Summer Public Health Intern Report: Organizing in Rural Communities Around Mental Health

By Aidan Stotz

Over the course of the past eight weeks, I have had the opportunity to engage with the topic of mental health and the disparities that exist in rural communities in several capacities. I conducted independent research which provided a baseline understanding of some of the root causes and health impacts of mental health. It also gave insight into the disparities in research for rural mental health and the lack of mental health programming for rural areas country-wide. Based on this preliminary understanding, and the assigned contact list of individuals who work in addressing mental health needs, I began to have guided conversations about the greatest needs, barriers, successful programs, and what can be done with more resources. These conversations were incredibly insightful with local health departments, in addition to those that work with mental health to continue building an understanding of the successes and struggles with addressing mental health. 

I had always understood that mental health was a highly complex topic, as there are a seemingly infinite number of causes, and are exhibited differently based on the individual. However, throughout these conversations, I learned that although the odds are stacked extremely unfairly, there is so much passion in rural communities for improving the health and well-being of their neighbors. This is what instantly connected me to JONAH, centralizing human connection and relationship building as the core of the work being conducted. Before anything, we are human and that is often lost in society due to stigma and general cultural practices. JONAH works to address this very topic by bringing those together, and uplifting voices through practices such as radical inclusivity and intentional collaboration. Of all the lessons learned throughout this experience, the importance and power of genuine human connection can be the strongest protective factor for a person and community.

Lessons from 1-1 Conversations 
One of my first tasks upon starting the internship was reaching out and connecting with people who work to address mental health. The names on the list ranged from community members to local organizing groups, to mental health professionals. Having conversations with different ranges of perspectives was invaluable. I heard stories from local residents about personal mental health struggles and how they see it in their friends and families. I heard stories from mental health professionals about how much need there is in the community and how it can oftentimes go unaddressed due to financial, transportation, language, and several other barriers. And from the health department, I learned about data collection and how valuable canvassing and surveys are to establish places of intervention. 

Another lesson that I learned through my internship and meetings with rural residents is the importance of Churches and libraries in providing a sense of community and connecting residents with resources. I learned of the importance of the social worker position in the library, and how their job has greatly reduced the impact on local law enforcement in addressing needs that they may not have the training to address. From my experience, Public Health is primarily about prevention, and involving a social worker doubles as a way to prevent people from experiencing hardships and offering resources to those in need. Throughout each 1-1 conversation that I had, each mentioned a unique problem that mental health causes, and a way that they are working to combat it. Whether it was the correlation between mental health and substance misuse, or mental health and tardiness/disciplinary action at school. As previously stated, mental health is highly complex and interconnected which speaks to the importance of addressing it across every causative agent.

Community Events 
One of the ways that I was able to actively seek out resident perspectives was by attending community events in Eau Claire, Stanley, and Fairchild. My attendance was on behalf of JONAH, seeking to be a visual representation that JONAH is available and cares about the needs of their community while allowing me to engage with, and hear out stories that could potentially shape the next steps. While attending the summer concert series in the town of Stanley, Wisconsin, I tabled for the Green Bandana project and JONAH. It was here that I saw firsthand the mistrust of healthcare resources, and how hesitant people are to engage with someone they may not know. I would say that 50% of the people who I spoke with had heard of JONAH before but did not recognize me. They recognized the names of people who worked with JONAH and asked where they were. Many were skeptical when I was offering resources sheets and asking if they would be interested in signing the pledge form for the Green Bandana Project. Despite this barrier, I was able to connect with several residents about the project and the work that JONAH does, a few shared personal details and answered questions I had about the interest in support groups in Stanley. 

The Hope and Cope events in the town of Fairchild Wisconsin also had a profound impact on me and taught me the importance of intentional connection and active listening. Residents that were in attendance spoke to the difficulties that they were experiencing in their life and were able to be connected with resources that could help alleviate these issues. Most importantly, it gave rural residents a common place, a trusted place, to interact with each other and health institutions. For my second time at the Hope and Cope event, the Eau Claire Health Department as in attendance providing blood pressure screenings and teaching rural residents various strategies to monitor their health. I recognize the importance of distributing educational pamphlets and how effective mass education campaigns can be, however, the trust that is built through in-person interactions is too important to be overlooked. 

Besides local coalition meetings and both the JONAH and Eau Claire City-County mental health task force, the final community event that was invited to attend was the Coffee Klatch at the Democratic Resource Center. At this event, residents from the city and county come together to discuss the most pressing issues that they see and interact with and problem-solve solutions. One of the times that I attended the Coffee Klatch, the sheriff of Eau Claire was in attendance and answered a range of questions from residents. I felt that this was an effective way of providing a perspective that residents may have never heard before unless they had a law enforcement family. It allowed residents to explore a bit about the life of a sheriff and a law enforcement officer, and to understand a new perspective.

Overview of Health Department Conversations 
Throughout my independent research, I learned that mental health in rural communities poses unique problems. Although the rates of mental illness between rural and urban settings are comparable, the access to mental health care is where the disparities are truly highlighted. There were many interpretations of ‘access’ in the literature, both the literal act of traveling to a mental health care provider, but also the cost, wait times due to physician shortages, and stigma around asking for help. There exist several external factors that play a unique role in rural communities. More specifically, certain cultural practices in rural settings play a major role in the acceptance of mental health. In many instances, asking for help is seen as a sign of weakness. Coupled with the link between substance misuse and mental health, adds an additional layer of complexity.

The questions I asked the Health Departments were formulated with the express interest in hearing the unique challenges of each county as it relates to mental health, none of the questions sought to guide an employee towards a certain answer, which resulted in a wide array of responses. Additionally, information from conversations with health departments that are outside the Chippewa Valley was included because I felt that it was relevant to painting a necessary picture of the widespread issues of rural mental health.

The first question posed in each conversation was “In your opinion, what are the greatest needs regarding mental health in your county/community?”. Responses to this question illustrated a similar idea to the independent research, a highly complex issue influenced by the county’s makeup. Some of the more common responses I received throughout these conversations were access, stigma, a lack of providers, substance misuse, and mistrust. During my conversation with Clark County, I learned that the ratio of clinical health providers for Clark County is 3,000:1 while the Wisconsin average is 500:1. Another common theme during these conversations was the importance of addressing youth mental health. Each county had statistics posted to their CHNAs about youth mental health and had collected data from the YRBS (youth risk behavior survey).

When seeking to address the needs in the community, there was overlap in the barriers in place that each department deals with. I asked “What barriers exist when attempting to address mental health in your county/community?” intending to go deeper into the root causes of mental health gaps. Based on each of the conversations at the health departments, and from conversations I have had with other mental health professionals working to address the gaps in rural mental health, it seems that overwhelmingly the most common barrier is stigma. There exists a hyper-individualistic mindset in American culture which is especially prevalent in rural communities. This works in tandem with the stereotyped phrase “pull yourself up by your bootstraps” or doing an impossible task without outside help. This mindset was a focus of the conversation with Wood County who had mentioned that they feel this is the root cause of the mental health crisis in rural communities. Rather than seek support from their community (assuming they can access it or there is support in the first place) they would opt to self-isolate which only serves to foster an environment that produces unhappiness.

In the next section of the conversation, I asked “What do you feel are the most successful programs/initiatives that address mental health in your county/community?”. Each county had unique answers to this question. For example, Clark County has a large Mennonite and Plains population which makes outreach to these communities somewhat difficult. Therefore, in order to provide mental health resources to these communities, the department has to be culturally sensitive in its programming and be intentional with its outcomes. Eau Claire, Pierce, and Dunn County have seen a lot of success with providing medicine lockboxes and medication deactivation bags. Both of these programs have seen a decline in overdoses and accidental overdoses. Eau Claire County recently received funding for a Narcan vending machine that also provided fentanyl testing strips. This works to both provide a valuable resource to the community and no cost, but also destigmatize accessing health care. One particularly interesting program that Dunn County ran was an attempt to address the stigma of mental health in youth. They showed a documentary about teen mental health and combined that with a panel of mental health specialists for a discussion afterward. They received a lot of positive feedback and reported having a lot of discussions about resiliency.

The final question that I asked each health department was “If you had more resources, what are some initiatives that you feel would be the most effective to address mental health in your county/community?”. Although not the most realistic question, it allowed me to gain an understanding of where the money would go if they had it, and what category of programs they would fund given the opportunity. I believe it provided valuable insight beyond the first question asking what the needs were because it gives the agency to the health department to invest in what they believe would make the most profound impact. One health department mentioned the possibility of purchasing a Mobile Unit to travel to rural areas to provide immunizations. Another health department talked about a general increase in funding for public health infrastructure and the ‘built environment’ (roads, sidewalks, pipes, etc…). However, there was a commonly agreed-upon answer which was the investment in the youth in some capacity. Many described investing in public education, expanding childcare services, focusing on trauma/harm reduction (ACEs), and expanding the presence of guidance counselors at the school. Each health department had a unique approach to investing in the youth’s mental health. From ensuring that the child has a safe house and neighborhood, to a person at school who is trained and willing to talk, investment in creating a healthy and happy future generation was widely popular. 

Recommendations based on what was learned 
The independent research I conducted combined with the conversations I had with the health departments provided some fantastic ideas for how JONAH can be involved. As an entity that emphasizes the importance of addressing social justice issues, one of the many ways in which mental health can be addressed is through various trainings. Developing workshops and training programs for teachers as it relates to mindfulness was an idea that stemmed from a meeting I had with Mental Health Matters. MHM is a coalition organization that received funding from a grant seven years ago and has been working on addressing youth mental health. One of their big projects was providing mindfulness training to teachers as their role oftentimes goes beyond educator. Therefore, preparing teachers to be able to recognize patterns of behavior in mental illness, but also the appropriate responses is incredibly important.

Another potential area to explore is offering training in rural communities to reduce stigma. However, it is incredibly important to collaborate with local organizations or even Churches in order to gain support and spread through word-of-mouth. The training itself is not as important as the act of going into these areas with the intention of developing a sense of community. As I have discussed previously, social isolation is a major risk factor for mental illness and other negative health outcomes, and rural communities are often left out of the major programming events or are unable to access the resources. Building relationships with rural communities works to connect rural residents who may have not been aware of resources available to them, but also works to destigmatize mental health by making it more visible in the local community.

The final recommendation that I had was to continue the expansion of peer-support services. In every conversation that I had with a health department, alternatives to traditional methods of mental health care were mentioned. Several spoke specifically about the expansion of peer support and recovery coaches. These conversations also highlighted the importance of improving access and the visibility of mental health care in the community. Hearing that your neighbor may be a recovery coach could prompt a conversation that connects a person in need with local resources, beyond what a clinic has the capacity to do. Additionally, expanding the common perception of mental health, and acknowledging the overwhelming support needed to address the issue in manpower, resources, and a large-scale cultural shift, is a step that expanding peer-support services can help take.

Aidan developed a data sheet for the Green Bandana Project, a list of grants the Mental Health Task Force and Rural Project can apply for, a list of contacts from Health Departments all over the state willing to connect with us on improving mental health in rural communities, and a current list of mental health resources available for rural areas (which changed a lot since the COVID-19 pandemic). We’d like to thank Wisconsin Area Health Education Center (AHEC) for setting us up with Aidan!