2016 Data compiled by the Robert Wood Johnson Foundation provides insight into Northampton County. 20% of residents in the county are listed as having poor health, and report having four ‘bad’ mental health days per month. 46% of children are living in single parent homes, and 33% are living in poverty. Overall unemployment is almost 8%. All these factors help account for inadequate access to mental health for the residents of Northampton County, as well as other rural counties in the state.
Data from Mental Health America ranks Virginia 38th out of 50 indicating a higher prevalence of mental illness and lower rates of access to care as compared to other states. While accesses to services in Northern Virginia (DC Metro Area) are considered relatively abundant, even those numbers are not enough to skew results for the rest of the state. Take Northern Virginia out of the equation and a fundamental breakdown and lack of services available to rural communities in Virginia is a bleak picture.
The ratio of providers to patients in Northampton is 930 to 1. Break that down to child psychiatrists, and the ratio becomes even more challenging.
In the report, “Depression in rural populations: Prevalence, effects on life quality and treatment-seeking behavior” by the Office of Rural Health Policy, mental health issues may be worse in rural America, where major depression rates significantly exceed those in urban areas. The Institute of Medicine (2002), in its report “Reducing suicide: A national imperative” notes that teens and older adults in rural areas have significantly higher suicide rates than their urban counterparts.
The National Rural Health Association reports that majority of Mental Health Professional Shortage Areas (MHPSAs) are in rural counties. “Among 1,253 smaller rural counties with populations of 2,500 to 20,000, nearly three fourths of these rural counties lack a psychiatrist, and 95 percent lack a child psychiatrist”. An estimated two thirds of U.S. patients with clinical symptoms of mental illness receive no care. Of those who receive formal treatment, approximately 40% receive care from a mental health specialist and 45% from a general medical practitioner. Due to the lack of specialty behavioral health care, primary care caregivers provide an increasing proportion of behavioral health care in rural counties.
Decreased population density also impacts rural behavioral health care due to the distance patients may need to travel to access other mental health professionals and facilities. For Northampton residents, having to travel north or across the bay can be problematic due to the lack of public transportation and just the cost of travel.
Fifteen years ago, President Bush’s 2002 New Freedom Commission on Mental Health was convened to investigate the problems found in the current mental and behavioral health system. The report found that Americans living in “underserved, rural, and remote areas experience disparities in mental health services compared with their urban counterparts”, and that “…rural issues are often misunderstood, minimized, and not considered in forming national mental health policy. Too often, policies and practices developed for metropolitan areas are erroneously assumed to apply to rural areas”.
Unfortunately, not much has changed. The fundamental lack of available behavioral health providers, and restricted/limited resources strain existing services such as the local Community Services Board(CSB) and ultimately limit access to rural residents.
In places like Northampton, Medicaid based contract providers attempt to fill the gap by providing school based, home based and outpatient behavioral health services, however, the political climate of the day and policy shifts that effect funding and regulations can create a foundation of shifting sands that these firms are forced to operate on top of.
As America continues to get older, the funding strain on Federal and State programs such as Medicare and Medicaid will only be increasing. Being sure behavioral health continues to be funded at adequate levels will certainly require leadership at the state and local levels, but that leadership may not emerge without political pressure that begins at home, and eventually pushes its way to the top.
About the Author
It truly is a sign of the times and a sad commentary on society when you see so many articles lamenting the lack of Mental Health Care facilities, especially in rural areas. I am old enough to remember when funding began to dry up for government funded facilities and literally, institutions began to close and patients were sent back to their families or put out on the streets. Dare to guess who was in the White House during those times? And those who feel that is not the government’s place to maintain the mentally ill, you seriously need to reevaluate that way of thinking. State expenditures for prisons rose over fifty billion dollars as late as 2014. The government reimburses private prisons for incarceration of inmates. How many inmates are mentally ill? We have no way of knowing and state officials aren’t taking the time to thoroughly verify and weed them out of the prison system. By the time of incarceration, it generally is too late, regardless. The mentally ill consists of a myriad cross culture, such as war veterans, drug abusers (poor, middle and upper class) and those mentally impaired either due to chemical imbalances in the brain, accidents or birth defects. Yes, of course, many families are taking care of their own, but at what costs? And what costs are there to a society when many of these impaired human beings fall through the cracks and end up homeless on our streets or are locked up in our prisons system?
So, think along those lines when you see some mother berating (hitting?) their young child in the Walmart aisle or someone comes stumbling out of a bar and heads for their car. Think about all those normal homes all along those long back country roads and in quaint little bayside towns, with their normal little lives. Except, the mother is a closet pharmaceutical opioid abuser or the son is manic depressive with suicidal/homicidal tendencies. Or perhaps the father is just an abusive angry out of work wife beater. Is this the America you wanted to inherit? Think mental illness doesn’t affect you? Think again. It is no coincidence the poor is mentally strained. Between stress, malnutrition, physical abuse and a lack of society’s general caring, the only refuge they have are themselves and their church. A might thin line people, mighty thin. It spills over into incarceration and other dark areas. It also is no coincidence that America now has the largest per capita incarceration rate in the world. More than China, and more than Russia. Let that sink in.