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Ted Matthews drove past acres of fields, racing to meet with a farmer who called threatening to kill himself.

That’s when he got a call from another farmer in a different part of the state who was also threatening suicide. Since he couldn’t be in two places at once, he frantically got on his phone to try to find someone else who could help the second farmer.

Matthews might have the toughest job in the state of Minnesota. As the lone rural mental health counselor for the entire state employed by the Department of Agriculture, he gets 15 calls on a slow day and as many as 40 calls on a busy day. “People constantly talk to me about suicide,” he said.

He has worked alone for more than two decades, but there is now a proposal being considered by legislators this year to increase the number of people fielding calls from farmers and others in crisis by 100 percent — in other words, there would be a total of two full-time rural health counselors, including Matthews.

It’s greatly needed, said Matthews and others who testified before the Minnesota House Agriculture Finance Committee on Tuesday. Nationally, farmers have endured a 50 percent drop in net farm income over the last three years, the largest three-year drop since the start of the Great Depression. And there’s no relief in sight: according to an annual report from the University of Minnesota Extension and Minnesota State system, 2017 was another year of thin profits for farmers in the state. Roughly one-third of farmers lost net worth last year, and dairy farmers were hit the hardest, with prices for milk plunging in the second half of the year.

For farmers and those who work with farmers every day, it feels a lot like the farm crisis of the 1980s, when inflation, massive debt and high interest rates forced thousands of farmers out of work.

According to the Census, there are roughly 100,000 farmers in Minnesota, and the most recent downturn has taken a toll on those individuals. A 2016 study by the Centers for Disease Control and Prevention found people working in agriculture-related jobs take their lives at a rate five times higher than the general population.

Legislators and Gov. Mark Dayton are considering a number of proposals to tackle the problem this year. Dayton proposed to add another full-time mental health counselor through the Minnesota State system, as well as increase education and outreach about options for farmers in crisis. A bipartisan group of legislators are proposing funding for more mental health counseling options for individuals and families in rural parts of the state, including a proposal from Rep. Jeanne Poppe that’s similar to Dayton’s, transfering funds to the Minnesota State system to add more health counseling support. She’s also authoring a bill to offer a grant to the Farmers’ Legal Action Group, which provides legal aid to farmers struggling with finances or other issues.

More than money problems

It’s not just financial struggles affecting farmers, according to the farmers and advocates who testified in committee on Tuesday. The physical pain from the arduous work of farming can take its toll, and in some far-flung rural areas, farmers don’t have great access to the health care they need. In some cases, farm culture dictates anyone with physical or mental conditions should suck it up and get back to work.

Brad Schloesser, dean of agriculture for the Southern Minnesota Center of Agriculture, said the farming lifestyle is also isolating and solitary, and in their small, close-knit communities, farmers are often worried about how they are perceived by others. That can affect their willingness to seek out help in a public place like a mental health center.

“We are proud individuals, often solitary,” Schloesser said. “[Farmers are] often not the type of people to drive their pickup truck to a place that would identify them to their neighbors as someone who is struggling.”

As the only rural mental health counselor working currently, Matthews keeps his cellphone number posted online, and usually the calls are anonymous. He doesn’t take down names, but lets the caller know that he might check back with them down the road to make sure they are OK. The calls can last five to 20 minutes, and if it gets to that point, he will travel from his home base of Hutchinson, Minnesota, and meet families in person.

There’s no charge for his services — that’s covered by the state — but he’s often not making any diagnosis, either. He’s just there to listen and answer any questions.

“When a farmer calls me they never say anything except, ‘Hi, Ted,’” Matthews said. “Everyone identifies me as Ted, [they don’t ask about my] credentials or [offer] thoughts about those credentials because that makes them uncomfortable.”

More than having an extra counselor working to field calls, Matthews would prefer a situation where he’s not rushing across the state to help someone in the middle of a breakdown. Matthews wants more resources put into training people who work with farmers to recognize signs of depression. The state also recently started a hotline for farmers to call if they are dealing with stress and suicidal thoughts.

“All farmers have lots of stress — it’s a matter of lowering it,” he said. “The idea is not to find people who are really depressed and help them out of that. That is obviously a goal if they are in that position, but the idea is to have a lower stress and lower depression by working with them far, far ahead of those issues.”

Read more on MinnPost.com.

There is a powerful stigma surrounding mental illness in Asian American communities which is causing a crisis for their mental health. In a 2010 study of Asian Americans’ use of mental health services, participants said the primary factor preventing their use of mental health services was due to it being looked down on in their communities.

How exactly does this stigma against mental illness work within Asian American communities?

Here’s what it looked like for Rakshya Devokta from St. Louis University: “Growing up, it was pretty clear to me that something was off, but I couldn’t find the words to explain it to my parents, who had struggled so much to succeed in this country as Nepalese immigrants.

“To seek help for my mental illness would be to admit defeat — because in my culture, to be mentally ill is to be weak. I thought it would be a slap in the face to my parents, who had sacrificed so much and given me so much, for me not to be their perfect, well-adjusted child. So for years, I chose to hide my illness.

My story, after examining the data, is not an unusual one.”

According to the American Psychological Association, Asian Americans, on average, are three times less likely to seek help for mental illness than white Americans.

There are multiple reasons for this gap in Asian American mental health access: pressure to conform to the model minority myth, inadequate understandings of mental illness within Asian cultures, language barriers and lack of culturally competent mental health professionals. All of these issues prevent Asian Americans from accessing mental health services and sharing their mental health stories within their communities  — which, in turn, reinforces the stigma.

Thankfully though, many organizations focused on Asian American mental health are fighting the stigma and lack of access.

Here are a few of these organizations:

1. National Asian American Pacific Islander Mental Health Association (NAAPIMHA)

NAAPIMHA is a nonprofit based in California whose primary goal is to raise awareness about the importance of mental health in Asian American Pacific Islander communities. The organization works towards this mission by training mental health professionals in cultural competency, working with Asian American community organizations to raise awareness of mental illness and developing mental health fact sheets in a variety of different Asian languages.

Asian Americans often fear that the mental health help they receive may not be sensitive to or aware of their culture — and by focusing on cultural competency and breaking down language barriers, NAAPIMHA is working to make using mental health services a far more comfortable and beneficial experience for Asian Americans. NAAPIMHA has also partnered with Active Minds and the National Asian Pacific Islander American Panhellenic Association in an initiative called the “Friends DO Make a Difference” Initiative.

A particularly stressful time for Asian American young adults is when they are enrolled in college. Stressing factors like the pressure to succeed, the expectations of parents as well as the social pressures of being away from home all can trigger mental illness.

With this project, NAAPIMHA seeks to reach out to Asian American college students dealing with mental illness by giving students a platform to discuss mental health through programming. The program also raises awareness of resources available to students.

2. I-AM SHAKTI

Started just last year by Archit Baskaran, a 21-year-old medical student, I-AM SHAKTI is an initiative aimed at getting South Asian Americans to share their mental health stories. The organization was co-founded by undergraduate students and medical students from Northwestern University and the University of Wisconsin-Madison.

I-AM SHAKTI’s goal is to break down the stigma against mental illness in South Asian American communities. By giving South Asian Americans going through a mental illness a place to share their stories and to learn about other South Asian Americans’ mental health stories, I-AM SHAKTI seeks to break the silence.

It also aims to foster a sense of community and solidarity among South Asian Americans suffering from mental illness. Future plans for the foundation include working with South Asian student groups, and speaking and providing programming related to mental health at places of worship. Ultimately, the group wants to make a nationwide database of culturally competent mental health resources for South Asian Americans.

3. National Asian Pacific American Families Against Substance Abuse (NAPAFASA)

NAPAFASA was founded in 1987 with a goal to address substance abuse in Asian American and Pacific Islander communities.

One of their current initiatives, Problem Gambling Prevention and Technical Assistance Project, hopes to raise awareness about problem gambling in Asian American Pacific Islander communities and train professionals in treating it.

In an earlier initiative, the Technical Assistance Project, NAPAFASA trained professionals in cultural competency for addressing Asian American mental health needs with a focus on substance abuse.

The NAPAFASA website also has an extensive resource list for Asian Americans — not only linking to resources related to substance abuse and mental health services but also linking to more general health, human services and civil rights organizations focused on serving Asian Americans.

4. A3PCON DACA Mental Health Project

In response to the Trump administration’s decision to end DACA, the Asian Pacific Policy & Planning Council (A3PCON) started the DACA Mental Health Project to give DACA recipients somewhere to turn in their time of need. The program provides free counseling and case management services to DACA recipients in the Los Angeles area.

The project provides services in a wide variety of languages: Bangla, Cambodian/Khmer, Cantonese, Hindi, Japanese, Korean, Mandarin, Tagalog, Thai, Urdu, Vietnamese and English.

By seeking to address the language barrier as well as by providing support to the often-neglected population of undocumented Asian Americans, the DACA Mental Health Project is providing vital mental health support to the most vulnerable members of the Asian American community.

Read more on StudyBreaks.com

Communities are going above and beyond to focus their work around local social determinants of health as part of the Healthiest Cities & Counties Challenge. Now, midway through the two-year effort, the challenge is recognizing some of the communities that have seen results already.

On Jan. 31, the Aetna Foundation announced that 10 communities participating in the challenge were receiving Spotlight Awards, $25,000 prizes to boost continued efforts to making healthier and more equitable communities, and an additional five were receiving an honorable mention prize of $10,000 for the same.

The Healthiest Cities & Counties Challenge is a partnership of the Aetna Foundation, APHA and the National Association of Counties, helping to lift the public health work that is making a difference in 50 small- to mid-size U.S. cities and counties. Since 2016, participating organizations have received funding to make their health efforts reach those whose health needs are greatest.

“Where a person lives has a profound impact on how they live — particularly when it comes to their health,” said Mark Bertolini, MBA, chair of the Aetna Foundation and chair and CEO of Aetna, in a news release. “The Spotlight Award recipients are outstanding examples of how important progress can be made when communities work together to look at the biggest issues facing their neighborhoods and develop healthy, home-grown solutions.”

The award recipients are already seeing their hard work paying off. Debbie Sims, vice president of the East End Neighborhood Revitalization Zone and co-founder of the group’s Pop-up Market & Café of Connecticut’s Bridgeport Coalition United to Reach Equity, knows their efforts are making an impact: She has lived in the neighborhood served by the coalition for 30 years. She said the East End of Bridgeport is the longest-standing food desert in Connecticut, lacking a full-service grocer for 35 years. There, the rate of adults with overweight or obesity is 87 percent.

But that could be changing, as the coalition helped to implement a small community-run grocer, addressing not just access to healthy food, but also community cohesion, job training, business development and violence prevention. Local kids participating in gang violence prevention programs have helped to set up the shop, while union workers have volunteered construction efforts and health departments have provided refrigeration equipment. Groundbreaking could begin soon for a permanent shop.

To expand on that work, Sims said a local church has started growing fresh vegetables as part of its community feeding program, working the produce into Easter events, kids’ activities and healthy, budget-conscious cooking demonstrations.

“We realize that will take time, as we raise funds and work through permitting and the like,” Sims told The Nation’s Health, but noted big changes are already felt within the community. “I am so proud of the work that we are doing.”

Pride is a common theme among Spotlight Award recipients, many of whom have found new ways to collaborate with community partners to improve public health. Kentucky’s West Louisville Outdoor Recreation Initiative is a collaboration between the Louisville Department of Public Health and Wellness and Department of Parks and Recreation designed to ensure every resident has access to a safe and healthy environment that increases physical activity, reduces stress and leads to healthier lives through outdoor recreation, environmental education and a sense of stewardship.

Betty Adkins, MEd, community resource director for the health department, said she was proud to help highlight the work being done with the parks department. She noted how the initiative, led by Bennett Knox, MEM, parks administrator, incorporates trauma-informed care practices to address the needs of the community.

“Public health is everybody’s business,” Adkins told The Nation’s Health. “We’re not going to go out and do Bennett’s work because he does it beautifully, but (we will work) to help shape that and help (the parks department) understand that what they do affects health. I think what Aetna, APHA and NACo did was provide that platform…so we could start the fire in the community and keep talking about it. His amazing work is getting the deserved attention it should.”

In Texas, too, collaboration is showing success in public health outcomes. Emily Green, CHWI, a public health education specialist at the Waco-McLennan County Public Health District, said many community groups have come together to make Live Well Waco, an initiative to improve community health and well-being, a successful effort. Highlights of the work in Waco include Mission Waco, which opened a nonprofit grocery store in a food desert; the Waco Downtown Farmer’s Market, which offers cooking classes and recipes using foods from the market itself; and the Office of Community Engagement & Service at Baylor University, Waco Chapter of Delta Sigma Theta Sorority Inc. and the Hispanic Chamber, which have worked together to host healthy, culturally specific food demonstrations throughout the year.

“I am continually amazed at the determination from our community partners to improve the lives of the people living in Waco,” Green told The Nation’s Health.“Waco’s various organizations and the people that run them is why we are experiencing such success in the Healthiest Cities & Counties Challenge.”

Winners of the Spotlight Awards were:

• the Bridgeport Coalition United to Reach Equity, which works to increase food accessibility and living wages;
• the Florida Department of Health’s iGrow Food Network, to decrease food inequality;
• the City of Miami’s Live Healthy Little Havana program, which increases health care access;
• Louisville and Jefferson County Metro Government’s West Louisville Outdoor Recreation Initiative to improve mental wellness and healthy behaviors;
• the Cooper’s Ferry Partnership in Camden, New Jersey, where an initiative is increasing water quality;
• the Chatham Health Alliance, which works to decrease obesity in the North Carolina county;
• the Mecklenburg County Health Department’s Village HeartBEAT program in North Carolina, which is decreasing heart disease;
• the Heart of Texas Urban Gardening Coalition, part of the Waco-McLennan County Public Health District, which is increasing access to, and consumption of, fresh foods;
• Danville Pittsylvania County United Fund’s Health Collaborative, which works to create healthy living policies in the Virginia county; and
• the Active Design for a Healthier Thurston County program, part of Thurston County, Washington, Public Health & Social Services’ efforts to increase walkability.

But the award winners are not the only Healthiest Cities & Counties Challenge participants doing good work within their communities. All 50 organizations are doing strong work to improve health for residents, said JeVonna Ephraim, MPH, APHA’s project director for the challenge.

Read more on TheNationsHealth.APHAPublications.org.

April 10, 2018 is National Youth HIV & AIDS Awareness Day (#NYHAAD). Use the CDC’s hashtag #DoingIt to encourage young people and their caregivers to get tested.
 
Capacity 4 Health joins with Advocates for Youth in observing this awareness day, it’s important to recognize the vulnerabilities experienced by young people:

• In 2015 (the most recent year statistics were available), young people aged 13 to 24 accounted for 1 in 5 new HIV cases.
• Young African American and Hispanic/Latino gay and bisexual males are disproportionately affected.
• About 8% of all new AIDS diagnoses are made up of youth in the United States. 

The CDC says, “Addressing HIV in youth requires that we give young people the information and tools they need to reduce their risk, make healthy decisions, and get treatment and care if needed.”
 
Nonprofit providers and advocacy groups can help spread the word about the National Youth HIV & AIDS Awareness Day on April 10 by:

• Using #NYHAAD and #GetTested in your social media updates.
• Share this video that features young people discussing why getting tested is so important.
• Issue a press release or write a blog post on April 10th to get the word out.

Resources:

• Find out more about National Youth HIV & AIDS Awareness Day on the HIV.gov website
• Learn about the State of the Youth HIV Epidemic and find related fact sheets from WhatWorksInYouthHIV.org
• View the NYHAAD 2018 toolkit from Advocates for Youth
• Use the HIV Testing Sites & Care Locator from HIV.gov to get tested and find a provider near you
• Read the POZ articles on NYHAAD 2018, Generation PrEP? (about the uncertain future of the HIV prevention drug available), and Vote of Confidence (Supporting youth leaders to address HIV among Latinos)
• Read the Ryan White and National Youth HIV and AIDS Awareness Day post from the Target Center
• Learn about HRSA’s Special Projects of National Significance (SPNS) that is investigating social media interventions that can engage HIV-positive youth who are not in care to engage in such services.
• Read the HIV.gov blog post Viral Suppression Among Youth and People Who Inject Drugs Is Improving, But Results Are Still Below the National Average

The call for abstracts is now open for the Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau’s (HAB) 2018 National Ryan White Conference on HIV Care and Treatment. The conference will take place December 11-14, 2018, at the Gaylord National Hotel and Convention Center at the National Harbor in Oxon Hill, MD.

This year’s theme is Catalyzing Success: Advancing Innovation. Leveraging Data. Ending the HIV Epidemic.

The 2018 National Ryan White Conference is the largest national conference for comprehensive HIV care and treatment providers and brings together HIV clinical decision makers, direct-care providers, and program/fiscal administrators working in Ryan White HIV/AIDS Program-supported settings from across the country as well as members of planning councils, board members, national and local stakeholders, federal staff, and people living with HIV.

The deadline for abstract submission is April 30, 2018.

In keeping with the conference theme, six session tracks will serve as the basis for this year’s workshop and poster sessions:

• Increasing access, engagement, and retention in HIV care and treatment;
• Data utilization;
• Leveraging innovative practices to improve outcomes and address emerging priorities;
• Clinical quality management and quality improvement;
• Ryan White HIV/AIDS Program planning and resource allocation: collaborative partnerships and community engagement; and
• Ryan White HIV/AIDS Program fiscal and grant management boot camp.

To submit an abstract for a workshop or poster presentation, visit the conference website. On the website, you can also register for the conference and view the conference agenda in brief.

Learn more on HIV.gov.

The following was written by and from the perspective of Megan Gibbard Kline, director of A Way Home America.

In November 2017, findings from the first national survey on unaccompanied youth, showed that one in 10 young adults ages 18-25, and at least one in 30 adolescents ages 13-17, experience some form of homelessness over the course of a year. The results, from Chapin Hall’s Voices of Youth Count Initiative (VoYC), reinforce familiar points for providers working to end youth homelessness. But the data adds critical authority and context, helps frame the conversation on youth homelessness with community members and policy makers who may be new to the issue, and supports communication of a shared message. These findings are powerful supplementary tools.

The most powerful finding in the VoYC data, however, is not the number of young people experiencing homelessness, but rather which young people are at greatest risk of experiencing homelessness.  When we understand who experiences homelessness, we are led beyond the question of what scale of response is needed to end youth homelessness. We need to also consider whether our programs and systems are designed to work best for the young people most impacted. VoYC findings powerfully reinforce what we’ve been talking about from the inception of our movement: that to prevent and end youth homelessness for ALL young people, our strategies must be inclusive of and effective for the most vulnerable young people.

We now know which socioeconomic factors lead young people to be the most at risk: not graduating from high school, being unmarried and parenting, or living with a household income of less than $24,000 a year. And we also have national data to back up what we’ve seen in many communities across the country: that young people experiencing homelessness are most likely to be African-American, Latino/a and/or lesbian, gay, bisexual, transgender and/or queer (LGBTQ). Specifically:

• Among racial and ethnic groups, African-American youth were especially overrepresented, with an 83% higher risk of having experienced homelessness than other races. This disproportionality mirrors black youth racial disparities documented in school suspensions, incarceration and foster care placement.
• Latino/a/x youth were found at higher risk of experiencing homelessness than non-Latino/a/x youth. Further, while Latino/a/x youth were 33% of the 18-25 year-olds reporting homelessness, only 19% of youth served by federally funded runaway and homeless youth programs in 2014 were Latino/a/x.
• LGBT youth had a 120% higher risk of experiencing homelessness than youth who identified as heterosexual and cisgender.

Future briefings from VoYC, and the forthcoming Phase I National Report from the Center for Social Innovation’s SPARC (Supporting Partnerships for Anti-Racist Communities) initiative, will dig deeper into these intersecting risk factors: exploring how African-American, Latino/a and lesbian, gay, bisexual, transgender and/or queer (LGBTQ) young people not only experience homelessness at higher rates than their peers, but that their risk is uniquely concentrated because of their race, sexual orientation, or gender identity, and the systemic inequities at play.

What might this mean for us as a movement? 

It is now clearer than ever that we cannot solve youth homelessness nationwide unless we can solve it for the most vulnerable young people. And in many communities across the country that means designing, implementing, and scaling up our strategies to meet the needs of young people of color and LGBTQ youth.

How might we get there?  A Way Home America has been inspired and challenged by examples of industries centering people on the margins—like in the case of universal design. Take, for example, the sidewalk curb cut. Curb ramps are installed on city sidewalks so that an individual using a wheelchair can better access the opportunities available in a community. But then so can a parent with a stroller. Or an elderly person using a walker. When people who are the most marginalized are at the center of our design, everyone benefits.

What does it mean to center young people of color and LGBTQ youth? It means solving problems from their perspective, and considering them first in every potential solution. We need to move beyond asking whether a strategy will serve everyone to focusing first on whether it will effectively address the needs of those most likely to be in need.

To do that, we must use all of the data we have available to look squarely at who is at greatest risk of experiencing homelessness in our communities and making sure that our current responses are centering on those people. Using data like VoYC, and with young people as collaborators and colleagues in the work, we will show it is possible to #endyouthhomelessness.

Read more from the United States Interagency Council on Homelessness.