Limited resources continue to plague rural treatment facilities

Nov. 17--Mental health, like physical and spiritual health, is one piece of a person's overall wellness. However, stigma and lack of funds limit the amount of resources available to those in need, particularly in rural areas.

According to Mental Health Texas, one in five Texans will experience some kind of mental health concern sometime in their lives. In the Kerrville area, there are multiple resources and centers for those in need of mental health assistance.

Dustin Biel, clinic director and therapist at the Hill Country Mental Health and Developmental Disabilities Center, said the center offers mental health services, including access to recovery coaches, pharmaceutical referrals and therapy. The center also has a crisis stabilization unit.

"It's a step lower than a psychiatric hospital, but it functions about the same," Biel said. "It's less expensive than a full-fledged psychiatric hospital, and we don't have to wait for a bed to open up in Austin or San Antonio, because we can provide more immediate care, which is better for the people that have to use it."

Jason Scanlan has received treatment from both MHDD and New Hope. He has lived in Kerrville since elementary school and was diagnosed with depression when he was 16. He started receiving medication and service from MHDD, but after a divorce and work troubles, he started looking for professionals within the community for support.

He began to attend New Hope Counseling, another resource for mental illness in the area, for sessions about five years ago. He now visits the counselors

when he needs someone to talk with and to gain advice.

"I have never been ashamed that I needed people to talk to," Scanlan said. "Everybody needs people to talk to. You can sit there and say you don't, but being lonely and being just you gets old real quick."

MHDD, while it does offer therapy services, does not include counseling for a broad range of mental health needs. New Hope Counseling offers counseling services for what people usually associate with mental illness, such as depression, but executive director Sharon Renter said the nonprofit also can offer support in matters of grief, marriage and behavior management in children, which Renter said all play a role in one's mental state.

Funding concerns

One challenge for mental health resources across the state and country is funding. The National Association of State Mental Health Program Directors Research Institute reports that Texas spent about $41 per capita per year on mental health between 2004 and 2013, second from the bottom of the list. The United States spent on average about $120 per capita in the same time period. Maine, at the top of the list, spent on average $350 per capita. The 2013 Texas Legislature budgeted about $2 billion through 2015 for mental health care, an increase of about $250 million from the last biennium.

Biel said MHDD receives some funding from the state and federal government, but more comes from groups wanting to fund mental health services and research.

"The state provides general revenue, and then we bill Medicaid, Medicare and private insurance," Biel said. "Our mental health services are not free. Most of it is paid through insurance, but we don't refuse service for non-payment."

Cuts in funding have led to narrower treatment focus. The primary diagnosis of someone treated for mental health at the center has to fit into three categories, Biel said -- major depression, bipolar disorder or schizophrenia. The person must also have a low level of function.

Renter said the organization relies on local funders and grant programs. But, like MHDD, New Hope has trouble getting enough funding.

"We are constantly in a battle for money," Renter said. "We have a different challenge than other people do, because seeing less clients in some ways is a better thing for us than seeing more, but funders want quantitative outcomes."

Thomas Kim, internist and psychiatrist in Austin, focuses on telemedicine and works with clients with mental illnesses. He also serves on several councils within the Texas Medical Association. He said the lack of sufficient mental health funding at both the state and federal level has a negative impact on rural regions in terms of who they can feasibly serve.

"Broadly, health care funding has both federal (Medicare) and state (Medicaid) level sources to pay for care," Kim said. "The current political landscape in Texas led to the rejection of potentially available Medicaid expansion dollars, resulting in less money to pay for services for those with the greatest need, including desperately needed mental health care."

Stigma

For years, there has been a stigma around mental illness. Wanda Sutton, licensed clinical social worker at New Hope, has been working in community mental health since 1992. She said there are popular misconceptions about mental illness, and patients themselves often are embarrassed to share information about their conditions.

Biel said sometimes it isn't the person in need who has the stigma.

"Sometimes the spouse of the person in need feels ashamed about the mental illness or will deny that it's really there," Biel said.

Kim said stigma, along with the experiences some people seeking mental health assistance go through, can be challenging to the system.

"Patience and persistence is required, as getting in to see a psychiatrist can take weeks and months of effort only to see someone for a few minutes and leave with a fist full of prescriptions and a follow-up appointment months away," Kim said. "This generally unsatisfying experience makes it far from surprising why folks are not more engaged with mental health services."

All agreed that they are starting to see some improvements in the way society discusses mental health.

Rural care

Both centers serve Kerr County and those in the surrounding area. In rural areas, Biel said people seeking mental health services can receive the same level of care as in an urban area, but the difference is in the distance traveled to get service.

Kim said rural communities across the county are particularly vulnerable.

"Historically, a number of programs and initiatives have sought to improve rural health care from monetary incentives for services to programs aimed at recruiting providers to these areas," Kim said. "Despite these efforts, rural America still needs a lot of help, as do the rest of us."

Scanlan said one benefit to rural mental health services is the community aspect of it. He said New Hope let him paint at the center even if he wasn't in a session and when he didn't have anywhere else to go.

Ways to address the problems

Kim said telemedicine, involving video appointments, is an option for mental illness treatment, particularly in rural regions to help reduce the burden on patients. Changes in legislation and regulation of mental health services to provide more preventative and proactive care, similar to those offered for physical illness through wellness checks, also could have a positive impact.

"If we can identify mental illness early on and prevent them from worsening, we are all better off," Kim said. "The problem, again, is defending a negative. It is hard enough to get payers and legislators to pay for acute services."

While there is a need for more funding and resources, Scanlan said resources and mental health professionals in the area and the state work hard to offer support and care.

"They do a lot and give a lot," Scanlan said. "We do have an awesome MH center and counseling centers. Lots of places, I feel, don't have it this good."

New Hope will be moving into a new office at the Hill Country Resource Center Facility on East Main Street, and Renter said the new office has the potential for expansion.

Along with increasing and improving resources, education about mental health and illness also is needed. MHDD offers training and education courses on mental health first aid for both youth and adults, along with other outreach programs. Kim said it is important for those wanting to advocate for mental health to continue to gather support and attention.

"While physical health is also important, if we are not mentally healthy, everything else tends to go to crap," Kim said.

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