're providing classes primarily online
3:28
in a virtual setting to Minnesotans who are
3:30
maybe concerned about a loved one who might
3:32
be experiencing signs and symptoms of a mental
3:35
illness, looking to understand how to navigate a
3:37
really complicated set of resources, struggling with access,
3:42
looking for guidance and support.
3:44
And we also have support groups that are
3:46
primarily peer-led and supported by our staff,
3:49
creating that space, that supportive space for people
3:52
who are directly impacted by mental illness.
3:55
On the advocacy front, we do quite a
3:57
bit of work at the state legislature shaping
3:59
policy to work towards a mental health system
4:03
in Minnesota that's simple, sustainable, and easy to
4:05
use.
4:06
Last year, we touched over 53,000 Minnesotans
4:09
through our work and just have an incredible
4:11
team that's committed to doing everything they can
4:13
to support people who are impacted by mental
4:16
illness.
4:17
Awesome.
4:17
I love that.
4:18
That advocacy is so important.
4:21
Now I want to lead our listeners.
4:24
If you remember, we always talk about articles
4:26
and today we're doing a slightly different format
4:28
where we're talking about an article and then
4:30
digging in and then the next one and
4:32
digging in.
4:33
So this first one is from NPR News.
4:36
It's called Mental Health Providers Say Federal Medicaid
4:39
Halt Will Lead to More Crisis.
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This is from February 2026 and I'd love
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to kind of dig in a little bit
4:48
more to this article.
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This is the one that put Marcus on
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our radar.
4:53
Earlier this year, the federal government moved to
4:55
withhold about a quarter billion of dollars in
4:58
Medicaid funding from Minnesota.
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And I'd like you to just think about
5:03
that number for a minute.
5:04
A quarter billion.
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I can't even do the math on that.
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Marcus joined NPR's Nina Muini to talk about
5:11
what it means for community mental health providers
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and the people that they serve.
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He talked about programs that prevent repeat hospitalizations,
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clinics already operating on thin margins.
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And something that really stayed with us is
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that once those services close, rebuilding them could
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take years.
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We'll put the link to that interview in
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the show notes.
5:33
But I want to kind of dig into
5:35
this a little bit with you, Marcus, since
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we have you in person.
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You talked about specific programs like intensive residential
5:42
treatment services or IRTS as an example of
5:46
what is at risk for clinicians or for
5:49
business owners in the industry who may not
5:51
be familiar with how community-based mental health
5:54
programs are structured and funded.
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Can you walk us through a little bit
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about what a program like that actually does
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and then what happens when it closes?
6:04
Sure.
6:04
Yeah.
6:05
So like you mentioned, Minnesota really just needs
6:07
a break.
6:08
When we think about the pandemic, we think
6:10
about the murder of George Floyd.
6:13
We had a very traumatic school shooting that
6:15
impacted a lot of people here in the
6:17
Twin Cities area.
6:18
We had an assassination of a very well
6:21
known member of our state legislature last summer
6:24
and also were impacted pretty significantly through immigration
6:29
enforcement, Operation Metro Surge, but also quite a
6:32
bit of immigration enforcement across the state of
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Minnesota.
6:35
And that's impacted people in myriad ways, whether
6:38
they are experiencing trauma or our immigrant community
6:41
being re-traumatized as a result of that
6:45
experience.
6:45
Families were separated.
6:46
I had to explain to my kids, 9
6:48
and 10, who go to a Spanish immersion
6:50
public school in the Twin Cities, what was
6:52
happening.
6:53
So through that experience, we saw a significant
6:56
uptick in the engagement with our team, a
7:00
4,000% increase in our social media
7:03
engagement or helpline through the roof.
7:06
And what we saw was a need for
7:08
a lot of information, something that is really
7:11
reshaping our work and I hope to talk
7:13
more about this in this conversation is the
7:16
need for resources for parents about how to
7:18
connect with their kids and help them navigate
7:21
a changing landscape, something that is impacting people
7:24
pretty profoundly and we are so concerned about
7:27
here as it changes to Medicaid.
7:30
And what makes Minnesota unique, as you mentioned,
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is this hyper-focus.
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I refer to it as a manufactured crisis
7:37
coming from the federal government in response to
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fraud that was surfaced in our portfolio of
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Medicaid programs here in Minnesota.
7:45
So Minnesota is known for a generous approach
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to providing safety net support for those who
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are vulnerable in this state.
7:53
And unfortunately, what we experience and is not
7:56
unique to Minnesota is that there have been
7:59
some bad actors taking advantage of that generosity
8:02
in those programs that was exacerbated during the
8:06
pandemic when we saw site visits from state
8:09
regulators move to a virtual format.
8:12
So people weren't showing up and seeing that
8:14
these storefronts of these shops that were opening
8:18
up to provide housing stabilization services, for example,
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were empty.
8:23
So that context is really important in what
8:25
is happening here in Minnesota and there is
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certainly a political angle to all this when
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we think about, you know, our governor and
8:35
President Trump and just some dynamics there.
8:38
But yeah, Minnesota has been under assault when
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we think about our Medicaid programs.
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We have nearly a quarter of a billion
8:45
withhold that required with Medicare and Medicaid services,
8:49
putting some milestones in place for the state
8:51
to respond, to continue to stay in compliance
8:55
with these programs.
8:57
And over 3,000 providers were part of
9:01
this review process and have been asked for
9:03
information that they'd never been asked for before.
9:06
And so surprise site visits, you know, a
9:09
state regulator asking for information that, you know,
9:12
they hadn't been familiar with asking for before,
9:15
a process that was put together on the
9:17
fly to meet some really tight deadlines from
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CMS. And it's just put so much pressure
9:23
into our mental health ecosystem when you have
9:26
a workforce that has been struggling for years
9:28
because of all those events that I mentioned.
9:32
Yeah, so some of these programs and something
9:34
that we care deeply about at NAMI Minnesota
9:36
are community-based resources.
9:38
We want people who are living with mental
9:40
illnesses who need that support to get that
9:43
support in a setting that is familiar to
9:45
them, where they have people and opportunities to
9:49
engage in the community on a regular basis
9:51
surrounding them.
9:53
And we're always advocating for these programs.
9:55
And we have a handful of those that
9:57
are supported through Medicaid dollars that are being
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scrutinized right now as a result of the
10:03
fraud, which is very legitimate, and this manufactured
10:06
crisis, which is completely unnecessary and very harmful
10:10
to the people that we're trying to serve
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right now.
10:13
And so what I feel like I'm hearing
10:15
you say is there's an additional kind of
10:17
administrative burden happening too for providing documentation for
10:23
kind of jumping through some hoops on this.
10:27
Yeah, very much so.
10:28
Very much so.
10:28
We're seeing an administrative burden that is insurmountable,
10:34
particularly for our smaller providers in greater Minnesota,
10:37
so in our rural communities.
10:39
They're already stretched thin.
10:40
I was just talking with one the other
10:42
day, and because of this process, they're in
10:45
appeal stage because they were found to be
10:47
very compliant.
10:48
And some of these things are significant.
10:50
Some of these things are very minor.
10:52
It's paperwork that wasn't completed correctly, board roster,
10:58
boards of directors, information that is outdated, because
11:00
the system that we're putting together on the
11:03
fly here in Minnesota is just, it's complicated,
11:06
and we have so many providers that are
11:08
doing good work.
11:09
And so we're seeing as a result of
11:12
that providers having to close their doors.
11:15
They're having to struggle to finish cash flow.
11:17
I was talking with one the other day,
11:18
and they had to reach out to their
11:20
insurance providers and vendors to ask them to
11:24
delay invoicing until their appeal was done so
11:28
that they were able to return to service
11:30
at a fully operational level, and they're cutting
11:33
workforce.
11:34
But for some of these shops that are
11:36
doing really important work in these small communities,
11:38
a 20% workforce reduction means one staff
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out of five.
11:42
And we're really concerned that you're going to
11:44
see organizations unable to provide services, unable to
11:49
cash flow, close their doors, and they're not
11:52
going to reopen.
11:52
People are going to go find other opportunities,
11:55
and they're already operating on thin margins, as
11:57
you mentioned.
11:58
Wow.
11:59
Yeah, and these are all Medicaid providers, correct?
12:02
That's where this is happening?
12:04
Yep, they're organizations that may be doing multiple
12:07
services, wraparound services, but they're also billing for
12:11
Medicaid-eligible services.
12:13
So for those community supports, for people who
12:16
are living with disabilities or mental illnesses that
12:19
really require that, you know, that support in
12:22
order just to maintain that stability.
12:24
So they may be relying on Medicaid billables
12:28
at 30% or 40% of their,
12:31
you know, their revenue in order to operate.
12:34
So many of these are nonprofits.
12:35
They're nonprofit organizations that are just scrapping to
12:38
find resources, and staff are underpaid, overworked, and
12:42
just struggling with all the other economic pressures
12:45
that so many of us are experiencing right
12:47
now, and the work is hard enough.
12:49
Yeah.
12:49
Wow.
12:50
So how is Minnesota, and maybe NAMI in
12:54
particular, looking at this crisis?
12:57
Like, it can feel overwhelming.
12:59
As I hear you talk about this, we've
13:01
definitely talked about themes on this show for
13:04
any mental health provider that more and more,
13:09
the reimbursement rates are lower, the costs are
13:12
higher, right?
13:13
And the administrative burden is tougher, certainly for
13:17
Medicaid and Medicare, as a standard rule.
13:21
And now what I'm hearing you say is
13:23
there's this additional audit piece, there's funds that
13:26
are being frozen, and that I can see
13:28
how easily that can just tip the scales,
13:32
right?
13:32
The scales are already on a tightrope, regardless
13:36
with this additional piece.
13:38
So it can feel overwhelming to think, how
13:41
can we rally?
13:42
How can we work with this?
13:43
I'm just curious what some of those thought
13:45
processes are for you.
13:47
Well, I appreciate the question.
13:49
We continue to remind ourselves right now that
13:52
it's great to have purpose in this moment.
13:55
We do have a team that has really
13:56
rallied through so many of these events over
14:00
the last few years, and this last year,
14:03
particularly in Minnesota, has been really difficult.
14:06
But pessimism is not a strategy.
14:07
Right.
14:08
How we're approaching it at NAMI Minnesota, through
14:11
this Healing Minnesota initiative that we soft-launched
14:15
last month, so mid-July.
14:18
And the inspiration behind that was really, how
14:20
can we respond, given the threats to the
14:24
programs that are supporting people who are living
14:26
with mental illnesses, this assault on Medicaid, which
14:29
is the backbone of Minnesota's mental health infrastructure,
14:33
and these really traumatic experiences that so many
14:37
people have gone through, and the exhaustion that
14:41
the helpers are feeling.
14:44
So Healing Minnesota has three components.
14:47
First and foremost, we are investing the $1
14:50
.2 million that we were able to raise
14:54
through private sources in eight weeks in our
14:58
programming.
14:59
So we are leveling up our programming to
15:02
get asynchronous.
15:03
And what I mean by that right now
15:04
is those classes that I had mentioned earlier,
15:07
you have to be in a specific time,
15:09
at a specific place, in order to access
15:12
that free support from us.
15:14
What we're going to do is we're going
15:16
to make this curriculum available 24-7.
15:19
So we're talking TED Talk level quality, in
15:23
multiple languages, in order to help serve Minnesotans
15:26
who might be balancing that job, concerned about
15:31
their kiddo who's struggling, and prioritizing their own
15:35
wellness.
15:35
They don't have to make that trade-off.
15:37
They can access these resources on their own
15:42
schedule and get connected with us in an
15:44
authentic way.
15:46
We're also leveling up across our services and
15:50
really investing in storytelling and awareness.
15:54
And what I mean by that are empowering
15:57
people who have been through some of this
15:59
trauma or the people who are providing that
16:01
support to share their stories and really amplify
16:04
this message that you're not alone and there
16:07
is actually something on the other side of
16:09
this.
16:10
So as we're making progress supporting people and
16:12
people, you know, naturally are resilient here in
16:14
Minnesota that there's this contagion that takes place
16:19
and people see that communities are healing and
16:22
they are getting the support and that support
16:23
is available.
16:24
We're also poised to launch a statewide mental
16:27
health awareness campaign in 2027 and we're looking
16:30
for some partners to help us shape and
16:34
amplify that message.
16:36
And finally we're using a significant portion of
16:39
these funds that we were able to raise
16:41
very quickly due to our reputation strong brand
16:43
and talented teams to put into the community.
16:47
And the term that we use is we're
16:49
the anti-funder.
16:50
In order to access these funds, and it
16:53
could be small, a thousand bucks or five
16:54
thousand bucks, you know, to do a convening,
16:57
to invest in technology, to help a group
16:59
of people who really stepped up during metro
17:01
surge, to provide support to their Latino neighbors,
17:04
to form a 501c3.
17:06
So that we're providing support so that they
17:08
can get access to those resources and consultation
17:11
to launch their own non-profit.
17:14
But really responding to that community need and
17:16
helping fill gaps primarily around the mental health
17:19
support that is needed in all communities.
17:22
Underserved communities, communities in greater Minnesota, immigrant
17:25
communities, organizations that are serving communities of color
17:29
here in Minnesota.
17:30
And this is a short-term investment and
17:32
it's a one-time investment.
17:33
And our hope here is really that we're
17:36
building authentic sustainable relationships to help adapt our
17:41
resources so that we're able to double our
17:43
impact in three years.
17:44
I mentioned last year we served 53,000
17:46
Minnesotans.
17:47
Our goal through the Sealing Minnesota initiative is
17:50
we will double that impact and we will
17:51
reach over 106,000 Minnesotans over the next
17:54
three years.
17:55
Wow.
17:55
That's pretty awesome.
17:57
When I hear that fundraising goal being met
18:00
so quickly, it kind of makes me think
18:03
about how there seems to be some energy,
18:05
like people are just stepping up, right?
18:08
In Minnesota and maybe elsewhere, kind of seeing
18:11
the need and recognizing that, yeah, we've got
18:16
to do something.
18:17
And community is coming together to do that
18:19
is kind of what I hear.
18:20
It's so true.
18:21
And one of the silver linings with everything
18:24
that we've gone through is Minnesota, we've prided
18:28
ourselves on neighborliness.
18:30
As long as I've been a Minnesotan, there's
18:33
been sort of this energy, we're re-energized
18:37
around that.
18:38
You saw during Metro Surge and some of
18:39
these other traumatic events, neighbors stepping up and
18:42
helping neighbors, providing a ride, checking in on
18:44
somebody, picking up groceries.
18:46
And we want to maintain that momentum.
18:48
And we're seeing that personal level through just
18:52
individual relationships, but we're also starting to see
18:55
it.
18:55
And I think we're playing a role in
18:56
fostering an environment in which our employers are
19:00
stepping up, our funders are stepping up, and
19:03
some of our sports teams and other organizations
19:06
that are providing entertainment and recreation in our
19:10
communities across the state wanting to contribute.
19:12
And that's because everybody's been exposed to this.
19:14
And everybody, I think, is gravitating towards something
19:17
that's positive and something that's productive and actionable
19:20
because we're all tired of feeling this way.
19:23
We're all tired of this next traumatic event
19:26
that's around the corner.
19:27
And I think everybody is just exhausted with
19:30
some of the conversation that's happening at the
19:33
national level and some of the economic instability
19:35
that seems to be starting to permeate and
19:38
might intensify in the months ahead.
19:41
Yeah, I mean, you know, when we first
19:44
started this conversation, it really stuck out to
19:47
me that yes, there's this impact of all
19:49
of these things.
19:51
And to your point, and so then what
19:54
are we doing?
19:55
What can we do?
19:57
And so that has ended up the conversation
20:00
today, which I think is really important and
20:03
even important for a broader group of people,
20:07
right, in terms of you're talking about Minnesota
20:09
in particular, but things like this are happening
20:12
all over.
20:13
And so thinking about what are some of
20:16
the ways that people can actually do something.
20:19
And so that kind of leads me to
20:22
our closing question here, because we're about out
20:25
of time, but what does meaningful action actually
20:28
look like for someone who's listening today who
20:31
wants to do something?
20:33
Could be a clinician, a practice owner, a
20:35
client, family member, just someone who's interested in
20:38
mental health.
20:39
Appreciate the question.
20:40
Something that we rallied around over the last
20:44
several months and I think has really become
20:45
part of our North Star here moving forward
20:48
is this quote from Max Dupree.
20:51
And anybody who's been a part of leading
20:53
an organization, I'm sure has been subjected to
20:56
some of his work, but we say, and
21:00
Max said, we cannot become what we need
21:02
to be by remaining what we are.
21:04
And I think that that evolution or adaptation
21:07
mindset right now is really, really important.
21:09
And how we can connect that to action,
21:11
I think is doubly important.
21:13
A few ways that people can contribute, starting
21:16
here in Minnesota, getting involved in your local
21:19
NAMI Minnesota affiliate is critical.
21:22
I just visited here in Grand Rapids, Minnesota,
21:24
which is a community in North Central Minnesota
21:27
and experiencing a lot of the challenges and
21:29
barriers to access and care and sustainability and
21:33
mental health supports.
21:35
And this group of people are so inspiring.
21:37
I mean, they're all volunteering their time.
21:39
They're all impacted in some sort of way.
21:41
But I think that energy is just so
21:43
important.
21:44
And so if you can bring that energy
21:46
to a local NAMI Minnesota affiliate or to
21:49
any mental health group or any group that
21:52
may be tangentially engaged in conversational mental health,
21:56
I really encourage you to do it.
21:58
For my fellow Minnesotans, anything you can do
22:01
to contribute financially to our work is important
22:04
right now as well.
22:05
To others across the country and others who
22:08
are listening to your program, Rachel, I would
22:10
just really encourage them to pay attention, stay
22:14
engaged, identify ways that they can support on
22:16
a small scale, right?
22:18
There's just so much power in thinking big,
22:20
starting small and moving fast.
22:22
And there are also a lot of organizations
22:24
that are doing this important work.
22:26
And your contribution, whether it's, you know, time,
22:29
talent or treasure, I think is really needed
22:32
right now.
22:33
And that positive energy, not toxic positivity, but
22:37
positive energy, people really, I think, need it
22:40
right now.
22:41
And last, there's an opportunity.
22:43
I mean, this mental health conversation has really
22:45
evolved and it is front and center.
22:47
For people who know what I do, it
22:49
always comes up.
22:50
And for people who don't know what I
22:52
do, it is coming up.
22:54
And so really, I think educating yourself and
22:57
engaging in that conversation.
22:59
And for those of your listeners who are
23:01
mental health professionals or familiar with this space,
23:04
I think realizing that they're a resource and
23:06
a leader in making progress in that conversation
23:09
to reduce stigma and connect mental health to
23:13
all these various facets of challenge and struggle
23:17
that people are experiencing right now, I think
23:19
is really going to do the movement a
23:20
lot of good here over the long haul.
23:22
So let's take advantage of opportunity in crisis.
23:25
Yeah, I love that.
23:26
One thing that really stood out for me
23:28
and what you just said was thinking big,
23:31
starting small and moving fast.
23:33
And I think that moving fast is something
23:36
that can be difficult in this space to
23:39
do, but it is so critical right now.
23:42
It's grassroots, right?
23:43
We're talking more about grassroots kind of things.
23:46
What can the everyday person do?
23:47
And I am really inspired by this conversation
23:50
and by what you're doing.
23:52
So I recognize the massive challenges that you
23:57
all are facing and I just applaud you
24:00
and your organization for, and anyone contributing, right?
24:04
The many, many volunteers contributing for what you
24:07
all are doing.
24:08
It's truly inspiring.
24:09
Absolutely.
24:10
Thanks, Rachel.
24:11
Well, the world's been paying attention to what's
24:13
been going on here in Minnesota and we,
24:15
I think, certainly showed them how we respond
24:18
and now we're going to show the world
24:19
how we recover.
24:20
Love it.
24:21
Well, we hope you enjoyed this episode and
24:24
thank you so much, Marcus, for being here
24:26
today.
24:27
Thank you, Rachel.
24:28
Stay tuned for our next interview where we
24:31
will continue to explore everything that is changing
24:34
in the mental health landscape on the Mental
24:36
Health Evolution podcast.
24:38
Bye for now.
24:40
Thanks for listening to the Mental Health Evolution
24:43
podcast.
24:44
Join the conversation, find us on social, send
24:47
us your thoughts, and tell us what you're
24:49
seeing in your corner of the mental health
24:51
world.
24:52
Until next time, stay curious and keep evolving.