Dan DeSmet lives on the front lines of the health care crisis.

The Minneota native is a manager with North Memorial Services that provides ambulance and EMT services to Marshall.

“I think the health care system is broken,” DeSmet told me as we sat inside the North Memorial conference room in Marshall. I was actually there to talk to him about the opioid situation in southwest Minnesota, but the conversation ended with his career path that took him to becoming manager of North Memorial services in Marshall.

“I did law enforcement for about 15 years. Still, as a matter of fact. I’m a licensed law enforcement officer,” DeSmet said.

While some officers don’t want to deal with “blood and guts,” DeSmet took a different approach.

“I started out as an EMT actually back in high school. I was a senior in high school and I took an EMT class. I was interested in doing law enforcement as a primary job. I worked for the city for a couple years and then went to the sheriff’s office. So I worked for them for seven or eight years as a deputy. As I was working with them, I was working part-time as a paramedic,” he said.

That paramedic experience eventually led him to the Marshall post for North Memorial. And that is where his perspectives on mental health changed.

“When I first started in law enforcement, it was ‘lock them all up,'” DeSmet said of those suffering with mental health issues and causing calls for law enforcement. “But I’ve seen the bigger picture and I think as you get older you realize it’s not all handcuffs and look ‘lock them up,’ especially working both professions. You really do see the bigger picture of what’s going on.”

The picture he described to me is something that frustrates many new paramedics.

“They have seen the same person two or three times maybe in a week or two weeks and say how can we work with them? What can we do?”

And then there’s the law enforcement side.

“So you start out as a mental health issue, and all of sudden, a year later, you end up dealing with this person from a law enforcement perspective because they are addicted to whatever the substance is. And maybe two weeks later you see them from an EMS perspective because now they are suicidal,” he said.

And that’s how DeSmet says he’s come full circle and looking for answers, just like everybody else trying to deal with health care crisis.

“You know here in Minnesota we lost mental health centers like in Willmar, or like some of those crisis centers across the state 10, 15 years ago. Now we are trying to get back. How do we fix that when we have folks that have to go all the way to Fargo, North Dakota to get mental health services? That’s not right. Why should you have somebody having a mental health crisis that is 13 years old go all the way to Fargo or Minot, North Dakota, or whatever, for those services when you are taking them away from their parents?” he said.

DeSmet says nurses and doctors are seeing the same chronic issues.

“They see repeat folks that come and how do we get them services?” he asked. “How do we stop that addiction that is theirs? Because Medicare doesn’t always pay for those substances (drug addiction). A lot of people are without work because of their mental health issues. It becomes a bigger circle.

“It’s kinda like a DWI. The discussion has started. Do we incarcerate that first-time DWI person? Then they can’t work. They lose their job because they have been gone for that first day. They can’t drive. How do we work with them? It all can’t be soft and cuddly and fuzzy. But yet how do we do that appropriately?”

While politicians debate health care in St. Paul and Washington, D.C., the data support DeSmet’s description of the health care crisis. According to a 2017 report by the Minnesota Rural Health Association, the state has experienced a 500 percent increase in deaths related to opioid abuse between 1999 and 2014. It also stated that 338 Minnesotans died of opioid overdoses in 2015. Meanwhile, according to the report, rural treatment options are scarce.

The report also shows that rural Minnesotans are, on average, older with lower incomes and less healthy than those living in urban areas. And rural areas face an older and shrinking health care workforce.

The bottom line is that the mental health crisis is not going away. Just ask DeSmet and other first responders on the front lines.

You can follow Mike Lamb at Twitter@indymlamb