Wellness: The state of mental health in our rural communities

Dr. Ralph E. Jones, Special to the Star

By Dr. Ralph E. Jones, Special to the Star

Despite the many acts of legislation over the years, and the attempts to deliver those services, individuals and their families in the rural environs still lack the services and care for mental health and mental illness than those living in urban communities. This is so very especially true when it comes to diagnosable depression, wherein Farmers and others in rural environments lead the nation in suicide.

It was not until 1963, with the first legislation to address the needs for mental health services in our rural communities (the Community Mental Health Act), that recognition was to be placed on development and funding for needs of those in rural areas. The aim at that time was to shift mental health care away from the larger mental health hospitals and facilities in urban areas and place it in communities where the focus would be on prevention as well as treatment.

This act, as well as many other legislative acts over the years, lead to the development of community mental health outreach centers, rural clinics, and other initiatives to address the needs of our rural communities. The major problem with all of the legislative efforts has been the inadequate funding and subsequent professional staffing of the facilities and programs.

This is especially true in Texas, as we have lagged so very, very much behind other States in per-capital spending on mental health services; and most particularly in our services to the rural communities. As President of the Texas Mental Health Association in the mid 1980s, and as I was Director of a large rural out-patient mental clinic; I was asked by a Texas Legislator to provide him a talking paper on the need for increased funding for rural mental health.

He presented this paper to the Texas Legislature which led to an increase in service funding for rural mental health initiatives; but hardly adequate to meet the needs of our very large rural population in our State.

Currently more than 60% of rural Americans live in mental health professional shortage areas. More than 90 percent of all psychologists and psychiatrists, and 80 percent of Social Workers and Professional Mental Health Counselors, work exclusively in metropolitan areas. More than 65 percent of rural Americans get their mental health care from their primary care physician.

The mental health crisis responder for most rural Americans is a law enforcement officer. Additionally, there exists other major areas of concern involving the populous in rural areas; rural Americans travel further to receive needed services, rural Americans are less likely to have insurance benefits for mental health care, and rural Americans are less likely to recognize mental illnesses, and understand their care options.

Another area of major concern in rural areas are the values and attitude that the rural population has toward mental illness and mental health professionals; which very often prevent them from obtaining services. These values and attitudes, which includes stigma associated with mental illness, pervades small towns and communities in our rural areas.

A colleague of mine, whom was involved in providing a mobile mental health clinic in our valley counties, related to me recently that these same values and attitudes still exist today.

According to data from the Rural Mental Health Association, mental illnesses, such as anxiety and depression, are common among older adults in rural areas, affecting 10 to 25 percent of that population. But many of those people with them suffer in silence rather than seeking treatment. Many studies have shown that the most common barrier to treatment is the belief that “I should not need help.”

Other commonly cited barriers are not knowing where to go, distance, mistrust of counselors and other therapists, “not wanting to talk with a stranger about private matters,” and of course stigma. Stigma — the sense that something is shameful — may be felt more acutely in small rural towns and communities because of the relative lack of anonymity there.

Many older individuals living in rural areas were raised in a very different time period, when people of a “pioneering spirit” and being self- reliant did not talk about mental illness; and many of those believe that seeking help is a sign of weakness or an inability to be self-reliant.

In discussing more about stigma towards individuals with mental illness in rural communities, the National Alliance on Mental Illness (NAMI) tells us that although 1 in 5 adults in the U.S. experience a mental disorder in any given year. Yet, the misconceptions, myths, and cultural stigma associated with mental illness are significant barriers that keep people with mental disorders from seeking and receiving treatment in rural areas.

They relate that factors that may influence rural residents to avoid seeking care include such issues as: lack of understanding and knowledge of mental illness, sometimes even among healthcare staff; prejudice or stigma towards people with mental disorders, often based on fear and unease; secrecy about mental illness in the community and general hesitancy to seek care; and perception of a lack of confidentiality and privacy in small towns with closely-tied social networks.

Due to these aforementioned areas the rates of suicide has increased over time in rural America, wherein rural areas have experienced a 20 percent increase in suicides versus a 7 percent increase in urban areas; and this especially holds true for teens and older adults.

The key to understanding and accepting mental health disorders and the myths and misconceptions surrounding them lies in the area of awareness education. As our values and attitudes are shaped behaviorally, and most of you familiar with my works, can attest to my beliefs in this area; so the changes in thoughts and actions associated with all aspects of mental illness can be changed.

We need to “keep up the fight” in this! Until next time, Stay Healthy My Friends!