Experts are concerned about a growing mental health crisis across the country, and in part one of our rural health series, we look at the struggles facing people in Eastern Kentucky as they grapple with accessing mental health care.
“Because we’re Appalachian, we’re seen as strong. That’s how we want to portray ourselves. And when you have any kind of mental illness, it’s seen as a weakness.”
Casey Wright is the system director of behavioral health, education and psychological support at Appalachian Regional Health. She says it’s a mental health stigma that many people in Eastern Kentucky face. Wright and her colleagues try to convince patients otherwise.
“As I’ve said before, we try to tell our patients, if you have diabetes, you need treatment, it’s a disease; if you have depression, you need treatment, it’s a disease.”
For some people, it is only after a major event that they decide to seek help.
“I attempted suicide when I was 21.”
Valerie Jones of Morehead, Kentucky, reached a breaking point about 20 years ago. She says her substance abuse and dealing with anxiety were getting out of hand.
“I couldn’t live like that. I was depressed, I couldn’t survive, I couldn’t function, I couldn’t work, I lost my job, I just couldn’t function. So that’s when I thought, ‘It’s time to do something, this is really a chemical imbalance.'”
But it hasn’t been an easy road. Once I started receiving help, it became difficult to continue with my treatment.
“Appointments got cancelled or rescheduled, and the third or fourth appointments I was finally able to attend were always with a new therapist due to work or other schedule conflicts. This is partly my fault.”
And she said seeing a new therapist every other session was a struggle in itself.
Jones said it’s frustrating because she’s constantly being told she needs to use medication in combination with therapy.
“I’m taking all the medications my doctors have prescribed, and they’re saying, ‘You need to get counselling, you need to get therapy while taking your meds, because that’s the most effective way to deal with your issues,’ but I’m trying to keep my appointments and then they keep cancelling and they’re like, ‘Basically, it’s not that important.'”
She said sometimes it gets her down.
“This makes them reluctant to go, and limits the medical facilities they can access.”
Jones works in the mental health field herself, and she knows it’s not easy for the people she’s trying to help.
“So I get it. The pay isn’t great, the work is hard, it’s emotionally draining. But as someone on the other side of it, as someone trying to get those services for themselves, and as someone who is anxious, it’s hard to just go and talk to someone.”
And that’s not the only hurdle people face: Casey Wright of ARH said in southeastern Kentucky, it can be hard to even get to an appointment on time.
“We don’t have Uber here, we don’t have taxis, we don’t have anything like that. Most people live in the valleys and stuff, out of town, so it’s really hard to get a car when you have an appointment.”
Paulina Jones is director of counseling and psychological services at ARH. She said public transportation is also not much of an option.
“With our public transport system, you have to make an appointment to be picked up, and you have to make an appointment three days in advance. So some of our patients don’t have phones, and when it comes to WiFi, we don’t have good WiFi service.”
Paulina Jones said another obstacle for people seeking help is finances: Many who receive help from ARH are on Medicaid, but for those who aren’t, paying for care can be much harder.
“But if you’re on Medicare, only certain providers can pay for that treatment. And if you’re private or insured, you only have a limited number of days allotted for outpatient treatment, so you might only have 10 days or so to resolve whatever the issue is. And if you have something like trauma or PTSD, you’re probably not going to be cured in 10 sessions.”
Paulina Jones and Casey Wright said they acknowledged that more funding is being directed toward mental health care, but they want officials to do more. Jones said there are some inpatient facilities for people with substance use disorders, but long-term mental health care facilities are also needed.
“We have patients here, they’ve been here for quite some time, they need a low level of care, and there’s no place for them to go. There are no private care homes, there are no good facilities where chronically mentally ill people can live out the rest of their lives and not end up with high relapse rates and continue to be hospitalized because they don’t have a living environment or a safe place to go.”
In addition to funding, other efforts are underway. Earlier this year, Gov. Andy Beshear signed House Bill 385, known as the Seth Act, into law, which officials say will reduce the number of people who need to be placed under state custody to receive health care.
The bill honors the memory of Seth Stevens, a mental health reform advocate who died by suicide in 2023.
Anyone who may be experiencing suicidal thoughts or any type of mental crisis can call or text 9-8-8 24 hours a day, 7 days a week, to speak to someone qualified to help.
More information about the 9-8-8 Suicide and Crisis Lifeline can be found here.
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