The New Normal

Mental Health in Our Rural Communities (Part 4)

We all know someone with high blood pressure, with diabetes, or who has broken a bone and received treatment. We don’t think of them as abnormal. Chances are, we also know someone with some degree of mental illness, whether that be mild depression, anxiety or something more serious.

Despite one in four people suffering with mental health issues, the tendency to think of them or ourselves as abnormal is still prevalent. This way of thinking reinforces the stigmas that prevent so many from receiving the support they need. And according to Sue Abderholden, MPH and Executive Director of NAMI Minnesota (our state’s branch of the National Alliance on Mental Illness), “stigma” is just a nice way of saying discrimination.

Instead of normalizing the discrimination, the push now is to normalize the fact that a large percentage of us struggle with our mental well-being and that it’s nothing to be ashamed of. As Abderholden said, it happens to everyone. “It’s not a personal failing. It really happens to all sorts of people. Democrats, Republicans, rural, urban, farmers, machinists. No one is spared. Not any religion. Not any sex. It’s a worldwide issue.”

Denise Hellekson, the EAP Clinical Supervisor for The Village Business Institute, stressed that mental health conditions are physical conditions. Even depression is because of a bio-chemical issue, she said. “I can no more talk myself out of major depression than I can will myself to process sugar if I’m diabetic. It’s biological.”

Just as if you were pre-diabetes, where certainly diet and exercise can help, there are behavioral practices that will help address mental health issues as well – see the sidebar for ideas and resources. For some people, those will be enough, and for others, just like in the case of diabetes, more support will be needed.

Taking an honest look at our own mental health is the first step. According to Hellekson, we need to know our coordinates, just like a GPS unit needs to know where it’s starting from. “Knowledge is powerful,” she said. “Asking ’Where am I at? What am I feeling?’ and knowing that whatever the answer is, here I am and it’s OK. Based on this, what can I do to have a good day? What can I do to be supportive and compassionate to myself? I’m a human being.”

For prevention and early-treatment, self-awareness is indeed the first piece. Knowing the signs and symptoms of what may develop into a more serious issue is a close second. And thirdly, accepting the physicality of our mental well-being will help remove the negative perceptions we might hold around finding the right resources or asking for help.

Still, on average, adults live with their symptoms for ten years before seeking help. “Imagine what can happen in those ten years!” Abderholden said.

We need to start normalizing the conversation so people will get early treatment, she said. “As with any healthcare condition, early identification and treatment yields the best outcome. We really want to get people to talk about it, to talk to their primary care, to get that treatment early before it leads to loss of employment, marital problems, family problems.

“And actually, poor mental health leads to problems in other areas. A lot of people with diabetes have depression, so their diabetes is not well managed because of their depression. So when you treat both, you yield better outcomes for both.”

The more we can get that word out, the more we can mainstream it and normalize it, it will open the doors for individuals to have these conversations with someone they trust, Hellekson said. When something we’re feeling is in the category of unknown, we assign the worst case scenario to it. “That’s the biggest thing,” she said, “If I don’t know why I’m feeling this way, it can feel like I’m the only one feeling this way, and then it becomes this big scary thing that I can’t let people know because what would they think.”

The catch-22 of mental illness is part of what kept countries around the world, including the US, from addressing people’s mental health needs until the latter part of the twentieth century. Indeed, the last bill that President Kennedy signed into law was the Community Mental Health Act. It envisioned a gradual move from institutionalized care (in which conditions were notably horrid) to more community-based treatment and care. Kennedy was assassinated three weeks later and the legislation was never fully enacted. Today, in the US the largest mental health care providers are jails.

But in other ways, we as a society are getting closer to Kennedy’s vision. According to Hellekson, more and more businesses are asking for trainings about self-care and mental health, about signs and symptoms. They are bringing the conversation into their organizations and to their people, which all helps normalize this issue. “This isn’t some big hidden secret,” she said. “This impacts lots of people. Employers are asking ‘how do we support one another? How do we recognize the signs? How do we have these conversations?’”

Abderholden said, “One of the things we like to say here at NAMI is that the mental health system isn’t broken; we haven’t finished building it.” What started as a group of families around a kitchen table in 1979, is now the largest grassroots organization for mental health in the country. The nonprofit helps fight for and fund everything from more progressive legislation to student loan forgiveness to address the critical workforce shortage in the mental health field to onsite school programs so parents don’t have to leave work each week to get their kids the care they need. NAMI’s reach is vast and their resources are plenty, all of which are free and listed online. See the sidebar links and phone numbers for more information.

The message NAMI wants to leave with rural residents is one of hope, Abderholden said. Hope because “treatment works. People can get better. We don’t have to be living with our symptoms of depression or bipolor or schizophrenia or anxiety. Treatment is very effective.”

And don’t be ashamed, she said.

This is what normal looks like.

(Published in the February 13th, 2018 issue of the Warroad Pioneer)

Part 1 What’s Eating Rural America?

Part 2 It Takes a Village to Raise an Adult

Part 3 Safe, Calm and Consistent Wins the Race

Part 4 Sidebar 1 Know the Signs and Symptoms

Part 4 Sidebar 2 Where to Get Help

Part 4 Sidebar 3 Six Things You Can Do Today to Feel Better Tomorrow

 

 

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