Sunday, September 7, 2014

Mental health in rural America and the need for more progressive solutions

Andrew Droz Palermo and Tracy Droz Trago’s 2014 documentary, Rich Hill, focuses on the lives of three young individuals and their families living in Rich Hill, Missouri. Rich Hill is a small town with a population of approximately 1,341, a median income just under $30,000, and a poverty rate of about 27% according to the Census Reporter. The film's audience will quickly observe the many struggles that come with living in this poor, rural area, including struggles with mental health issues. In fact, two of the three boys featured in the film are medicated for illnesses including Obsessive-Compulsive Disorder, Attention Deficit Disorder, and anger problems. Watching this film made me wonder how prevalent mental illness is in rural areas, and what is access to mental health services like there?

Mental illness is a common malady that affects approximately 25 percent of adults and 20 percent of youths in the United States. However, studies have found major depression rates in rural areas are higher than those in urban areas. Additionally, studies report a higher suicide rate in rural areas.
(See more on rural suicide here). Some articles have explained that this is due to the prevalence of guns and social isolation in rural areas. Whatever the explanation, these statistics suggest that people in rural areas need better access to mental health services.

Unfortunately, barriers to mental health services exist in rural areas. One major obstacle is availability. For example, 85 percent of 1,669 federal designated mental health professional shortage areas are rural areas. With a shortage of professionals, this may mean that individuals simply do not get the help they need, or they have to travel far distances to get help. Another factor is a lack of affordable health insurance coverage.

Suzanne Robinson of Montana was forced to deal with both these challenges when seeking help for her schizophrenic son. Suzanne reported, “If you have schizophrenia in Montana you either need good private insurance or you need a lot of money. We had neither.” At the time, the state only had three Medicaid psychiatrists, and two were for children. She had to drive at least 85 miles to seek help for her son.

So, what can be done to improve access to mental health services in rural America? Government support is a good starting point. Last year, the USDA announced their goal of investing $50 million to increase access to mental health care in rural areas over the next three years. The funding is to be used for construction and improvement of rural mental health facilities. Because a limited amount of money can only go so far, and many people suffer from mental illness, more innovative ideas are needed to improve access to mental health care in rural areas.

This is where progressive ideas, such as telemedicine, should come into play. University of New Mexico’s project, Project ECHO (Extension for Community Healthcare Outcomes), is a form of telemedicine where medical specialists hold weekly virtual training sessions to discuss their current patients and determine appropriate treatments. The Robert Wood Johnson Foundation and General Electric are sponsoring a mental health clinic in New Mexico based on Project ECHO in order to help primary care doctors in rural areas in New Mexico become better educated in mental health care. This way, doctors in rural areas can provide proper mental health services, and people residing in rural areas will therefore have better access to the care they need.

Mental health is a serious problem in rural America and monetary support can only go so far. Hopefully, more private institutions take notice of the mental health crisis affecting so many people, and they are willing to take the leap and undertake projects similar to Project ECHO.


Kate said...

This is a wonderful post. Very well written. Personally, I believe that remote treatment for mental health disorders is an imperative in an ever expanding world. As the demands for mental health assistance grow with the population, it is refreshing to read that progressive thinkers are exploring means of servicing the remote and underprivileged. Great blog!

Ahva said...

I definitely agree that, in addition to government support, creative solutions are necessary to address the shortage of mental healthcare in rural areas. Toward this end, Arkansas, Maine, New Hampshire, North Carolina, Tennessee, and, most recently, Kentucky, have allowed pastoral counselors to become licensed mental health professionals. Pastoral counselors, like others with professional mental health degrees, must complete courses in psychotherapy and a certain number of hours of supervised counseling, among other requirements that vary by state. While pastoral counseling may not be for everyone, I applaud these states' efforts to license more professionals in the mental health field in an effort to provide better care to their rural populations. There is no doubt that there are a substantial number of religious people in America as a whole, perhaps more so in rural areas. Pastoral counseling may be an especially attractive option for religious persons struggling with mental health issues in rural areas.

Damon Alimouri said...

Perhaps depression, suicide, and mental illness need to be discussed more frequently, openly, and educatedly(?) in rural areas.

I suspect that discussions concerning these painful and often controversial topics are anathema to those who espouse conservative values.

A lot of these problems, I feel, could be solved through a reorientation of cultural values. Social alienation, atomization, and individualism, which plague all of this nation, produce all sorts of maladies. I feel that these cultural values are materialized in the most extreme manner in rural America.

Moona said...

Interesting article. I also wonder how negative stereotypes of rural areas and people in rural areas affects ones mental health. Some of the boys in the Rich Hill video expressed how city people look down on them for being from poor rural areas, and I wonder if this affects their mental health. I imagine that this would have a big impact on younger rural residents as younger people are generally more impressionable. Along with the lack of access to mental health resources it may also be that spending money on mental health is seen as "frivolous spending" at least in comparison to all the other needs a family might have