Editor鈥檚 note: Throughout 2023, OPB is taking a deep look at the biggest social and economic challenges facing Oregon today 鈥� their origins, their impacts and possible solutions. This week we are looking at .
PROBLEM: People living in rural areas of Oregon have higher rates of depression, anxiety and suicidality.
Oregon鈥檚 coastal and rural communities face a heightened version of the state鈥檚 mental health care system crisis. Rural communities of so-called 鈥渄eaths of despair,鈥� like overdoses, alcohol related deaths and suicides, than the more urban parts of the state.
And the risk of suicide is elevated for people, and in particular men, working in some of the industries that are central to rural lives and identities: fisheries, farming and ranching. The impact of suicide in rural communities was the subject of a between Todd Nash, the president of the Oregon Cattlemen鈥檚 Association, and Allison Myers, who directs the OSU Extension Family and Community Health Program.
They discussed the isolation and the unique economic stressors people live with in rural Oregon.
鈥淲hen you combine the economic environment with how challenging it is to earn a living producing food, it鈥檚 stressful,鈥� said Myers. 鈥淵ou have this combination where folks are feeling alone, or where it鈥檚 not OK to talk about the stuff underneath.鈥�
Rural communities also have even more limited behavioral health providers and treatment options, and longer waitlists, than Oregonians living in the Portland-Salem-Eugene corridor.
And some services, like , are virtually non-existent outside the Portland metro area.
In testimony this week before the state House Committee on Behavioral Health and Health Care, Dr. Beech Burns, a pediatric emergency medicine specialist, described what that lack of services means for families in rural Oregon who have a kid struggling with thoughts of self-harm. Children may end up being transported hundreds of miles away, by ambulance, just to be evaluated at a pediatric emergency department in the Portland metro area. If doctors decide the child doesn鈥檛 need to be hospitalized 鈥渢hey are discharged the same day back to their community, with the family left to determine how to arrange transportation home and how they will pay for the ambulance fee and cost of the emergency department visit,鈥� Burns said.
PROMISING STRATEGIES: A first aid mental health course offered through the extension service at Oregon State University could help train people to recognize signs of mental illness and connect them with resources to provide support. And a bill before the state legislatures would create children鈥檚 psychiatric units in three hospitals outside of the Portland metro area.
Many of the strategies OPB has explored elsewhere in - like the EASA program and new investments in residential care - are being deployed statewide, including in rural areas, but there are also initiatives tailored to the needs of people living in the rural parts of the state.
Oregon State University鈥檚 Coast to Forest initiative is taking advantage of its deep reach into rural Oregon to train people in . It鈥檚 a short course that helps people learn how to recognize signs and symptoms of mental health distress and how to respond.
The course prepares people to have conversations that may not come naturally, but can be helpful in a crisis. For example, many people fear that if they ask someone if they are considering suicide, it can plant the idea. That鈥檚 a myth. But people who are considering suicide are often relieved to find out they can talk to someone about those scary thoughts. Mental health first aid can teach how to ask the question and how to receive the answer.
Oregon State also includes in the training.
They鈥檙e giving the training to experts who work in rural and coastal communities across the state, including the staff of 4-H, outdoor school program leaders and extension experts working with people in forestry, agriculture and marine sciences.
The idea is that people experiencing a mental health crisis might be more likely to talk to someone they already know and trust rather than reaching out to a professional, particularly in parts of the state where professionals are few and far between.
鈥淧eople who work in forestry and ag and youth development might have connections that behavioral health professionals don鈥檛,鈥� said Dusti Linnell, an associate professor with Extension Family & Community Health.
Another project seeking to improve mental health care in rural Oregon would build connections between small, rural hospitals that can鈥檛 offer much specialty care for mental illnesses and larger hospitals that would share their staff and expertise.
A bill in this legislative session, HB 3126, would pilot this approach by designating three hospitals in three separate parts of the state as 鈥淩egional Child Psychiatric Centers.鈥� Each of these hospitals would have a small psychiatric emergency unit for children, overseen by at least one child psychiatrist and a behavioral health clinician. The units would provide 24-7 care and observation for children in crisis, for up to three days at a time.
Dr. Ajit Jetmalani, who directs 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 Child Psychiatric Centers would operate in much the same way the state鈥檚 regional trauma system does, triaging patients so that children with less intense needs can stay in their community, while those with more complex needs are admitted for specialty care. Jetmalani says the proposal is one of several big system changes, including the rollout of the 988 suicide and mental health crisis helpline, meant to create a more cohesive statewide response for people in crisis.
鈥淧eople feel like things are completely chaotic and there鈥檚 no plan, but there really is a plan,鈥� he said.
Hospitals would work together to decide which should serve as the regional center, and would sign agreements so that when a child in crisis shows up in their emergency department, they could get consultations over video from the team at the regional center.
Proponents of the bill say if the pilot is successful, they鈥檇 like to expand it to create seven such centers statewide. And, they say the same strategy could be applied to strengthen emergency psychiatric care for adults in rural Oregon too.
If you or someone you know is suicidal, you can call 988 to connect with a trained listener. To text with a trained helper, text SAVE to 741741. Both services are free, available 24/7, and confidential.
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