Image Credit: Quotefancy

I recently read another CNN article that I felt was worthy of sharing. It was published on June 20, 2018.

Here’s the link to the article:

• There’s a severe shortage of mental health professionals in rural areas. Here’s why that’s a serious problem.

For years, I’ve been fascinated with the Appalachian region of the United States. Part of it is because my grandmother (Mom’s mom) was raised in West Virginia, and other extended family members have lived in West Virginia and Kentucky, to name a few states.

The mountains are beautiful. Grandma Grace was raised during The Great Depression, and they survived. I have vague memories of visiting Great-Grandma Laura Bethany (whom I’m named after) on her farm in Ripley, and seeing Mom’s aunt’s and cousins in Beckley. These two areas aren’t deep in the mountains, but you can definitely see and feel the hills and valleys.

With all that said, Ripley and Beckley are small, but mighty. Other areas of West Virginia, and other states in the Appalachian region, have certainly struggled with the volatility of the coal mining industry, among other issues. The limited amount of research I’ve done shows years of struggles with poverty, unemployment, access to health care, and more. However, the Appalachian people are steadfast. I don’t want to be prejudicial, but research-based.

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Along with difficulties accessing quality health care, and affording that care, mental health care is somewhat tied to that. It’s fascinating, as well as immensely frightening.

When I was diagnosed with Generalized Anxiety Disorder (GAD) in the summer of 2015, I started taking a bigger interest in mental health, including news articles about the topic. I’m grateful that I have a stable job, with good health insurance, and access to good mental health resources and services.

I’ve seen several counselors since I was in college, for a variety of reasons, but the counselor who diagnosed me with GAD was a watershed moment for me. She helped me unpack a variety of issues that were causing significant stress, and in turn, contributing to my anxiety. I’ve been able to better understand GAD, and to work to figure out the best ways to limit and control my anxiety. It’s a daily exercise, but I’m proud to say that I’m not taking any medication, and I’m able to live a fairly productive life thanks to a powerful and helpful support system. I realize that my situation is very unique, and I’m grateful for everything!

The article is packed with statistics. I won’t go through all of them, but the main point is a majority of non-metropolitan counties do not have a psychiatrist, and nearly half do not have a psychologist. The best definition of a non-metropolitan county that I could find is one that does not have a Metropolitan Statistical Area (MSA) and has a population of 10,000 or less (Health Resources & Services Administration).

One of the interviewees, a clinical psychologist, pointed out that many rural areas only have generalists, i.e., primary care providers (PCPs), and there’s little to no specialized care. People are left on their own due to a lack of community mental health care, and nearby relevant hospital services.

The services that are available are focused on crisis intervention, not prevention. These services attempt to address the crisis as it’s happening, but nothing is available to prevent the crisis.

In addition to the lack of services and resources, health care funding cuts are exacerbating this problem. Roughly 80 rural hospitals closed between 2010 and 2017. Hundreds more are at risk.

Another problem the rural population faces is isolation. Isolation can spark downward spirals, which can lead to drug addiction, overdoses, depression, and suicide. According to the Centers for Disease Control (CDC), rural areas have a higher suicide rate than non-rural areas, which has been widening since 2001.

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This is a significantly complex and challenging problem that can’t be addressed with a single solution. However, there’s one bright spot that is starting to emerge – Telebehavioral health. The article provided the example of a patient in Wyoming “seeing” a psychologist in Pennsylvania via virtual sessions and online portals.

As promising as telebehavioral health appears, the article points out a host of other issues that rural residents face. Access to the Internet is one, being proficient with computers / technology another, and having the financial resources to access these mental health professionals.

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To me, there needs to be a series of steps to tackle these issues. I don’t have all the answers, and I try to be as objective as possible.

There needs to be consistent investment in mental health services across the U.S. Every rural area that does not have a psychiatrist or psychologist should probably have at least one of each. The currently practicing doctors should be linked up to the existing mental health services, as well as be / become advocates for improving those services. Continued work to reduce the stigma of mental illness, addiction, and other mental health issues will also be beneficial.

Those support systems that people turn to in the event of a crisis – Family, friends, ministers, chaplains, and even first responders – should also have connections to mental health services. More mental health training for these support systems, specialized if possible, is also a good idea.

Throughout the network of ideas and potential solutions, the idea of making and sustaining connections and cooperation appears to be a common theme. In order to help the neediest residents, everyone involved with helping them should be educated, connected, and cooperative.

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Example: Someone in a rural area is struggling with isolation and drug addiction, and overdoses. When the family member calls for an ambulance, the first responders take the resident to the local or nearest hospital. While recovering in the hospital, a series of people work behind the scenes to quickly identify others that can help – Family members, the hospital chaplain, the resident’s pastor, the resident’s primary care physician, and anyone else. Together, this network of resources work together to locate the nearest psychiatrist or psychologist, or even the nearest behavioral health center. The idea is to build a strong support system to get the resident the best mental health services possible.

This is strictly an example, but ideally, there needs to multiple levels of support and accountability for this to work. Every situation is different – Sometimes there’s no family, no primary care physician, difficulty accessing a behavioral health center, among other things. Regardless, if we invest in building these networks and support systems, maybe there can be a shift in crisis prevention, and less crisis intervention.

For more information, check out these resources. Several of these were also cited in the article.

• Cuts threaten rural hospitals ‘hanging on by their fingernails’ – CNN, June 2017
• How Much of a Struggle Is It to Get Mental Health Care in Rural Areas? – U.S. News, April 2018
• Geographic Variation in the Supply of Selected Behavioral Health Providers – American Journal of Preventive Medicine (APJM)
• National Association for Rural Mental Health (NARMH)
• National Institute of Mental Health
• Rural Behavioral Health
• Rural Mental Health – Rural Health Information Hub
• Rural Mental Health Is Lacking, But Mental Health First Aid Can Help – Mental Health First Aid
• The State of Rural Mental Health: Caring and the Community – National Register of Health Service Psychologists, Fall 2012

Until the next headline, Laura Beth 🙂