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.