Editor’s note: In 2023, OPB takes an in-depth look at the biggest social and economic challenges facing Oregon today—their origins, their impact, and possible solutions. This week we look at the gaping holes in the state’s mental health system.
PROBLEM: People living in rural Oregon have higher rates of depression, anxiety and suicidality.
Oregon’s coastal and rural communities are facing an exacerbated version of the crisis in the state’s mental health system. Rural communities have higher rates of so-called “deaths of despair,” such as overdoses, alcohol-related deaths and suicides, than more urban parts of the state.
And the risk of suicide is elevated for people, and particularly men, working in some of the industries that are central to rural life and identity: fishing, farming and livestock. The impact of suicide in rural communities was the subject of a recent video conversation between Todd Nash, president of the Oregon Cattlemen’s Association, and Allison Myers, who directs OSU’s Family and Community Health Program.
They discussed the isolation and unique economic stressors that people in rural Oregon live with.
“When you combine the economic environment with the challenge of making a living producing food, it’s stressful,” Myers said. “You have that combination when people feel alone or when it’s not good to talk about the things underneath.”
Rural communities also have even more limited behavioral health providers and treatment options and longer waiting lists than Oregonians living in the Portland-Salem-Eugene corridor.
And some services, like psychiatric care for children, are virtually non-existent outside the Portland metro area.
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In testimony this week before the state Commission on Behavioral Health and Healthcare, Dr. Beech Burns, a pediatric emergency medicine specialist, described what this lack of services means for families in rural Oregon who have a child struggling with thoughts of self-harm . Children may find themselves transported hundreds of miles by ambulance just to be evaluated in a pediatric emergency room in the Portland metro area. If doctors decide the child does not need hospitalization, “they are discharged the same day back to their community, leaving the family to decide how to arrange transportation home and how to pay for the ambulance fee and the cost of the emergency room visit.” Burns said.
PROMISING STRATEGIES: A mental health first aid course offered through the counseling service at Oregon State University can help train people to recognize signs of mental illness and connect them to resources to provide support. And a bill before the state legislature would create child psychiatric units at three hospitals outside the Portland metro area.
Many of the strategies that OPB explored elsewhere in this series — such as the EASA program and new investments in residential care — are being implemented across the country, including in rural areas, but there are also initiatives tailored to the needs of people living in rural parts of the state .
Oregon State University’s Coast to Forest Initiative takes advantage of its deep reach in rural Oregon to train people in mental health first aid. This is a short course that helps people learn how to recognize the signs and symptoms of mental health and how to respond.
The course prepares people to have conversations that may not come naturally but can be useful in a crisis. For example, many people fear that asking someone if they are considering suicide might prompt the idea. This is a myth. But people who are considering suicide are often relieved to know they can talk to someone about these scary thoughts. Mental health first aid can teach how to ask the question and how to get the answer.
Oregon State also includes county resource guides in the training.
They provide training to experts who work in rural and coastal communities throughout the state, including 4-H staff, outdoor school program leaders, and extension experts working with people in forestry, agriculture, and marine science.
The idea is that people experiencing a mental health crisis may be more willing to talk to someone they already know and trust rather than see a professional, especially in parts of the state where professionals are few and rarely.
“People who work in forestry and agriculture and youth development may have connections that behavioral health professionals don’t,” said Dusty Linnell, associate professor at Extension Family & Community Health.
Another project aimed at improving mental health care in rural Oregon would build connections between small rural hospitals that can’t offer much specialty mental health care and larger hospitals that would share their staff and expertise.
A bill this legislative session, HB 3126, would pilot this approach by designating three hospitals in three separate parts of the state as “Regional Children’s Psychiatric Centers.” Each of these hospitals will have a small psychiatric emergency department for children, overseen by at least one child psychiatrist and behavioral health clinician. The units will provide 24-7 care and monitoring for children in crisis, up to three days at a time.
Dr. Ajit Jetmalani, who chairs the Division of Child Psychiatry at Oregon Health & Science University and is a consultant to the Oregon Health Authority, helped develop the proposal.
He says the regional children’s psychiatric centers will work much the same way the state’s regional trauma system works, sorting patients so children with less intense needs can stay in their community while those with more -complex needs are accepted for special care. Jethmalani says the proposal is one of several major changes to the system, including the introduction of a 988 suicide and mental health crisis helpline, designed to create a more cohesive response across the country for people in crisis.
“People think things are completely chaotic and there’s no plan, but there really is a plan,” he said.
The hospitals will work together to decide which one will serve as the regional center and sign agreements so that when a child in crisis shows up in their emergency room, they can receive video consultations from the regional center team.
Supporters of the bill say that if the pilot project is successful, they would like to expand it to create seven such centers across the country. And they say the same strategy could be applied to strengthen emergency psychiatric care for adults in rural Oregon.
If you or someone you know is suicidal, you can call 988 to be connected to a trained listener. To send a message with a trained assistant, text SAVE to 741741. Both services are free, available 24/7 and confidential.
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