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Rachel Harrison, of rural Dallas County, Missouri, lives with Schizoaffective Disorder and says her psychiatrist works in three counties each week.A critical shortage of mental health workers is making life difficult for both patients and providers across Missouri, particularly in rural areas. In this series, we hear their stories to learn about the extent of the crisis, and investigate what's being done to address it. Hear the series by selecting individual stories below.

Mental Health Stigma in Rural Areas has Unique Factors

Flickr via Creative Commons
Photo Credit: Nebraska Rural Health

Suicide rates are higher in rural areas than urban areas—and the gap between urban and rural suicide rates is widening, according to the Centers for Disease Control and Prevention.  

A small clinic sits on the main drag in Mansfield, Missouri – that’s in Wright County, one of Missouri’s 70 counties without a full-time psychiatrist, according to the Missouri Board of Healing Arts.

But the county does have three psychologists, and one is Dr. Loretta Fuge.  She says many locals are hesitant to make an appointment with her because they’re afraid someone will recognize their vehicle here.

“They know that Ralph drives, you know, a Ford truck that’s blue. So if they see a Ford truck parked in front of the mental health place, then they assume that that’s what’s going on. So I think for them a lot of times there’s this, like, a fishbowl effect in that they assume that everybody knows what they are doing.  Sometimes they do, sometimes they don’t.  Sometimes, people don’t pay attention. But I think there is very much this stigma that people might,” Fuge said.

In its March, 2017 report on the growing disparity between urban and rural suicide rates, the CDC says one way to help prevent suicide in less urban areas is to promote positive social norms, like seeking help.

Fuge says in rural Missouri, seeking help is loaded with stigma.

“Because I think in rural areas, people tend to be strong and independent and, really, work ethic is really high. So if they see anything that they feel like is not meeting kind of that cultural view, that they’re somehow ‘less than,’” Fuge said.

She says she talks to clients about how normal it is to seek help for Depression or Bipolar Disorder, and how they’re seeking “a hand up,” not a “handout.”  She tells them it’s not about them having weak faith in God—it’s a health condition, she says.

As fact-based awareness spreads, stigma tends to decrease.

And Fuge said she’s noticing a trend here in Wright County:  people are starting to talk about mental health more openly.

“I mean, I’ve got referrals from the insurance agent, or maybe from the bank, or somewhere like that—someone’s been talking and someone’s said, ‘Well it sounds like you might be depressed. You might want to go up to [the clinic],’ and they’ll send them up here,” Fuge said.

In Springfield, Paul Thomlinson is acting president and CEO of Burrell Behavioral Health

“Folks who tend to choose to live in rural areas, perhaps, have even more of a cultural ethos or ethic of, you know, rugged individualism, and ‘We take care of our own,’” Thomlinson said.

He’s got a benchmark he’d like both rural and urban culture to reach.

“When people go and get cancer treatment and come back, we give them parties and say, ‘Welcome back! Good on ya, mate,’ and all that. One of my stock statements now is, I’ll know we’ve really made progress with mental health stigma when we start doing that after somebody’s had a week long stay in the psychiatric unit.  And they come back to work and we have a little party for them and bring cake, and say, ‘Yay. Good job. Good job, recovery…recovery’s possible. Recovery works,’” he said.

The CDC report says one suicide risk factor “known to be highly prevalent in less urban areas” is access to mental health care.  Missouri is currently facing a severe shortfall of mental health professionals, and that shortage is most acute in rural areas.