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.