Pessimism Is Not a Strategy with Marcus Schmit

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next. Hey everyone, thank you for joining us today on the Mental Health Evolution podcast. I am just excited to talk to you about what this episode with Marcus Schmit with NAMI of Minnesota was all about. If you have been noticing in the news, Minnesota has had a lot of things happening there, a lot of different traumatic situations, a lot of stress on their Medicaid system and their support net in particular. And this conversation with Marcus was really inspirational to hear not only what he is leading with NAMI in that place, but what people are stepping up and doing. As he talks about Minnesota is a neighborly place and he talks a lot about action steps that we can do in all of our communities to support mental health when funding goes away. So I hope you enjoyed this conversation as much as I did. Take a listen. Welcome back to the Mental Health Evolution podcast where we talk about how the landscape in the mental health industry is rapidly evolving. Today we are joined by Marcus Schmit, Executive Director of NAMI Minnesota. Nami, if you're not familiar, stands for the national alliance on Mental Illness. Listeners to our show may remember that we spoke with Sue Abderholden, Marcus's predecessor at NAMI Minnesota, earlier this year. That was a wonderful conversation. So when we came across Marcus's interview on npr, Minnesota Public Radio, we reached out and asked him to join us to update us on the work of NAMI Minnesota and specifically on what the Medicaid funding cuts mean for Minnesotans, which as you will hear, is very much applicable to what's happening in many states across the country. NAMI Minnesota is the state's largest mental health advocacy organization. They work every day with families and individuals living with mental illness fighting to make sure the systems that support them stay intact. Marcus came to this role after years leading Herth Connection, a nonprofit focused on ending long term homelessness. And he has spent his career at the intersection of public policy and some of the most vulnerable populations in Minnesota. Marcus, welcome to the show.

Thanks so much Rachel. It's a pleasure to be here.

We are really glad to have you here. And before we get into the policy, I want to start with a simple question what does NAMI Minnesota actually do day to day? And what does it mean to be the largest mental health advocacy organization in the state?

So the NAMI Minnesota team is doing incredible work across the state to provide education, support and advocacy. We do that a few different ways through our education. We're providing classes primarily online in a virtual setting to Minnesotans who are maybe concerned about a loved one who might be experiencing signs and symptoms of a mental illness, looking to understand how to navigate a really complicated set of resources, struggling with access, looking for guidance and support. And we also have support groups that are primarily peer led and supported by our staff, creating that space, that supportive space for people who are directly impacted by mental illness. On the advocacy front, we do quite a bit of work at the state legislature shaping policy to work towards a mental health system in Minnesota that's simple, sustainable and easy to use. Last year we touched over 53,000 Minnesotans through our work and just have an incredible team that's committed to to doing everything they can to support people who are impacted by mental illness.

Awesome. I love that that advocacy is so important. Now I want to lead our listeners. If you remember, we always talk about articles and today we're doing a slightly different format where we're talking about an article and then digging in and then the next one and digging in. So this first one is from NPR News. It's called Mental Health Providers say Federal Medicaid Halt Will Lead to More Crisis. This is from February 2026. And I'd love to kind of dig in a little bit more to this article. This is the one that put Marcus on our radar. Earlier this year, the federal government moved to withhold about a quarter billion of dollars in Medicaid funding from Minnesota. And I'd like you to just think about that number for a minute. A quarter billion. I can't even do the math on that. Marcus joined NPR's Nina Moini to talk about what it means for community mental health providers and the people that they serve. He talked about programs that prevent repeat hospitalizations, clinics already operating on thin margins. And something that really stayed with us is that once those services close, rebuilding them could take years. We'll put the link to that interview in the show notes. But I want to kind of dig into this a little bit with you, Marcus, since we have you in person. You talked about specific programs like intensive Residential treatment services or irts as an example of what is at risk for clinicians or for business owners in the industry who may not be familiar with how community based mental Health programs are structured and funded. Can you walk us through a little bit about what a program like that actually does and then what happens when it closes?

Sure, yeah. So like you mentioned, Minnesota really just needs a break. When we think about the pandemic, we think about the murder of George Floyd. We had a very traumatic school shooting that impacted a lot of people here in the Twin Cities area. We had an assassination of a very well known member of our state legislature last summer and also were impacted pretty significantly through immigration enforcement, Operation Metro Surge, but also quite a bit of immigration enforcement across the state of Minnesota. And that's impacted people in myriad ways, whether they are experiencing trauma or our immigrant community being re traumatized result of that experience. Families were separated. I had to explain to my kids 9 and 10 who go to a Spanish immersion public school in the Twin Cities what was happening. So through that experience we saw a significant uptick in the engagement with our team. A 4,000% increase in our social media engagement. Our helpline, wow, through the Roof. And what we saw was a need for a lot of information. Something that is really reshaping our work. And I hope to talk more about this in this conversation is the need for resources for parents about how to connect with their kids and help them navigate a changing landscape. Something that is impacting people pretty profoundly. And we are so concerned about here are the changes to Medicaid and what makes Minnesota unique, as you mentioned, is this hyper focus. I refer to it as a manufactured crisis coming from the federal government in response to fraud that was surfaced in our portfolio of Medicaid programs here in Minnesota. So Minnesota is known for a generous approach to providing safety nets support for those who are vulnerable in this state. And unfortunately what we experience and is not unique to Minnesota is that there have been some bad actors taking advantage of that generosity in those programs that was exacerbated during the pandemic when we saw site visits from state regulators move to a virtual format. So people weren't showing up and seeing at these storefronts of these shows, shops that were opening up to provide housing stabilization services, for example, were empty. So that context is really important in what is happening here in Minnesota. And there is certainly a political angle to all this when we think about, you know, our governor and President Trump and just some, some dynamics there. But yeah, Minnesota has been under assault when we think about our Medicaid programs. We have nearly a quarter of a billion withhold that required with Medicare and Medicaid services putting some milestones in place for the state to Respond to continue to stay in compliance with these programs. And over 3,000 providers were part of this review process and had been asked for information that they'd never been asked for before. And so surprise site visits, you know, a state regulator asking for information that, you know, they hadn't been familiar with asking for before. A process that was put together on the fly to meet some really tight deadlines from cms. And it's just put so much pressure into our mental health ecosystem when you have a workforce that has been struggling for years because of all those events that I mentioned. Yeah. So some of these programs and something that we care deeply about at NAMI Minnesota are community based resources. We want people who are living with mental illnesses who need that support, to get that support in a setting that is familiar to them, where they have people and opportunities to engage in the community on a regular basis surrounding them. And we're always advocating for these programs and we have a handful of those that are supported through Medicaid dollars that are being scrutinized right now as a result of the fraud, which is very legitimate and this manufactured crisis, which is completely unnecessary and very harmful to the people that we're trying to serve right now.

So what I feel like I'm hearing you say is there's an additional kind of administrative burden happening too for providing documentation, for kind of jumping through some hoops on this.

Yeah, yeah, very much so. Very much so. We're seeing an administrative burden that is insurmountable, particularly for our smaller providers in greater Minnesota. So in our rural communities that are already stretched thin. You know, I was just talking with one the other day and because of this process, they're in appeal stage because they were founded ERA compliant. And you know, some of these things are significant, some of these things are very minor. It's, you know, paperwork that wasn't completed correctly, you know, board roster, boards of directors, information that is outdated. Because the system that we're putting together on the fly here in Minnesota is just, it's complicated and we have so many providers that are doing good work. And so we're seeing as a result of that providers having to close their doors, they're having to struggle to finish cash flow. I was talking with one the other day and they had to reach out to their insurance providers and vendors to ask them to delay invoicing until their appeal was done, um, so that they were able to return to service at, at a fully operational level. And they're cutting workforce. But for some of these shops that are doing really important Work in these small communities, a 20% workforce reduction means one staff out of five. And we're really concerned that you're going to see organizations unable to provide services, unable to cash flow, close their doors, and they're not gonna reopen. People are gonna go find other opportunities, and they're already operating on thin merchants, as you mentionships.

Wow. Yeah. And these are all Medicaid providers, correct? That's where this is happening?

Yep. They're organizations that may be doing multiple services, wraparound services, but they're also billing for Medicaid eligible services. So for those community supports for people who are living with disabilities or mental illnesses that really require that, you know, that support in order just to maintain that stability. So they may be relying on Medicaid billables at 30% or 40% of their, you know, their revenue in order to operate. So many of these are nonprofits. They're nonprofit organizations that are just scrapping to find resources and staff, are underpaid, overworked, and just struggling with all the other economic pressures that so many of us are experiencing right now. And the work is hard enough.

Yeah. When. Wow. So how is Minnesota, and maybe NAMI in particular, looking at this crisis? Like it. It can feel overwhelming. As I hear you talk about this, we've definitely talked about themes on this show for any mental health provider that more and more the reimbursement rates are lower, the costs are higher. Right. And your. And the administrative burden is tougher, certainly for Medicaid and Medicare as a standard rule. And now what I'm hearing you say is there's this additional audit piece, there's funds that are being frozen, and that I can see how easily that can just tip the scales. Right. The scales are already on a tightrope regardless, with this additional piece. So it can feel overwhelming to think, how can we rally? How can we work with this? I'm just curious what some of those thought processes are for you.

Well, I appreciate the question. We continue to remind ourselves right now that it's great to have purpose in this moment. We do have a team that has really rallied through so many of these events over the last few years. And this last year, particularly in Minnesota, has been really difficult. But pessimism's not a strategy.

Right.

How we're approaching it at NAMI Minnesota, through the Ceiling of Minnesota initiative that we staff launched last month, so mid July. And the inspiration behind that was really how can we respond given the threats to the programs that are supporting people who are living with mental illnesses. This assault on Medicaid which is the backbone of Minnesota's mental health infrastructure, and these really traumatic experiences that so many people have gone through and the exhaustion that the helpers are feeling. So healing Minnesota has three components. First and foremost, we are investing the $1.2 million that we were able to raise through private sources in eight weeks.

Wow.

In our programming. So we are leveling up our programming to get asynchronous. And what I mean by that right now is those classes that I had mentioned earlier, you have to be in a specific time, at a specific place, order the access that free support from us. What we're going to do is we're going to make this curriculum available 24 7. So we're talking TED talk level quality in multiple languages in order to help serve Minnesotans who might be balancing, you know, that. That job, concerned about, you know, their kiddo who's struggling and prioritizing their own wellness. They don't have to make that trade off. They can access these resources on their own schedule and get connected with us in an authentic way. We're also leveling up across our services and really investing in storytelling and awareness. And what I mean by that are empowering people who have been through some of this trauma or the people who are providing that support to share their stories and really amplify this message that you're not alone. And there is actually something on the other side of this. So as we're making progress, supporting people and people, you know, naturally are resilient here in Minnesota, that there's this. There's this contagion that takes place and people see that communities are healing and they are getting the support and that support is available. We're also poised to launch a statewide mental health awareness campaign in 2027. And we're looking for some partners to help us shape and amplify that message. And finally, we're using a significant portion of these funds that we were able to raise very quickly due to our reputation, strong brand and talented team to put into the community. And the term that we use is we're the anti funder in order to access these funds. And it could be something small, a thousand bucks or 5,000 bucks, you know, to do a convening, to invest in technology to help a group of people who really stepped up during Metro Surge to provide support to their Latino neighbors, to form a 501C3 so that we're providing support so that they can get access to those resources and consultation to launch their own nonprofit.

Wow.

But really responding to that community need and helping fill gaps primarily around the mental health support that is needed in all communities. Underserved communities, communities in greater Minnesota, immigrant communities, organizations that are serving communities of color here in Minnesota. And this is a short term investment and it's a one time investment. And our hope here is really that we're building authentic, sustainable relationships to help adapt our resources so that we're able to double our impact in three years. I mentioned last year we served 53,000 Minnesotans. Our goal through this Healing Minnesota initiative is we will double that impact and we will reach over 106,000 Minnesotans over the next three years.

Wow, that's pretty awesome. When I hear that fundraising goal being met so quickly, it kind of makes me think about how there seems to be some energy like, like people are just stepping up right in Minnesota and maybe elsewhere kind of seeing the need and recognizing that, yeah, there, there needs, we gotta do something and, and community is coming together to do that is kind of what I hear.

It's so true. And one of the silver linings with everything that we've gone through is Minnesota. You know, we've prided ourselves on, you know, neighborliness. You know, as, as long as I've been a Minnesotan, there's been sort of this energy, you know, kind of we're re energized around that you saw during Metro Surge and some of these other traumatic events. Neighbors stepping up and helping, neighbors providing a ride, checking in on somebody, picking up groceries. And we want to maintain that momentum and we're seeing that personal level, you know, through just individual relationships, but we're also starting to see it. And I think we're playing a role in fostering an environment in which our employers are stepping up, our funders are stepping up, and some of our sports teams and other organizations that are providing, you know, entertainment and recreation in our communities across the state wanting to contribute. And that's because everybody's been exposed to this. And everybody, I think, is gravitating towards something that's positive and something that's productive and actionable because we're all tired of feeling this way. We're all tired of this next traumatic event that's around the corner. And I think everybody is just exhausted with some of the conversation that's happening at the national level and some of the economic instability that seems to be starting to permeate and might intensify in the months ahead.

Yeah, I mean, you know, when we first started this conversation, it really stuck out to me that yes, there's this impact of all of these things. And to your point. And so then, what are we doing? What can we do? And so that has ended up the conversation today, which I think is really important and even important for a broader group of people. Right. In terms of you're talking about Minnesota in particular, but things like this are happening all over. And so thinking about what are some of the ways that people can actually do something? And so that kind of leads me to our closing question here, because we're about out of time, but what does meaningful action actually look like for someone who's listening today, who wants to do something? Could be a clinician, a practice owner, client, family member, just someone who's interested in mental health.

Appreciate the question. Something that we rallied around over the last several months and I think has really become part of our North Star here moving forward is this quote from Max Dupree. And anybody who's been a part of leading an organization, I'm sure, has been subjected to some of his work. But we say, and Max said, we cannot become what we need to be by remaining what we are. And I think that that evolution or adaptation mindset right now is really, really important. And how we can connect that to action, I think is doubly important. A few ways that people can contribute, starting here in Minnesota. Getting involved in your local NAMI Minnesota affiliate is critical. I just visited here in Grand Rapids, Minnesota, which is a community in north central Minnesota, and, you know, experiencing a lot of the challenges and barriers to access and care and sustainability and mental health supports. And this group of people is so inspiring. I mean, they're all volunteering their time, they're all impacted in some sort of way. Um, but I think that energy is just so important. And so if you can bring that energy to a local NAMI Minnesota affiliate or to any mental health group or any group that may be tangentially engaged in conversation around mental health, I really encourage you to do it. For my fellow Minnesotans, anything you can do to contribute financially to our work is important right now as well. To, you know, others across the country and others who are listening to your program, Rachel, I would just really encourage them to pay attention, stay engaged, identify ways that they can support on a small scale. Right. There's just so much power in thinking big, starting small, and moving fast. And there are also a lot of organizations that are doing this important work. And your contribution, whether it's, you know, time, talent, or treasure, I think is really needed right now. And that positive energy, that toxic positivity, but positive energy, people really I think need it right now. And last, there's an opportunity. I mean, this mental health conversation has really evolved and it is front and center.

Yeah.

For people who know what I do, it always comes up. And for people who don't know what I do, it is coming up. And so really, I think educating yourself and engaging in that conversation and for those of your listeners who are mental health professionals or familiar with the space, I think realizing that they're a resource and a leader in making progress in that conversation to reduce stigma and connect mental health to all these various facets of challenge and struggle that people are experiencing right now, I think is really going to do the movement a lot of good here over the long haul. So let's take advantage of opportunity and crisis.

Yeah, I love that. One thing that really stood out for me in what you just said was thinking big, starting small, and moving forward fast. And I think that moving fast is something that can be difficult in this space to do, but it is so critical right now. It's grassroots, Right. We're talking more about grassroots kind of things. What can the everyday person do? And I am really inspired by this conversation and by what you're doing. So I recognized the massive challenges that you all are facing, and I just applaud you and your organization for and anyone contributing. Right. The many, many volunteers contributing for what you all are doing. It's truly inspiring.

Absolutely. Thanks, Rachel. Well, the world's been paying attention to what's been going on here in Minnesota, and we, I think, certainly showed them how we respond. And now we're going to show the world how we recover.

Love it. Well, we hope you enjoyed this episode and thank you so much, Marcus, for being here today.

Thank you, Rachel.

Stay tuned for our next interview where we will continue to explore everything that is changing in the mental health landscape on the Mental Health Evolution podcast. Bye for now.