Ramstad: Hazelden Betty Ford and its 'Minnesota Model' has been the standard for 75 years

Many executives and business owners say they want their company to be the best at what they do. Few express it as an expectation rather than an aspiration.

When Dr. Joseph Lee, chief executive of Hazelden Betty Ford Foundation, began a recent conversation that way, I knew I was in a place that's working on a different level.

"Our role is to be the standard," Lee said. "That's what we've been and that's what Mrs. Ford was as an advocate. When we've spoken on national issues, policy ... quality of care, researching our outcomes, it's really been about how to be a leader and a standard."

Hazelden Betty Ford, celebrating its 75th year, is widely considered the nation's top nonprofit provider of addiction treatment. It is based just north of the Twin Cities in Center City and has facilities in eight states.

It started on lakeside property in Center City and in 1953 opened a halfway house for men in St. Paul's West 7th neighborhood.

"We've always thought of ourselves as a social reform movement, not as a treatment center," Lee told me as we sat in the house that is still part of Hazelden Betty Ford's St. Paul campus.

Ten years ago, Hazelden merged with the California-based Betty Ford Clinic, which the former first lady of the United States started in 1982 after revealing her addiction to painkillers and alcohol. At a White House event in March where a postage stamp honoring Ford was unveiled, Lee told the audience the expectation at Hazelden Betty Ford is not just to be the best, but "to be the best with love."

"That's why we have a publishing arm, a graduate school, a research center, family and children services and prevention services. What the public sees, largely due to stigma, is people getting treatment from all walks of life. We've really been about changing hearts," he said.

The vocabulary of recovery from addiction and other mental health ailments is now part of everyday life in the U.S. and most developed countries. As societies became wealthier, people used that wealth to separate, sometimes inadvertently. Life became less communal and less community-oriented. In recent years, smartphones, the internet and other technologies have also been blamed for contributing to this mental and emotional separation.

"I find the recovery community — not having been in recovery, just being a physician who has been near it for so long — has some wonderful solutions that I wish the rest of society would pay attention to," Lee said. "There's this unapologetic humility that people enter recovery communities with. There's an emphasis on empathy and not duking out over who's right on some particular issue, but really focusing on connection and volunteerism and sharing."

After the repeal of Prohibition in the 1930s, researchers began to study alcoholism. Alcoholics Anonymous started in Ohio in 1935. In Hazelden's early years, treatment focused on AA's Twelve Steps. By the mid-1950s it embraced an insight from what was then Willmar State Hospital — that addicts can help each other. A treatment regimen that became known as the "Minnesota Model" formed around the notion of treating a person's whole being, meaning body, mind and spirit.

"There's a lot of gratitude for the state of Minnesota allowing a recovery community to foster good and to flourish here," Lee said. "We want to give thanks, and we want to celebrate all those families who've been on that journey, all the different recovery communities, not just ours. That would be within the spirit of recovery."

Betty Ford Clinic based its treatment techniques on the Minnesota Model. Ford's openness about her battle with addiction was groundbreaking for its time.

For all the gains in public acceptance and understanding of addiction and mental illness since then, however, one giant gap remains — financial.

In 2022, the latest year for which data is available, almost 1 in 4 American adults had a mental illness and about 1 in 5 Americans ages 12 and up had a substance-abuse disorder, according to a survey by the Department of Health and Human Services. And yet, the amount of money that is spent is on treatment, or that insurers and government will cover, is tiny in the scheme of health care overall.

My colleague Christopher Snowbeck illuminated the impact of lower financial incentives on mental health care in Minnesota in an exceptional series of stories in the Star Tribune last year. The payment models on mental health care, he wrote, don't provide enough return on investment for hospitals.

Hazelden Betty Ford, for all its national reputation, has annual revenue of about $250 million, which is only 2% of Minnesota's other nationally known and standard-setting health care institution, Mayo Clinic.

"Stigma isn't just the shame of talking about your experiences," Lee said. "It really has to also do with resourcing and prioritization and the disconnect of how can something be so ubiquitous and still so disproportionately marginalized? It doesn't make any sense."