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Chad Reznicek knows all too well the stigma surrounding mental health in rural Colorado. A behavioral health specialist with the Colorado AgrAbility Project, Reznicek noted that communities remain tightly knit in small towns, and it’s not uncommon for everyone to know each other’s business. Residents, he said, are wary of seeking help precisely because they fear being judged, particularly when that judgment could potentially jeopardize entire livelihoods.

But it’s not just the stigma that acts as a barrier to access, a confluence of factors has made rural Colorado a “mental health desert.” There are fewer mental health facilities in rural Colorado, and it’s tougher to persuade a practitioner to give up the convenience of city living and move to a town far away.

According to the Colorado Rural Health Center, there is one mental health provider for every 1,282 residents in rural Colorado, compared to one for every 755 residents in urban areas. One of the obvious reasons is the population weight across the state. Census data shows that rural Colorado has nearly 80% of the state’s land but only about 14% of its population.

In many rural parts of Colorado, it’s not uncommon to have to travel several miles to reach a neighbor’s house and even farther to access the nearest medical provider. Patients seeking mental health care in some regions may have to drive several towns away to reach a clinic, which can be impractical or even impossible for many. The way experts put it, these factors have created a perfect storm — communities struggle with limited mental health services, exacerbated by the pervasive stigma surrounding mental illness.

Many have looked to technology to help the gap in rural areas. Telemedicine, for example, has grown significantly since the COVID-19 pandemic, and it offers a promising option for patients in remote areas. But it’s not a universal solution precisely because broadband access remains a significant issue in rural Colorado, with more than a dozen counties reporting nearly a quarter of the population lacking at-home internet service.

One in five rural Coloradans reported experiencing depression, based on data from the Colorado Rural Health Center. House attributed this figure to the unique pressures of agricultural work, compounded by some level of isolation of rural living, as well as the financial strain and supply chain disruptions brought on by the pandemic.

Help is available for those who need it and are ready to seek treatment, experts and others emphasized. Organizations, including the Colorado Department of Agriculture, Colorado State University Extension, Farm Bureau Foundation, and the Colorado Office of Behavioral Health, oversee a program that provides vouchers to agricultural workers and their families for six free telehealth therapy sessions. Numerous legislative efforts at both the federal and state levels have sought to increase access to mental health care in rural communities. The Rural Wellness Act, introduced by U.S. Reps. Yadira Caraveo of Colorado and Brad Finstad of Minnesota would reauthorize the USDA’s Distance Learning and Telemedicine Program, which provides grants to help rural communities implement technology projects, such as telemedicine treatment for substance use disorders.

Read more at ColoradoPolitics.com

Carter J. Carter became a therapist to help young people struggling with their mental health. Rosanne Marmor wanted to support survivors of trauma. Kendra F. Dunlap aspired to serve people of color. They studied, honed their skills and opened practices, joining health insurance networks that put them within reach of people who couldn’t afford to pay for sessions out of pocket. So did more than 500 other psychologists, psychiatrists and therapists who shared their experiences with ProPublica.

But one after another, they confronted a system set up to squeeze them out. Although federal law requires insurers to provide the same access to mental and physical health care, these companies have been caught, time and again, shortchanging customers with mental illness — restricting coverage and delaying or denying treatment. These patients — whose disorders can be chronic and costly — are bad for business, industry insiders told ProPublica.

There are nowhere near enough available therapists in insurance networks to serve all of the people seeking care. And although almost all Americans are insured, about half of people with mental illness are unable to access treatment. The consequences can be devastating. To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.

A psychologist from Eugene, Oregon, Todd was treating a young woman with a history of trauma whose father had died unexpectedly. When the patient came to Todd, she was often unable to sleep more than an hour or two for days on end. “She described it to me as maddening,” said Todd, who recognized an array of symptoms that fit a diagnosis of bipolar disorder.

Longstanding practice guidelines recommend that providers consider a combination of therapy and medication when treating patients with bipolar disorder, so Todd sought a psychiatrist who could manage the young woman’s prescription. Although the patient was covered by UnitedHealthcare, America’s largest insurer, Todd was unable to find anyone who had openings. Her patient had to pay hundreds of dollars for out-of-network psychiatry sessions. Then, six months into treatment, UnitedHealthcare began to question whether therapy was even necessary.

Todd walked an insurance reviewer through the details of her patient’s fragile state. Even when the woman had periods of calm, Todd said, she knew the disorder was unpredictable. She worried her patient could attempt suicide if care was cut off at the wrong time. The reviewers responded that the patient needed to be actively experiencing severe symptoms to continue with treatment and suggested that the therapy wasn’t working.

In the end, the reviewers demanded a date when therapy would no longer be needed. Todd left the network so she could treat her patient without interference. The patient could afford to pay out-of-pocket because of a small settlement after her father’s sudden death. People are more than twice as likely to pay their full bill out of pocket for visits to mental health providers than primary care physicians, according to a ProPublica analysis of federal survey data.

Read more at NPR.org.

The Defense Health Agency is introducing a new approach at behavioral health clinics, called targeted care, to help improve access to mental health resources.

Targeted care refers service members and other beneficiaries to the clinical or non-clinical mental health resources best suited to support their needs, offering earlier interventions and promoting force resilience and readiness.

Pivoting off an Air Force Medical Service model with a vision to expand it across all military hospitals and clinics, DHA conducted a six-month targeted care pilot at 10 military behavioral health clinics. The pilot ran from April to October 2023.

Results from the pilot found that about 40% of individuals who contacted outpatient behavioral health clinics at the pilot sites did not require medical intervention or have a diagnosable mental health condition; however, they would benefit from other mental health services.

Whiteman Air Force Base in Missouri was the first base within the Air Force Global Strike Command to fully roll out targeted care after a pilot phase, said Whiteman Mental Health Flight Commander U.S. Air Force Maj. Callie Cooper, a doctor of clinical psychology.

Its benefits quickly became apparent, said Cooper, with “notable reductions” in patients receiving off-base mental health referrals. There were 180 airmen referred off base before Whiteman started targeted care in the fall of 2022, and only 40 in the year after implementation. For those patients not referred off base, targeted care assessed the patient’s needs and, where appropriate, referred them to on-base services for immediate support.

Targeted care reduced wait times, created prompt access to specialty mental health services, and lowered provider caseloads, said U.S. Air Force Capt. Oliver Bauer, a doctor of psychology and a staff clinical psychologist in Whiteman’s mental health clinic.

Whiteman Air Force Base in Missouri was the first base within the Air Force Global Strike Command to fully roll out targeted care after a pilot phase, said Whiteman Mental Health Flight Commander U.S. Air Force Maj. Callie Cooper, a doctor of clinical psychology.

Its benefits quickly became apparent, said Cooper, with “notable reductions” in patients receiving off-base mental health referrals. There were 180 airmen referred off base before Whiteman started targeted care in the fall of 2022, and only 40 in the year after implementation. For those patients not referred off base, targeted care assessed the patient’s needs and, where appropriate, referred them to on-base services for immediate support.

Targeted care reduced wait times, created prompt access to specialty mental health services, and lowered provider caseloads, said U.S. Air Force Capt. Oliver Bauer, a doctor of psychology and a staff clinical psychologist in Whiteman’s mental health clinic.

Since then, there have been a number of MHS early adopters of targeted care in the U.S. and overseas. These early adopters may serve as models for successfully rolling out targeted care across all MHS hospitals and clinics by 2025.

Read more at NewsRoom.TriCare.mil.

The 2022 National Survey on Drug Use and Health showed that just over one-fifth of Hispanic adults reported having a mental illness, defined in the report as a diagnosed mental, behavioral or emotional disorder that may have interfered with their lives. That’s slightly less than white Americans (24.6%) but more than Black Americans (19.7%) and Asian Americans (16.8%).
 
The same survey showed Hispanic adults were less likely to receive treatment than multiracial adults and white adults. Mental health experts, community clinics and politicians are increasingly calling attention to barriers Latinos might face in seeking treatment — like the lack of mental health professionals who are Latino and speak Spanish or other languages — and working to create new programs to address access issues.

SOMOS Community Care in New York City started doing mental health screenings for all patients regardless of the reason for the appointment, said Riquelmy Lamour, the director of behavioral health and social work.

Many of the patients live in heavily Latino neighborhoods in upper Manhattan and the South Bronx, and Lamour said that it can be easier for someone to lower their guard when a doctor who’s been treating the family for generations sets them up with a mental health professional. The organization also conducts screenings at street fairs, providing an immediate connection to a provider and resources to find other appropriate services.

An American Psychological Association interactive tool shows about 8% of psychologists identified as Latino in 2021, the most recent data available. Dr. Julia Macedo, a psychiatrist in Pittsburgh and a fellow with the National Hispanic Medical Association, said patients are less likely to seek help if they don’t have someone who can understand their experiences, such as the anxiety and fear of having a family member deported.

The Department of Mental Health in Los Angeles County, California, started expanding mental health care services for the county’s 4.8 million Latinos during the pandemic. That included the creation of the speaker’s bureau, where licensed clinicians provided reliable information on COVID-19 and now give “clinically, culturally and linguistically” appropriate information about mental health and other topics, said Sandra Chang, who is the program manager for the county’s mental health clinical program.

 Read more at Health.WUSF.USF.edu.

On an ongoing basis, Wailuku nonprofit Ka‘ehu invites families impacted by the August 2023 wildfires to partake in lei making, lauhala weaving, plant stamping, T-shirt printing and other cultural activities.  The repetitive tasks ground attendees in their bodies as they reflect on their feelings and thoughts. Attendees can also participate in ho‘oponopono, lomilomi, grief counseling, and other services.  These activities are part of the Hawai‘i Community Foundation’s culturally grounded and holistic approach to Maui’s mental health response. Embracing the principles of trauma-informed care, it recognizes that a variety of alternative therapies can help individuals impacted by a collective trauma reflect on and improve their mental health.  

HCF’s Maui Strong Fund mental health strategy stems from Hawai‘i’s efforts to become a trauma-informed state. In February 2024, Gov. Josh Green declared Hawai‘i trauma-informed and directed the state Office of Wellness and Resilience (OWR) to implement a trauma-informed care framework throughout state departments and with community-based organizations. The framework integrates safety, trust and transparency, empowerment, collaboration, peer support, and honoring cultural, gender and historical issues.

HCF’s strategy has led to better coordination and more diverse therapeutic support options for fire-affected households. For example, the foundation has contracted nine clinicians and group practices to provide free therapy sessions to affected individuals—up to 10 sessions—and on-site mental health support at community meetings. It’s a short-term solution to reduce barriers to mental health care, such as lack of insurance or when individuals find it too difficult to get therapy sessions approved by their health insurance. “We really need to understand the needs of Maui and the needs of those serving those in Maui,” says Michele Navarro Ishiki, director of mental health services at Piha Wellness and Healing, and one of the contracted clinicians providing therapy funded by HCF’s Maui Strong Fund. Michele has been providing trauma-informed individual and community care to those affected by the Maui fires.

More requests for mental health support are expected as more individuals and families affected by the fire move into stable housing. Many partners and HCF grantees in mental health and wellness are preparing to meet the needs of people that will seek services in the upcoming months.

Read more at HawaiiBusiness.com.

Research estimates that 57.8 million people across the U.S. are experiencing challenges with various mental illnesses. Despite this, societal biases against mental health issues persist. Mental illnesses can be effectively treated, but there is a societal tendency to view mental illness differently from physical ailments. This stigma is particularly prevalent in Asian communities, where studies highlight it as the main barrier that prevents Asian Americans from seeking help.

Historically marginalized communities, such as Black, Indigenous and people of color (BIPOC) communities, face disproportionate challenges around access to and quality of mental health and substance use care. The Chinese community faces unique mental health challenges for cultural and structural reasons.

Deep-rooted cultural stigmas surrounding mental illness are a significant barrier. The perception of mental illness as a personal failing or a sign of weakness discourages individuals from seeking help.

In Chinese culture, the brain is regarded as the organ that governs all aspects of functioning. Consequently, mental health challenges are often perceived as indicative of a fundamental flaw in the brain, the command center of the body. This perception leads to the belief that individuals with mental health challenges are unreliable or unfit for social interaction, resulting in a perceived loss of social status.

To help address racial inequities and the associated stigmas that lead to disparities, the National Council for Mental Wellbeing built a directory of resources to support your community with tools and learning opportunities.

Read more at MentalHealthFirstAid.org.