Word Bank

Health Inequities, Health Disparities, Social Determinants of Health

I really like the new language and people’s conscious effort to move towards more inclusive terms that still denote that we have an issue with the way class, gender, race, and so forth factor into people’s health status.

For many, health disparities connote race, exclusively. I also think for a lot of people inequities only mean race and money, and not some of the other elements such as rural locations.

Although I don’t think we should push to change language specifically because people fail to or don’t take the time to understand concepts thoroughly, I recognize that when your dealing with touchy topics such as disparities or unequal access there is a lot of overused language out there.

So if it takes some novel and catchy phrasing like social determinants of health to lead people to think about things in ways that would not have previously, let’s go for it.

It can only help, right?

Dangerous, Mentally Ill

We pay attention to the portrayal of black people in the media. We look at gender-biased language. Now we need to add mental health to that list.

One particular misconception reinforced by the media is that there is a tendency of people with Mental illness to be violent. However, research indicates that the vast majority of people with mental illness are NOT violent. This is not to say that people with mental illness do not get violent, but the key to understanding the previous statement is the following: when violence does occur it is not at any significantly higher rate than the general population.

But all too often in newspapers, violence co-occurs with the topic of mental illness. It’s only the rare, dramatized, sensationalized incidents that make the front page.

Some hints at improving newspaper coverage given at the Association of Health Care Journalists Conference:

-Ask whether or not mental illness necessitates being part of your story

-Edit wire stories for coverage issues

-Be cautious of language, terms like “schizo rage” associate violence with mental health unnecessarily

-Watch headlines because many people don’t read beyond them. Headlines like “Mind of a Madman” and “Dangerous, Mentally Ill” promote stereotypes before the reader even gets to the story

Ironically, the very next day after the mental health panel, "Dangerous, Mentally Ill"* by Carol Smith of the Seattle Post-Intelligencer won an AHCJ award, placing second.

Wow. Yes, I’m almost screamed out during the luncheon, “It’s promoting stereotypes!!”
But I held it in, and am now writing a blog instead.


*If you click on the link to the story, you will notice that the title is different. This may in part due to the fact that print headlines are often shorter or it could be that they sought specifically to improve the title. Hmmm??

Here are more resources on mental health coverage:

Background Information and a Guide for Reporting on Mental Illness

The Realities of Severe Mental Illness: A Media Professional's Guide

Dealing with the Dead

“When you’re paying attention to the dead, you’re actually attending to the living,” said Onora Lien of King County Healthcare Coalition at a recent Association of Health Care Journalists conference.

This struck me as profound, even verged on leading to a mini-epiphany, given that I’ve never been on the inside of a major incident leading to mass casualties neither personally nor professionally.

Lien defined mass as anything that overwhelms the system that is in place. This means that 15 in a rural community is considered mass because it overwhelms the institutions that manage the dead like the medical examiner or funeral homes.

She also pointed out that it is important to understand that in many disasters that result in deaths, “unnatural” deaths are equivalent to homicides and will lead to an investigation. This means that the process of fatality management is complicated by the fact that each body is treated as a victim of a crime along with a crime scene.

Lien urged journalists to be sensitive to the complexities of fatality management. She reminded us throughout her presentation that the way death is managed affects overall how the community will recover from the disaster.

She suggested that we question ourselves on the following:

Framing of stories
What does it bring to the public to know how many are dead?
Are you extending the myth that all dead bodies lead to health hazards?
Understand the fluidity of body counts
Understand the complexity of identification and where it can go wrong, making sure to not release names too early (DNA, fingerprints, dental/ medical comparative tests, photo identification, visual identification are all part of the process of identification)
Is it best that officials make contact with families or journalists?

Although journalists may not be on the front line of dealing directly with deceased bodies, our roles contribute greatly in helping the living deal with the dead. This is an unexpected realization for me. One in which I am grateful for, because it has allowed me to understand my role as a journalist during and after disasters.

10 Minutes on Rural Health

Here’s a sample of what I learned in less than 10 minutes of a presentation given by Dr. Mark Doescher recently at the Association of Health Care Journalists conference. I was amazed at how much info Dr. Doescher, the director of the Office of Rural Health Care in the School of Public Health at University of Washington, got out in such a short amount of time.

Twenty percent of the population in America is served by rural health systems. In these particular areas, there is a rapid growth of racial/ethnic minority groups as well as the aged population 65 and older. Neither one of these trends is unique to rural areas, but I do believe what Dr. Doescher meant is that there are higher rates of growth in rural areas. Additionally, the rates of poverty in rural areas are also climbing at a fast rate. As Dr. Doescher put it, there “is an exportation of poverty” happening.

Rural areas account for only 10 percent of the physicians in America. Some organizations predict that there will be a 100,000 doctor shortage by the year 2025 (AAMC, COGME). Largely due to the fact that the physician work force is aging and MD programs are producing few doctors than in the past. Given that they already attract fewer doctors, rural areas will be doubly affected.

Most doctors in rural areas are general physicians, with a lack of specialists for areas such as surgery. But trends indicate that although the total numbers of doctors coming out of medical schools is decreasing, the number of those who go on to earn specialist status is increasing. This is in part due to the differential pay among general medicine and specialties, with the latter earning more. Ultimately, rural areas who rarely attract specialists, will now have an even smaller pool from which to draw. In general, few doctors are trained in rural areas. If you are not trained in a rural area, it is highly unlikely that you will practice in a rural area, another factor in the shrinking pool.

One last thing I that struck me as important, was that rural is a broad term. Yet, large rural, small rural, and isolated rural all fall in this category, but each have unique needs.

And this is only what I was able to write down. There was so much to Dr. Doescher’s 10 minute talk.

The Raving Lecturer

It seems that my most successful strategy in chasing stories this semester seems to have been showing up at meetings consistently. After a while, people start recognizing my face, inviting me to other meetings, speaking freely around me. Some people hear the word “journalist” and they clam up, which is why I often preface it with the fact that I am a graduate student (though I won’t be able to use this forever). Other times, I mention that I’m a journalist and people start listing off stories they want me to write. This always makes me smile, and reminds me of my big picture, which I need to remind myself frequently during the end-of-the-semester stress party:

I want to tell the stories that matter.
The stories that others aren’t always telling.
The stories that create conversation.
The stories that force people to act.

So, I’m always grateful for those who hear the word journalist and go into full-on raving, lecture mode. And I’m saddened by those who hear it and run from me, as if journalists are the new-age lepers.

Yes please, I’ll take a 20-minute lecture any day-– if it means you get what I’m doing.

Up the Mountain: Part III, The Expert That Came Through

So here I am back at the bottom.

All of UGA won’t email me back, and yes that includes both the school of social work and counseling, except for the one guy from the Gwinnett campus who never followed up when I responded back. And oh yes, I also emailed professors from both Georgia State and Georgia Southern. I guess no one was intrigued enough by my interest in “exploring barriers to accessing mental health services in rural areas.” I did a quick literature search, but couldn’t find any recent articles; the professors and doctors seemed to have retired or disappeared into the ether since the publications.

I’ve got nothing it feels. Amanda’s certainly not enough. So I do another search, on one of my most invaluable reporter’s tool-– google. I find the Georgia Rural Health Association. I’m no longer laid out flat. I’m sitting up a bit. I call the office, and I explain who I am and ask if there is anyone who would be willing to talk to me about blah blah blah, hopefully you know what I’m working on by part III.

“Yes, that would be the executive director,” the lady on the phone says. Hmmm, I think, do executive directors really talk to you?

“She’s working on a grant that’s due Friday right now, so if she’s doesn’t call you back then give her a call in a few days.” My draft deadline is tomorrow, but so many experts have brushed me off, that really I’m just going through the motions. And plus the economy is bad and everybody knows funding is being cut, so go get that money Ms. Executive Director. I’ve started to get comfortable down here at the bottom.

But I ask for her email address anyway, because that’s what you do, right? You follow-up, attempt to reach people through multiple methods. I send a quick email identical to the message I left over the phone.

It couldn’t have been more than 2 hours before she emailed me back this simple, yet beautiful question, “When’s your deadline?” Nothing else, not even a signature.

I carefully craft an email back, explaining that I have a draft deadline tomorrow morning. Yes, it’s just a draft. But I had nothing besides Amanda. With that, all I would have had on my paper would be a giant TK, the reporter’s notation meaning “to come.” I was still chasing my entire story! But my urgency need not be her urgency. My values tell me to not expect anyone to inconvenience themselves on my behalf. I detail a few questions, asking her to give me a couple of paragraphs in a conversational tone (or how ever much she has time for), always the last resort for interviews. But I figure that this would get me started and I could schedule a follow-up phone interview later to fill in the holes.

My phone rings a few hours later. “This is Marona speaking,” I’ve learned to answer since I started giving out my business cards to what seems like everybody in the world.

“This is Katherine Cummings from Georgia Rural Health Association,” says the caller. What? I’m caught off guard. It takes me a second, before I get it together enough to thank her for calling me and to go into it’s-time-to-get-what-you-want mode.

“I don’t even have time to write an email,” she says. “I’ve just spent the whole morning out of town.” She’s venting, but I have no complaints. After all, she’s called me back so promptly.

“Well do you have a few minutes right now?” I ask. “It won’t take more than about 10 minutes.”

She agrees. I don’t have to work very hard, because once again, she’s calling me. I ask her if she wouldn’t mind giving me a minute to put her on speakerphone record the interview, explaining that it would speed it up. A minute passes. I can’t get my recorder to work! Technical difficulties right now? Is this really necessary, I ask Mr. Recorder. But yes, the show must go on.

She’s talking. I’m sorting through the most crucial questions. I’m writing. She’s talking. I’m thinking about what to ask next. I’m writing. I’m reminded of my short memory. I’m writing. It takes me a split second to realize my best option is to fix the recorder. I zone out for a crucial 45 seconds of my 10 minute interview that is already about a minute and a half under way. But finally Mr. Recorder begins to work and I capture the rest of the interview, with plans to do a more extensive interview.

Later as I begin to write, I find that from those 10 minutes (actually more like 8 if you subtract my recorder struggles), I have enough solid quotes for my article. I’ve hustled an interview with a willing expert, and maximized my 8 minutes.

Now I have Amanda and at least one solid expert witness. I’m inching my way back up.

Up the Mountain: Part II, The Experts Who Shafted Me

Before I know it, I’m tumbling down the mountain with all the grace of someone flailing, trying to grab hold of anything. I know there are multiple witnesses to this particular stage of the journey.

Before I found Amanda, I had set up an interview with the coordinator of the Clarke County ABHS Mental Health Clinic. I gave him a quick spiel of what I’m trying to do, that I was looking for him to talk a bit about the issues confronted in rural areas when attempting to seek mental health treatment. But I had no story yet, so I gave him few details. After meeting Amanda the Monday before my meeting with him on Friday, I thought it would be only professional courtesy to give him a more fleshed out idea about what I was interested in doing. I believe in forecasting and in being honest about your intentions. Plus, if I was going to bring one of my multi-media partners interested in videotaping him, should I not give him a heads up? Not make him feel like he was being cornered into saying yes on the day we showed up?

Nope. I shouldn’t.

I fell into the hole of giving him too much information. Things I now know I should have kept to myself:

Amanda
Amanda is a client there
video camera
article

Being clear with your intentions is important. But so is not having a big mouth, I’ve decided. I’ve done a lot of thinking about this. I’m not in to manipulating people. I don’t like to beat around the bush. I like to be up front with people. As a journalist-in-training, I’m going to go ahead and be dramatic, and go so far as to say that I’ve had to redefine my values. Where’s my own moral line? How comfortable would I have been with waiting to give him more extensive details until I arrived? Is it okay to use the word story over article?

It’s still a touchy subject. But by now, I swear to you, I feel like I’m laid sprawled out on my back, at the foot of the mountain, once again. Dramatic, again? Yes, I know. But my entire story felt like it was falling part. I wasn’t expecting difficulties in finding experts. I had not prepared myself for this. If Amanda can list out her cocktail of 5 medications that keep her mood stable and tell me that when she’s not on them, she doesn’t feel like showering daily, then why can’t you, Mr. Coordinator, let me in your office and tell me about how people in rural areas struggle to find mental health services? I sent a follow up email, clarifying my intentions, in case there were any misunderstandings. I also sent a large batch of emails to various UGA professors. Thanks for nothing guys. If I sound bitter, it’s because I was at this point. No one likes to go from having it together, to feel like it’s falling part. So like I said, I’m at the bottom of the mountain, finally realizing how big the mountain actually is. You’re thinking the d-word again, I know. But he canceled on me the day of the interview and told me he thought “the best person to assist you would be the CEO.” Not even his British accent coupled with his excessive politeness helped. Polite doesn’t matter when it’s something you don’t want to hear.

Everyone knows CEOs don’t talk to you. But I pop a peppermint, because remember I have those sugar level problems, and I muster up my last bit of energy to go about harassing people via phone and email.

Up the Mountain: Part I, The Character

Article submitted. Deadline met. I’m done with my Mental Health article that I put so much sweat and tears into. Well, maybe not tears, but I did violently fist the air on multiple occasions at the imaginary apparition, hanging over my shoulder, that represented my story. I’ve spent weeks struggling to shape something that when I was finished with it I wanted to do more than just burn. But it wasn’t all smooth. It was certainly a strenuous climb to the top.

*************************************************************************************

So there I was staring up at the top of this mountain, wondering if maybe I should have picked something a little smaller. Of course you can’t even see the top, you never do. All you know is it’s big as hell.

I take off full force, enthusiastic, energized. I had thought my biggest obstacle would be finding someone who was willing to share their personal story with me about their experiences dealing with a mental illness and seeking treatment in a rural area. I wrote an entire post on what stake-holders I would contact to get the human interest element that I needed for my story. I’m down a half of year’s worth of business cards and fancy letter head, attempting to create the most confidential method I could think of for stakeholders protected by HIPAA laws, doctor/therapist-confidentiality, or basic morals to pass my name on to individuals who they think would be willing to talk to me. My fingers were crossed. All that effort and I don’t get a single hit. Not even one.

But it’s okay I’m just barely start to slip back down to the bottom before I luck out.

Have I mentioned that the agriculture extension office shares a building with the parole office? Small, rural towns make me smile. I roll into the parole office one day and ask if anybody has a few minutes to talk to me. I hate cold calls, but I love cold visits. I take pleasure out of just showing up. I dress down. One of my colleagues dresses up. He says he feels like he gets better responses when he’s dressed up. I say, I feel like I get better responses when I’m dressed down. Sneakers, jeans and a cotton shirt. My name is Marona, no last name needed. Maybe because I’m a female? Or maybe because I’m a black female in the south? Or maybe my smile is just so incredibly disarming that once you see it, you want to hold nothing back from me. Who knows. He leads me to Florence’s Manor, which I also blogged about. This is where I met Amanda. She shares her story with a level of transparency, that only makes you wonder, if she’s sharing all this, is there anything left to even hold back?

I’m taking that mountain in stride. I’m halfway up, and not even out of breath. Or at least that’s what I thought.

On Immersion

I enter a personal care home. 6 residents and a supervising couple. They function much like a family. The supervising couple’s mother, is called Mama by nearly all the residents.

Yes, hello. How are you? Thank you. Pleases. Formal. Get straight down to business. First interview started.

An hour and half later, less formal. “Is that the bus?” Mary asks. I insert myself into the family conversation, “Yeah, that’s the bus.” What was I thinking? She wasn’t talking to me.

Later. “Are those locs or kinky twists?” Mary’s sister-in-law asks me. Caught off guard, a delay before I realize she’s talking to me, I answer, “They’re twists.” I smile, I’ve been around long enough for her to feel comfortable asking me about my hair.

More time passes. We’re having a conversation about the two dogs. One’s a large black dog with a cute puppy-face that will make it look eternally young, a clumsy cast on the back leg. The other, a small, scruffy, white dog with curly hair. Mystery, the dog who after being hit by a car dragged herself home, sits at the foot of the husband of the owner’s daughter. He’s daddy to Mystery and the smaller dog, Diamond. Ms. Mary is warning Daddy to not let Diamond bite Mystery’s tail. Funny. Daddy doesn’t have to do anything, because Mystery has a sufficiently calm enough temper to ignore the overactive Diamond. But Diamond doesn’t settle. After a few minutes of more nipping at Mystery’s tail, Diamond turns around, positions her butt in Mystery’s face, and commences to place her tail on Mystery’s nose, insisting in a doggy way that Mystery nip her tail as return-favor. Funnier. Ms. Mary says to her husband, Daddy don’t let Diamond do that, her hot behind. The problem is that she’s hot, but they’re both females, Mary laments. So all Diamond can do is bite Mystery’s tale. Hilarious. You had to be there. I insert myself again, “It is mating season!” Her nasty behind, Mary repeats. We have a shared memory. The type of experiences that make you part of the family, that you sit and laugh about later.

I’m leaving. Thanks. No more thank you’s. Y’all have a good day. Mary stays in her seat, on the phone, but waves. She’s doesn’t get up to see me out. I smile inside. Flattered. No formality needed. I can only take this as a sign that I’ve immersed. Have I?

I think I have.

The Expert First-Hand Account

So I knew the personal care home would be my best bet in finding someone who would share their experiences with mental illness. With 6 residents, I figured at least one of them had to be that perfect story to shape my reporting around.

My first interviewee was the home’s biggest success story. Since coming to the home, she had lost nearly 100 pounds and was no longer scooter-bound, as she had been when she had arrived. An abusive husband, time spent living in a tent, bouts of depression, a stay in a psychiatric hospital were scattered throughout her life story. She could even remember her dates so precisely, which made my reporter’s timeline that much easier to create. But it just didn’t fit. It wasn’t what I was looking for. One down, five to go.

The second interview. Oh, the second interview. I was already drained by the first. Eliciting questions. Keeping up with the twists and turns of a woman who had experienced so much of what there was to experience in this life, attempting to sculpt a story in my head that was refusing to take shape. My second interviewee was born with Cerebral Palsy, and at age 50 had already lived longer than the doctors said she would. Abusive adoptive parents. Revealing stories on what it was like to be a special education student when the IDEA (Individuals with Disabilities Education Act now known as the Individuals with Disabilities Improvement Act/ IDEIA) was passed in 1975, and for the first time children with disabilities were integrated into mainstream classrooms. But the coherence was missing. It was a struggle to understand her, the CP and the onset of exhaustion were not helping. 2 down, 4 to go.

My third interviewee. If this doesn’t work, that will be over 50% of my potential “characters” I thought. She wasn’t one of the suggestions from the owner, who I had discussed my story idea with multiple times, but was self-appointed volunteer. I was hesitant, but emotionally drained. Stories of misery, even if only 2, will do that to you, no matter how many times you hear them. And I’m pretty broken in, having worked with children with emotional and behavioral disorders since I was 16 (I’m 24 now). And I should have brought a snack. But fortunately, my multimedia partner hooked me up with a couple of tic-tacs.

I should have seen her offering herself up after my first interview, saying that if I wanted country, she could give me some country, as a green light (but I hadn’t had my tic-tacs yet). After sitting through only my first interview, she had so clearly grasped from my questions, my follow-up questions, and the follow-ups to my follow-up questions, what I was looking for, the story I was trying to shape; that I was exploring the barriers to accessing mental health services in rural counties. But her eagerness, my fatigue, and the fact that at that moment, the other residents had disappeared into various corners of the house, having lost interest in the novelty of the UGA students with the cool recorders and mics, delivered her as my third interview.

Okay, than let’s go Ms. Amanda, I said.

My next green light was that Amanda was born and raised in Georgia. I had been struggling and stressing about localizing my story, with my first two interviewees hopping from state to state throughout their lives. Though she was not from the Athens area, she grew up in a rural county in Ga. and was living in Madison County now. Ok good.

By now I had learned that the best screening process was to give them free reign for the first few minutes, by prompting them to tell me “a little about their story.” That way, I could quickly judge for coherence and relevance. I knew I was depressed since I was 8 years old, Amanda began.

What? 8? You’re not serious, I said. But of course, the question only echoed against the walls of my head. She continued.

My first medication was Ritalin. But it didn’t help with my depression, only my concentration.

Correct, I think. Ritalin is typically prescribed for children with ADHD to help with concentration and impulsivity.

This didn’t help my depression, but they didn’t prescribe me other medications because so few of them have been approved for use in children, she said.

Okay, I thought. She knows her research. Even now, few psychotropic medications have been validated in clinical trials that include children. And then there’s that nasty finding in the ones that do, that some of them lead to increased suicide ideation/ suicide attempts in participants under the age 18.

Of course, the pre-journalism career special educator in me, trained to identify the “exceptional” child, smiled and asked her “You were in the gifted programs, weren’t you?”

“Yes”, she breezed over my question. (Nearly an hour and half later when I asked her about how she felt about the stigma surrounding mental illness, she passionately told me how angry it made her that people make the assumption that because you have mental illness you’re not smart. In this emotional state, she let it slip that she had an IQ of 130. She could have told me when I asked her if she was in the gifted program, but she didn’t. I believe her.)

She dropped words like hopelessness, episodes, bipolar I versus bipolar II, antipsychotics. A vocabulary as good as any mental health worker.

I settled into my seat, tic tac sugar absorbed into my blood, feeling relieved. Two strikes racked up, I knocked the third into the outfield. I have found an expert first-hand account.

The bases are loaded. Let’s see if I can bring it on home.

Everybody’s Got Something to Say

Everybody’s connected. It’s like the law of six degrees of separation. But in this case, it’s not simply through each other, but through an issue. As a newbie journalist, I’m finding that one of my favorite things is seeing what people have to say about the same issue. Even more interesting, is where what people are saying begins to converge, taking on a shape so solid that as your sources keep hurling it at you, it becomes almost impossible to dodge. So with marked enthusiasm you stand there and let it propel itself straight towards your forehead, where it leaves a welcomed, swelled imprint.

“Where do people go for mental health services in Madison County?” I asked.

“The building across the street is not the Advantage you’re thinking of. It’s not for mental health services,” the Health Department said. “This one is for the mentally challenged.”

“Well, we used to have an Advantage,” said the local agricultural extension agent.” “But we lost it a few years ago.”

A local parole officer said, “my parolees usually to go into Athens. That is, if they are getting services at all.”

A woman who owns a personal care home, speaks of how she works with the “disadvantaged.” “A lot of people don’t want to be bothered with them,” she said of her residents, most of whom she says has various mental health issues.

“Well depending on where they live, they come to us in Athens or go to Elberton. But, yes they have to leave their county to seek services,” said an Athens-Clarke Advantage Behavioral Health System employee.

My sources are converging. I ask the ABHS employee, “Well, they use to have one. Why don’t they have one anymore? I heard a few years ago, Georgia made huge cuts to their mental health services across the state.”

“Yes,” she said. “That’s when they lost theirs. And they’re still making cuts.”

“There’s your story,” she declares to the student journalist.

Cuts in funding. Rural counties. Mental illness still exists. Barriers to accessing services.

With Georgia having already made cuts and continuing to make cuts, are rural counties (already facing challenges of stigma and lack of knowledge surrounding MH), the first to be hit?

There’s that swelling imprint. Let’s see how much it starts to throb.

Chasing Sources in a Rural County

So I’m chasing a mental health story, with the goal being to explore the potential barriers to accessing services in rural areas. My first step is to find people who are willing to talk to me about their experiences. As most would guess, this is particularly difficult due to the stigma that so often surrounds the topic.

Being out in rural county with no publicly-funded mental health services seems to be both a blessing and a detriment. For one, it means that there is no one location I can go to gather information. But that’s okay, given the number of stakeholders and players in the mental health world. I’ll explain this further later, but first some more benefits and detriments.

One benefit is that if I’m not going to a mental health facility, which is a medical facility, HIPPA laws don’t apply (though there are some other confidentiality laws, such as the Individuals with Disabilities Education Improvement Act, IDEIA, that protects children receiving special education services).

Another benefit of a small town, which I discussed in an earlier blog, is the way information travels. Parole Officer Benjamin Nunley both joked and was half serious that because he was born, raised, and married in Danielsville, he was related to a good portion of the town either through blood or by marriage. I’m hoping my name and number will get out there by being passed from person to person.

Another detriment seems to be the effect of rural culture and lower socioeconomic status that results in an increased stigma surrounding mental illness or lack of awareness of mental health wellbeing. PO Nunley said that it’s not rare to find an elderly mom in the small towns in Madison County taking care of her adult son with mental illness, with no formal services being accessed.

So back to stakeholders and players in the mental health world. Here’s where I’ve started and where I will go:

*I’ve already made a visit to the Madison County Parole Office, due to the disproportionately high numbers of incarcerated persons with mental illness.

*I’ve made contact with the Director of Student Services (in essence, the modern name for special education) in order to hopefully get my name to families of students eligible for special education under the category of “emotional disturbance” and the school psychologists.

* I’ve learned of a group home in Colbert that serves adults with mental health issues and mental retardation.

* I plan to go to the local medical clinics to talk with general physicians who may have had individuals with mental health concerns pass through their practices.

* I also plan to make a visit to the police department and emt’s, often first responders to incidents involving an “Emotionally Disturbed Person” (EDP).

All I need is one or two people to share. . . I’m crossing my fingers!

Please feel free to post any suggestions!

Disparities on My Mind

I’ve got disparities on my mind, having recently returned from a National Association of Black Journalists conference dedicated to the issue.

Disparities is defined as the condition or fact of being unequal, or different.

For some health issues, disparities present themselves clearly in the mortality rates for a particular disease, such as death due to cardiovascular disease in the black community. They may also be apparent in prevalence rates, such as the growing number of newly HIV-infected African-Americans.

But in the case of mental health, the concern is largely surrounding access to mental health services. The argument is not that mental illness inherently occurs more in particular populations (a keyword here is “inherently” since social stressors experienced by historically oppressed communities certainly affect prevalence rates), but that some communities experience barriers in accessing mental health services.

The NABJ panel I attended focused on the African-American community, but rural communities, such as Madison County, potentially experience similar barriers to services. For instance, when Georgia restructured the mental health system a few years ago due to budget cuts, many behavioral health offices across the state were closed. Currently, Madison County does not have a “publicly-funded provider of behavioral health.” Though, nearby counties such as Oglethorpe and Elbert do.

***

If I’m savvy, lucky, privileged, informed enough– whatever you want to call it– I’ll stumble across the website http://mhddad.dhr.georgia.gov/.

I’ll spend way too long clicking around a site that requires training just to even navigate the home page, until I find that my county, Madison, is region 2.

I’ll try to locate an approved service provider in my county by looking at a list, and I’ll see there are none.

Or I’ll try to locate services by county, and all I will see is a map of my county and that the regional office is in Augusta. Yes, the map sure is pretty, but Augusta?

I click some more, there’s a bunch of numbers I can call. No, not too hard, but I’ve already been having a party on the Web for the last 10 minutes.

The issue is access. Who has it? Who doesn’t? My location in a rural county results in there being barriers to this access.

And how did I end up on http://mhddad.dhr.georgia.gov/? Oh, yes, I forgot, I’ve self-diagnosed my self with major depressive disorder and hopped on the Web, in all my clearheaded-ness. Or wait, was it more like this? Doc (from the practice) says, “ You have major depressive disorder.” I answer, “Thanks Doc, I’ll check out the site and get myself some help,” in all my clearheaded-ness.

Again, the issue is access. What barriers must I, if I were a Madison County resident, hurdle to get services? Not to mention stigma. . . because that would be a whole other blog.

What is rural?

Those of us who have driven through towns in the northern part of the United States may be struck by Danielsville’s northernesque feel. You enter the town through a roundabout, reminiscent of the many rotaries I learned to drive growing up in Massachusetts and New Hampshire. In the center of the roundabout sits the historic red brick courthouse, built in 1901.

Beyond the courthouse there’s the Huddle House. Then there’s the Rite Aid in addition the local pharmacy. There’s the Hardy’s and the Subway. And of course there’s the Chinese Buffet. There is even a stoplight (at this point I have only seen one)! Danielsville doesn’t feel rural.

The definition of rural varies, but most statistical definitions are based on population and population density. See What is Rural? published by the USDA. And by definition, Madison County is rural.

The appearance of rural or not, Madison County is still confronted with rural health issues. In the wake of the peanut product scare, Leigh Ann Aaron, a county extension agent for Madison County, tells how one thing that rural counties often struggle with is disseminating information. One time she called one person, she said, and received nine calls back. The individual had shared her number with other concerned community members. Word of mouth, local connections, being plugged into the community, are major pathways in the Madison County information network.

Though the town may not appear rural (at least to me), spreading pertinent health information is certainly still an issue.

Introducing Madison County

“The quintessential Southern Community,” the Madison County government website calls itself. Named for President James Madison, the northeast Georgia county dates back to 1811. “Madison is far from the hectic pace of Atlanta,” says Nancy R. Bridges, the University of Georgia Family and Consumer Sciences Cooperative Extension county agent for Oglethorpe and Madison Counties. As a county extension agent, Bridges serves as a liaison between UGA and the Madison County community disseminating helpful information.

With the closest access to a major interstate being I-85 in Commerce one county over, Madison County may maintain the charm of a small southern town, but the county seat of Danielsville sits 15 minutes away from Athens where UGA is located. The other Madison County municipalities include Carlton, Colbert, Comer, Hull, and Ila. “No municipality has a population over 1,000,” the county website says. “Only one, Comer, exceeds 500.” The 2001 census lists the county population of around 26,000, but estimated it to be closer to 28,000 in 2006. A daily average number of 26.7 miles driven to work suggests that though many of the Madison County residents enjoy living in a county that upholds “the rural flavor of the south,” they make a living in the more urban areas surrounding Madison.