Lack Of Mental Health Services In Rural America

Approximately 70% of New York State is rural and I live in one of the poorest rural counties of the state.  I grew up in New York City where there is a plethora of services and resources for people who suffer from mental illnesses.  Unfortunately I left the big city and moved far out into the country to another world.  It was here in the country that I encountered the legacy of child abuse, addiction, domestic violence, homophobia and racism.  I don't mean to imply that these things don't exist in big cities, they certainly do, but in the country the sense of isolation and shame along with the extreme lack of resources create a much deeper and more resistant problem.  The key culprit is poverty and a lack of community organization.  Money provides incentives to overcome problems.  Without the money people have to rely on their own inner resources and in doing that they pull into themselves and away from the help they need.  On top of that the general poverty means lots of low income families, lack of employment opportunities, single parents, a lack of health insurance, a prevalence of alcohol and drug addiction among other things.

Life is hard, but it is harder in the country.  The ethic out here is rugged individualism and self-reliance, especially amongst farming communities.  Unfortunately, self-reliance is not all that is needed when it comes to mental health.  What is needed is community support and action.  In my county there is not one mental health support group for people with serious mental illness and there are only a small handful of psychiatrists and psychotherapists to cover several counties.  Most people don't have health insurance and rely on social services and the emergency room to help them get through crisis situations.    Even if one does have health insurance and the ability to pay for services, there are very few options.
I'm in the minority in that I have health insurance, though that insurance does not cover the cost of therapy.  My health insurance covers most of the cost of my visits to my psychiatrist every three months and the cost of my medications, but that's it, the bare minimum.  Because I am not eligible for social services I have no community support.

One in four adults in the US, over 57 million people, will have mental health problems in any given year.  One in seventeen will have major psychotic disorders.  A distinguishing feature of mental illness is a pervasive feeling of isolation from others.  This sense of isolation is multiplied in rural areas where there are fewer people living at greater distances from each other.  Without solid community support people get pulled again and again into cycles of mental illness, abuse and addiction.  The burden gets shifted onto the families themselves who are ill equipped to handle these problems alone.  There is some community support for addicts and their families mostly due to 12 step support groups, but only for those who are motivated to go to them.  The stigma of mental illness and addiction is greater in the country because small town life means people are into each others business.  The foundation of many support groups is anonymity, but in small towns there is no guarantee that you won't run into someone you know and this prevents many people from getting help.

The problem remains, mental illness is rampant in poor, rural communities.  Those who are court ordered to go to the minimal support groups and rehabs available, sometimes in place of going to prison, at least have some chance, but many people fall through the cracks in the system.  Social services are overburdened and community action virtually nonexistent.  What's needed are thriving community centers where various kinds of support groups can meet and take on some of the burden of caring for those who need help.  What's needed are community organizers.  Some mentally ill and/or addicted individuals have the strength to start support groups, but most do not.  Because of this there is a need for people who are not afflicted but are dedicated to helping those less fortunate to come forward and set up groups.  The few psychiatrists and therapists that are available are flooded with clients and have no time or energy to set up groups.  Those that remain who aren't suffering from mental illness are busy trying to make a living in an area where there is a lot of competition for even minimum wage jobs.

I think it's fair to say that there aren't many community organizers interested in moving to very poor, rural areas that have very few resources.  Truth is you probably can't make a living at it here, let alone raise a family of your own.  There's just not enough incentive.  Occasionally there is a charismatic, civic minded person willing to make a difference in the community, but even those people eventually burn out when others don't join in to take on some of the responsibility.  Maybe there could be people hired to act as a community organizers that temporarily come into a community and live there for a month or two while training volunteers to facilitate support groups.  I tend to harp of the importance of support groups because I don't have one, but I have seen from going to some 12 step groups that they are effective and low cost.  I do think that bringing small groups of people together can create not only an atmosphere of support, but some motivational magic to combat and lessen the grip of mental illnesses.

People with serious mental illness sometimes act out, but more often than not they pull into themselves, isolate themselves because they don't quite fit into society.  Support groups organized by confident, healthy individuals who have the training to pass on the rules and structure necessary to sustain a group could change the lives of many by teaching those with mental illness how to take better care of themselves and each other.  The people who commit to a support group find through their commitment that they can gradually take on more responsibility within the group.  Before that can happen there must be a catalyst to get the ball rolling.  When I was in early recovery I found one of the greatest obstacles to my happiness was a strong lack of motivation.  I needed someone else to appreciate me and encourage me to reach outside of myself.  I didn't find that in my community, except with my therapist. My main support all these years has been online on support forums and in this blog community.  That has helped a great deal, but it can't take the place of belonging to a local community, taking on more responsibility and directly helping those in need.

I've wanted to be that charismatic community organizer, but the pull to withdraw and avoid responsibility is part of my illness.  Like so many people in my community, I need the extra help to get things started.  But if we had that extra help in our rural communities, there's no telling how far we could go with it.