[Music]
Hello, I'm Ivette Torres and welcome to another
edition of the Road to Recovery. Today we'll be
talking about providing treatment and support in
rural and frontier communities.
Joining us in our panel today are
Dr. Anne Helene Skinstad, Clinical Professor at the
Department of Community and Behavioral Health,
University of Iowa College of Public Health and
Program Director of the National American Indian
and Alaska Native Addiction Technology Transfer Center,
Iowa City, Iowa;
Walter Castle, Senior Public Health Advisor at the
Division of Behavioral Health, U.S. Department of
Health and Human Services, Indian Health Services,
Rockville, Maryland;
Mary Aldred Crouch, Manager of Substance Abuse
Treatment Services at Cabin Creek Health Systems
and President-Elect of the West Virginia Association
of Alcoholism and Drug Addiction Counselors,
Milton, West Virginia;
Dr. Karen Francis, Principal Researcher and Chair,
Diversity and Inclusion Council at the American
Institutes for Research, Washington, D.C.
Welcome to the show. Mary, what are some of the
challenges that are faced by people in rural and
frontier communities as they try to address their
mental and/or substance use disorders?
In West Virginia there are a myriad of issues,
primarily the biggest issue is transportation because
there are rural parts of the state that literally have
no public transportation. We've got an enormous
workforce issue because there are some areas
where it is remote enough that there are not
medical providers, behavioral health providers
available, so that without technology to assist
providing services there are none unless they can
travel a hundred miles which is incredibly difficult
because it's very mountainous rural terrain.
Funding obviously is an issue without insurance or
with under-insurance meaning that the premiums
are high and the deductibles are very high as well.
Culture. A lot of times in the rural communities
they have a culture that dictates that they rely on
their families first and then on their church if they
have to turn to help, so that people are loath to
turn to professionals either for medical or
behavioral health so that they don't access health
even if it is available.
Thank you. Anne Helene, are those issues
compounded when we talk about Indian Country?
In Indian Country there are-depending on what
kind of tribal community we're talking about.
There are a lot of infrastructure development issues
like roads, like access to care, like educational level,
and a lot of poverty issues that make people have a
hard time trusting the treatment system. So they
would go to their spiritual leader, they would go to
their community, their medicine men much more
and quicker than going to the traditional treatment center.
Very good. Walter, you also work with native
communities. What types of issues do we see in
terms of mental and substance use disorder? Is it
just alcoholism and depression or are there other issues?
There are other issues. It's a microcosm of society.
You'll find that there's alcohol abuse and substance
use disorders along the lines of methamphetamines;
we're struggling with that, we're seeing some
increase with heroine, along with everybody else,
and the opioids. As far as behavioral health there's
the depression, anxieties. We see a lot of trauma
kind of based on historical trauma that has
occurred, and so that tends to kind of look similar
to what you'll see with PTSD at times. So the
anxiety is there. A lot of the trust issues as well
which makes it difficult, I think, to engage at some
levels. But you would see they're not really
different in regards to the types of mental health
issues along with the substance abuse issues as well.
And Karen, dealing with the systems aspect of this,
how similar are the systems within mainstream
society versus the rural? Are they similar or are they
different in terms of we've already heard about the
problems in transportation and in getting to the
services, but the services themselves?
So we often talk about if you've been to one rural
community, you've been to one rural community,
right? There are no two that are the same. There's
been research done by the Carsey Institute,
University of New Hampshire that identified
socioeconomic, cultural as well as demographic
underpinnings that define what a variety of rural
communities look like, focused on issues around the
declining economic situations in some rural
communities. The abundance of resources in some
rural communities, as we know in some of the you
know- across our country in Jackson Hole,
Wyoming where many of us take vacations quite
often. And then there are some of the other
communities that are growing but then there are
still some issues around economic stability and
those types of things. So I think that as we look at
these rural communities, it's important to
understand that none of the two are the same.
We can't compare them and it's really a unique issue
that we're dealing with.
Within those unique issues, the structures- the
availability of clinics, would you say, is up to par or
are there less services, particularly for mental and
substance use disorder provided?
That's one of the challenges in rural communities is
the availability of these resources and things that
our panelists talked about, access to the workforce,
specialized qualified workforce in these rural
communities. The issue that the service provider
agency may also be co-located with another service
provider and so the issue with stigma. If I'm
walking into this agency, everybody in my
community is gonna know what I'm going in there
for. So those are some of the concerns we have.
And in terms of non-communicable diseases with
mental health and substance use disorders,
I suspect, Mary, that they are particularly challenging
in terms of the provision of services.
They are, and as Karen mentioned, one of the issues
is stigma. People don't want to walk through a lot
of doors which is one of the beauties of
collaborative care with putting behavioral health in
a primary care like an FQHC because people-
Tell us what that is, to our audience.
I'm sorry. It is a Federally Qualified Health Center
that typically is in a rural area that a number of
them, at least in West Virginia, have got behavioral
health collaborative care which means that when a
patient comes back from the front desk, you don't
know if they're going back to see the radiologist or
the lab or where they're going, so that it totally
eliminates stigma which is a beautiful way to
provide services in rural areas. But all the things
that we have talked about do indeed create
problems with people seeking services but stigma is
huge especially with addiction.
Anne Helene, do other entities within the
community-we've talked about the community
health centers and how we're trying to integrate
more services into that, but other structures within
the community also need to participate, as you
have mentioned, such as the churches and other
nonprofits as well?
I think in American Indian communities it's very
important to have a cultural component in the
treatment and also to engage the elders because
the elders really walk up the path and create a very
good community for people in recovery and coming
back. And I think the issue of stigma, I think, is very
important but the acceptance of when you recover
and the elder takes you under their wing, you have
a much better way and likelihood of recovering
than if you do not work with the elder. I think that
is very important in Indian country.
Does it take much to get that whole tribe engaged
and get the elder engaged in these services? Is it
difficult or is it a path that is one that is accepted
and welcomed?
I would say that it's more difficult not to. I would
say that if you follow the way of thinking that you
engage with the community rather than telling the
community what to do, you will have much quicker
and much better access to care and support around
you than if you don't. So in our department we
work with the model of community-based participatory
programming and I think that is crucial for success
in American Indian communities.
We'll be right back.
[Music]
The U.S. Department of Health and Human Services
(HHS) has taken many steps to address the opioid
epidemic, including expanding access to
medication-assisted treatment. For example,
qualified physicians who prescribe buprenorphine
can apply to increase their patient limit - which
should expand access to this evidence-based
treatment. Rural health care practitioners can also
download SAMHSA's new free app, MATx.
This mobile app will give providers- regardless of
location, immediate access to vital information
about medication-assisted treatment for opioid use
disorder. This app really fills a gap in the tools
available to providers. It enhances the ability of
physicians and other health care practitioners to
provide effective, evidence-based, and in some
cases, life-saving treatment to people with opioid
use disorders. More broadly, HHS has also provided
new funding to community health centers across
the country to increase substance use disorder
treatment services. This will expand medication-
assisted treatment of opioid use disorders in
underserved areas, including rural and frontier communities.
My family and friends are always with me, no
matter where I may be. Sharing stories from home
helps me sustain my recovery from my mental and
substance use disorder. Join the voices for Recovery:
our families, our stories, our recovery!
For confidential information on mental and
substance use disorders including prevention and
treatment referral for you or someone you know,
call 1-800-662-HELP. Brought to you by the U.S.
Department of Health & Human Services.
Welcome back. Mary, I just want to touch on, we
talked a little bit and you mentioned the role of the
faith community. Can we go back to that and really
expand on it in terms of how it supports the
behavioral health component that the local
community health center may address?
Especially in Appalachian culture, if you have to go
outside your family, they will often go to a pastor,
a spiritual leader, a minister because that is
acceptable. So one of the things that can address
actually getting services and de-stigmatizing is to
involve the faith-based community in providing
assistance, knowing where help is available,
normalizing getting either medical or behavioral
health, especially behavioral health but also in
helping to de-stigmatize addiction because if you
educate your faith-based folks, they can talk with
their communities and their congregations about
the disease of addiction and how to get help
because it is absolutely rampant so that it's critical
that we involve our faith-based communities.
I know that SAMHSA supports, through the
National Association of Children of Alcoholics,
we support the training of clergy in the area of
substance use disorders and mental health as well,
and I think this is one of the main reasons is that
indeed they are one of the ones that can do the
outreach. Anne Helene, what other training
programs are there? Are there some that you
know of through the ATTC's because I know that
you're with the Indian but there are other efforts
that are ongoing through the Addiction Technology
Transfer Centers. Are there other efforts to train
clergy in this area?
There are specifically certain times of the year when
we reach out to the clergy and, of course, that's
Recovery Month where we find it very important to
provide the clergy with talking points so they can
include it in their sermons and also be prepared
when there are questions from the congregation.
Also I think it's important to celebrate recovery and
to engage the faith community in that celebration
and especially during Recovery Month but I think
other times of the year as well and the ATTC's are
very often involved in that. But I think in addition,
we as ATTC directors try to reach out to the
community around the clergy and also to the
mutual self help group communities because they
are very often meeting in the churches and a lot of
times that's where you can provide information and
we look at it from a very specific point of view that
we maintain that connection very much.
Very good. Let's move on now. We know for a fact
that we've got the community health centers that
have incorporated behavioral health service
delivery systems and many of them are trying to
broaden and expand upon, if truth be told.
And then beyond that we see all these new technologies.
So, Walter, what types of new technologies such as
telemental health are being provided through the
Indian Health Service or through other means that
you may know of?
So within Indian Health Service, actually Division of
Behavioral Health, we've got the Telebehavioral
Health Center of Excellence, and Dr. Chris Fore runs
that out of Albuquerque, New Mexico and works
closely with the University of New Mexico. I think
he's really done a fabulous job of building that
outreach because it allows specialists that maybe
wouldn't be able to live in a remote area to provide
services in that remote of an area, it allows the
clients to have access to them. So they can literally
have that face-to-face through videoconferencing
with the specialists. Typically what we see is that
the clients will go to that clinic because that's their
resource. That's where they need help so they go
there for help regardless of what that help is, and
sometimes if it's a behavioral health issue or
substance use disorder issue, then we can connect
them with a telehealth, get the specialist there to
provide those services, and they also are able to
provide consultation with the primary care doctors
there, too.
And they do it all through online connections.
All through online, yeah. So it's been a real I think
blessing in that we're able to actually get them
services where in the past we wouldn't have been
able to do that.
So to be clear, you may have a room where there's
a computer and the person does come to the clinic
but the service is delivered via online services.
Correct.
Excellent, excellent. Karen, you've done a lot of
research in this. How broad is this practice around
the nation?
We do have a number of communities across rural
communities across the country who have
implemented telehealth, telemedicine programs,
but I think the broader thing as we talk about the
delivery of services, we focus on issues, what I call
the five A's, which is accessibility, availability,
acceptability, appropriateness and affordability.
So as we are looking, whether it be telehealth or
faith-based services, how are those service provided in
rural communities so that they're meeting the
criteria for those five A's. And when we talk about
accessibility, it is issues of transportation, how
you're breaking down those barriers to ensure that
individuals are able to access services appropriately.
The availability piece comes in as we look at the
workforce and the use of technology as well as just
the trained professionals that are providing the
services. And then this piece about acceptability is
how are we reducing the stigma. So even as we
look at a telebehavioral health or telemedicine,
is this the most appropriate way to provide services
for a community or individuals who may have some
problems with the fact that the person that's
providing the services to them, they can't reach out
and touch them. It's by video so the whole issue is
around trust and continuity sometimes. And then
the appropriateness is that, you know, are we
meeting those specific and unique needs whether
they are at the cultural level, the linguistic level,
and both. And then, of course, affordability.
How do we provide the services?
How do we get the systems in there so they can use
them? But I think Karen touched on a very good
point which is the social acceptance dimension to
the services and indeed let's face it. We are going
to have to go to telemedicine if we really want to
reach 100% penetration in those areas and have
access to everything. Do you have any examples
from West Virginia, Mary, in terms of what you
may have done to ameliorate some of the
resistance that there might be to telehealth or telemedicine?
Really, I have noticed that there's more resistance
among providers than the clients because in
behavioral health it's a graying field. You know, my
clients are doing this all the time. The beauty of
telebehavioral health is if I have a mom who doesn't
have a babysitter or she doesn't have money to put
gas in the car, you know, if you've got a secure
platform, which I do, she only has to have a smart
phone or a computer. I can be in my office, she can
be in her home which may be in the middle of
nowhere. And I would expect that older folks would
be more of a problem but as grandparents like
myself start skyping with our grandkids across the
country, we're gonna habituate to it. It's more and
more common every day and it is the only way we
can provide services. It's the only way we can
reach a decent penetration level.
The role of the rural public health clinic, in meeting
the behavioral health needs in frontier
communities, is there more work that needs to be
done in that area?
One thing that I really worry about when it comes
to rural and frontier areas is that sometimes the
counselors, the professionals, are not as prepared
and educated to do the job that comes in through
their door, and one of the things that I have seen a
lot of is because they have-even though they are
working in a healthcare setting-they are feeling
very pressured. There is very little what we would
say clinical supervision accessible to them, so there
is a lot of turnover. And I think at least when I think
about my job as an ATTC director, that's one of the
things I think is very important.
We'll be right back.
[Music]
We see Counseling Solutions Treatment Centers as
sort of a hub where folks struggling with opiate
addiction can start getting stable and then get the
case management services, the counseling services,
the medical attention they need and/or the
referrals to places that can do that if we can't.
So they can get back on with normal life and on what
we call the road to recovery.
We are truly in north Georgia, the Appalachian
community. People will drive for a couple of hours
to get here because there are no services.
It's a two-hour drive, and it's worth it to me.
Rural areas like Counseling Solutions Treatment
Center Chatsworth serves have their complications
and have their challenges.
You have a less dense population so a lot of
companies and a lot of people that provide
treatment don't want to come into that rural area
because they just don't feel there's numbers
enough to be a profitable business.
We were coming into a county where in our county
and at the time, all the counties that touch us had
no opioid treatment program. So we expected
growth but what we've seen has been
unprecedented, that we've admitted over 300
people in a matter of 10 months in a very rural area
is way more than what we expected.
You don't find a lot of people up here with degrees,
you don't find a lot of people who are certified,
even just addiction-specific, much less medication
assistance. So it's always difficult to bring staff in.
Part of that is because there haven't been job
opportunities in these areas. We've got to bring
effective treatments for mental health and
substance abuse to our rural communities. We're
not going to turn any of our problems around until
all of our communities are adequately served.
[Drumming]
Staying on course without support is tough, with
help from family and community, you get valuable
support for recovery from a mental or substance
use disorder. Join the voices for recovery!
Visible, vocal, valuable!
For confidential information on mental and
substance use disorders including prevention and
treatment referral for you or someone you know,
call 1-800-662-HELP. Brought to you by the U.S.
Department of Health & Human Services.
[Music]
I have been in recovery for 22 years now. I got
sober when I was 34 and, you know, my recovery is
everything because having grown up in an alcoholic
addicted home, I would never have the life I have
now if I hadn't become addicted, but I kid and tell
people that I've changed everything except my
gender since I got clean and sober. But it's simple
but it is not easy. It's incredibly difficult which I
think that makes it a little hard for folks who had
not dealt with addiction to understand, which is
why I think sometimes people lose patience with us.
But when we get clean and sober, all of the things
that drove us to become addicted, you know, the
pain, the trauma, the isolation, don't just vanish.
That takes years of work. Years. And I think that
sometimes folks who don't know I'm in recovery,
docs that I work with and other counselors who
don't know me well, wonder where the passion
comes from. But for me, I mean I've been there.
I am those people.
Recovery has allowed me to give back in a very
different way than some folks can by being able to
go back to school and change professions and give
back professionally as well as personally. It has had
a dramatic impact on my life. I, through recovery,
have become part of my family, become part of my
greater community, but much more significantly in
terms of impact on my life, a part of the recovering
community and a part of the professional
recovering community and professional treatment
and prevention community which is extremely -
it's a blessing.
For folks in rural areas who are struggling with
addiction, please don't give up. There is help.
There are all kinds of resources now even for areas
that don't have 12-step meetings and in West
Virginia there are some of those. But there are
online meetings and in the rooms. There are help
lines. West Virginia has a help line where you can
call and find out where you can get help. People in
recovery will come get you. So there is help.
Your path to recovery isn't like mine. But when you
need a hand with a mental health issue or a
substance use disorder, reach out until you find one.
For information on mental and substance use
disorders including prevention and treatment
referral, call 1-800-662-HELP. Brought to you by
the U.S. Department of Health & Human Services.
Welcome back. Mary, we were talking about one
of the elements that we may have left out which is
school-based efforts. Let's focus on that a little bit
because we need to get to the particulars of really
dealing with the adolescents and the younger age groups.
School-based to me is part of reaching people
where they are. And where do you find children?
In schools. There's an enormous movement I think
nationally and especially in West Virginia to put
school-based behavioral health in as many schools
as possible because relative to substance abuse and
mental health prevention starts now in first grade,
kindergarten. In order to reach these children we
have to be in the schools. In order for them to get
behavioral health and substance abuse in a lot of
our really rural areas, it has to be in their schools
and that is one area where telecounseling can help
because if the counselor isn't there, you know, I've
gotten a lot of calls when I was at rural health and a
remote area where a child was in crisis and they
didn't have a counselor on site.
Walter, are there programs within the Indian Health
Service that address school-based efforts for
younger audiences?
Yeah and I'm excited because IHS just recently
signed with the Bureau of Indian Affairs a
memorandum of agreement that we would start to
embed mental health practitioners within the Indian
Health Schools that they do cover. So we're
covering the schools as well as the youth detention
centers and we're gonna be providing mental
health services there as well. In addition to that,
we've recently increased some of our funding in
regards to Generation Indigenous which is the
Indian youth and we're providing money for them
to develop preventative type measures out in their
community that they think work best for them.
So again, kind of what we're seeing with that is a
lot of the elders are coming in and they're getting
involved with that and what we've discovered, I
think, is that we're seeing that culture is prevention.
And so it's a way that we can address that culture
piece which is so important and also kind of marry it
with the prevention and how do we get that long
term abstinence and assistance when they need it.
And you know, culture is prevention but are
prevention services-let's talk a little bit about that
because it's not all about waiting for us to treat the
problem but really in the prevention efforts, are we
talking about using the same systems of telehealth,
etc., Karen?
The interesting conversation as we talk about
delivery of services and cultural, and I would add
linguistic competence with those services, I think it's
important for us to really involve the community,
the families and these youth that are going to be the
recipients of services to help develop or decide
what those services and supports look like. Again,
the linguistic piece of it is because in mainstream we
have terms for symptoms of behavioral health
issues of concerns that don't resonate with a
diverse population. Some of the language that's
even used in the systems as treatment, it's far
beyond what a parent or-
Can comprehend.
Exactly. So it's really about making those services
accessible and the language that we're using and
incorporating children and families so that we talk
about this family involvement, family engagement,
youth involvement, those types of things.
Anne Helene, where can individuals who want to
know more, particularly this program is viewed not
only by our broader audience, but it's also used
many times to instruct counselors. Are there
resources that you know of where people can
actually go and really begin to learn more about
how to be culturally sensitive about how to really
begin to deliver these efforts in order to expand
access to care.
I think there are rural health organizations that
provide a lot of very important information. I also
think, of course, of my ATTC group because the
regions have specific things that they include in
their web pages, in their training events, and I think
communities can develop programs that will be
much easier implemented if they are shared in the
community. We talked a little bit about adolescents
and I think we need to really ask them also, more
than we do, what is it that they want and how do
they want to spread the information? What is
important for them to know? So I think the
engagement in the community is just as important
as us coming in and telling them. I'm also thinking
about the RADAR system because what this is are a
library system with information about substance
abuse, behavioral health, mental health...
That everyone can access.
Absolutely. They're connected to libraries in their
community. So I really recommend that, too.
Thank you. Mary, we know now that there are
these programs. What we have not talked about
are efforts for individuals in recovery. I know that
you're in recovery yourself and maybe you'd like to
talk to us about your own personal experience and
what you may have gone through in trying to get services.
Well, I have kidded and said, I wish I had known
about Ala-tot. I grew up in an alcoholic home. My
mom also had mental health issues so that I've been
steadying this since I was in diapers. There were no
school-based services really. I mean the only
contact I remember with a counselor was ACT time.
Obviously, someone could have reached me earlier
with prevention efforts, because like a lot of
children of alcoholics, you know, Claudia Black's
book, It Will Never Happen to Me. I had to do my
own experiential research.
How did it happen to you?
I added enough liquid basically. I added enough
chemicals. I think what happens is because of lack
of education. What I did not know is that there is
indeed a heritable element to addiction as well as
the setup, the trauma, the isolation, all that stuff.
How old were you when you started to use substances?
Eight.
Eight years old. And you became sober?
Twenty-two years ago. But I think that if all the
factors-and Gabor Maté talks about pain and
isolation being two of the primary drivers- we can
reach kids and address that isolation. We can offer
services that address that pain.
How did you seek services? Did you use mutual
support or were you able to have a significant
person that intervened and helped you through
your recovery process?
I had a minister in my church who was aware of
and spoke of Alcoholics Anonymous. That was
where I learned about that and was able to attend
those and discovered that these people had hope;
and from there sought help, sought out a
counselor, sought out some professional treatment.
Thank you, Mary. Anne Helene, very quickly, peer-
to-peer, do we have models for training within the
rural community and is it a different training
program or is it basically the same?
We have models for that. We have models actually
in Indian Country and we have models in rural
areas, and they are very successful. And I'm also
going to suggest the community health workers
that you see very extensively work in Alaska and we
have very good results. So, yes, peer-to-peer and
community health workers are really very important.
Very good, and I'm gonna come back to peer-to-
peer because I think that that's one area where we
can definitely broaden the service pool within a
community. We'll be right back.
[Music]
It takes many hands to build a healthy life. Recovery
from mental and substance use disorders is possible
with the support of my community. Join the voices
for recovery: visible, vocal, valuable!
For confidential information on mental and
substance use disorders including prevention and
treatment referral for you or someone you know,
call 1-800-662-HELP. Brought to you by the U.S.
Department of Health & Human Services.
[Music]
It was really hard to find a program that was
medication assisted, the closest one is probably a
good 45-minute drive for me. I went to rehab a
couple times and I went to a mental facility for
detox and nothing ever was as comfortable as it
was here at Counseling Solutions. We, I mean they
were really supportive, I didn't feel like nobody was
judging me. This was my last resort. I knew if this
didn't work it was going to be over for me. But it
did work. It's worked wonders. I've gotten one of
my children back. I've been working since January,
I've been doing really good.
I just love the people here. I love 'em.
I mean, they're just like family.
That keeps me coming back.
We don't treat anybody like a number. Our focus is
to get to know people, to understand people, to
understand their struggles, to work with them again
through the psychotherapy and ensure they are
getting what they need out of this.
Many of our patients have had no contact with any
area of health care for years and sometimes in their
whole lives until they meet with us. And so you are
serving a population that often feels that society has
forgotten about them or that society doesn't care
about them.
We create that sense of family for them. We don't
want them to think that they come here and it's
punitive in any way.
Where I was at was just a money-making, it was a
job; where here they care that's what I've found
and I would probably drive 4 hours one way if I had to.
It just means the world to me to remember when I
was on the other side of the desk so to speak, and
how broken I was at that time. And to realize that I
now have the opportunity to offer and help people
find the same wholeness I now have.
Since I started here at Counseling Solutions, my life
has changed tremendously for the better. I've got
goals now, I have a future now, that's not
something that I could say 10 months ago that I
have a future.
There was no tomorrow before,
and I've got a tomorrow now.
[Music]
We know that recovery does not happen in
isolation, but recovery happens in relationships
with others. And that having the support of friends,
families, communities, having the support of other
peers who have lived experience of mental health
and addictions is really critical. Now in rural
communities, it is an added factor because of the
geographic isolation. So there are things like
transportation, other community organizations and
increasingly through the use of technology that can
help reduce those distances, so that people can find
the community, the relationships and social support
they need.
It is amazing to see how technology is really
revolutionizing behavioral healthcare today.
Through the use of internet, you can find online
support groups, you can also find support groups
that are available in your local communities.
We also know that the development of mobile
applications are huge these days, and the kind of
things there where you can find support groups in
your community, we know the Veterans Administration
has even developed applications for Post Traumatic
Stress Disorder, so using these technologies is one
way to build those communities and social support.
[Music]
For more information on National Recovery Month,
to find out how to get involved or to locate an event
near you, visit the Recovery Month website at
recoverymonth.gov.
[Music]
Welcome back. Walter, the element of peer-to-
peer and community support, I suspect you're also
working with that and what are some of the
resources in that area?
Yes, actually we are and to Anne Helene's point,
Alaska has kind of a great model that they've
developed and part of IHS now, we're looking at
that model and being able to maybe start to
incorporate something very similar at a national level.
And what does the model consist of?
So it would be a series of trainings that would then
help these people get prepared to go out into the
community and address the members in the
community that maybe don't have access, don't
have transportation, so they would be able to go
out into the community. If someone was having
some sort of mental health crisis, they can go out to
that person's home and basically evaluate, make
some determinations, and kind of help go from
there. So it's really this-we don't need to have a
four-year school in order to get these people
certified. So they're not at a level where they're
masters or doctors or anything like that but they
serve a vital role.
But they're community-based individuals.
That also speaks to our workforce issues because
especially in substance abuse, a peer-to-peer or a
recovery coach is often far more effective than a
masters level or doctor level provider who hasn't
got the lived experience. You know, recovery
coaches are worth their weight in gold because they
are trained people with lived experience who can fill
in the gaps because there are not enough
professional providers in an area, but they can meet
the needs of the client so that they have a better
chance of success in achieving long-term recovery.
Very good. We have not talked about the whole
notion of suicide and suicide prevention within rural
communities. I think it is a very critical aspect of a
service delivery. What do individuals need to look
to as we look for models that are accessible to rural
individuals, Mary?
I think that initiatives need to be in schools because
I think that in rural areas that's the best way to
reach our kids. I think that prevention is vital.
I think that public information is critical using
technology as an outreach mechanism because if
people can find the help they need, they don't
reach that point but you've got to get to them
before they reach that point.
And I want to add something to that. I think suicide
is a very community devastation and it affects
communities on a very deep level, and we have
been involved in a project in a tribe where there
was this very serious suicide epidemic and we
haven't actually been present other than every
single week we have got together providers,
schools, elders, national experts on suicide, and
kept talking and providing ideas about what can
you do to prevent this in the future, and that's
when we realized that the elders are very
important, the kids really need to have an input,
and you see that when the community come
together and decide to do whatever the community
thinks is the right thing, you see a reduction in
suicide. But it's something you have to keep doing
because if you stop, it comes back again.
I think the major issue, and I think you touched on
it, Anne Helene, and I'm going to you, Walter, is
that within Native Country there is a tremendous
problem with youth suicide currently, correct?
We've had clusters. Again, right now one of the
programs that we've implemented is Zero Suicide
training, and we have a number of tribes that are
engaged with us at our IHS level to get them
training on how to get into the communities and
talk to the community members and make sure that
they're kind of keeping a finger on the pulse.
When we talked about what do the community providers
have, one of the things that the community
providers can do is really they know what's going
on. They know what's going on in their community
and they can typically react a lot faster. So it's some
training that we're doing on our end. We've got
Pam Indahorn out of our Division of Behavioral
Health is our Suicide Prevention Coordinator now.
So we've taken a serious look at that. We haven't
had the clusters recently but to the point, when you
look away, does it pop back up? So ever-vigilant,
and we're trying to make some adjustments and
make sure that we continue to keep that out front.
I think Anne Helene's point about ask the
community-who knows better what they need,
what's gonna work best than the community themselves?
Yes. I believe it's really about engaging community members.
And I'm thinking about we forget in rural
communities the farmers, and farmers have a very
high suicide rate, and what we've seen with
recovery coaches and with peer support is that they
are much more able to talk directly to the farmer
than anybody outside because the farmer doesn't
like to have the experience of being depressed,
upset, but a community member- they will talk to.
I absolutely agree in what you said but let's face it,
how do we address the issue of the generational
issues that are within the workforce? You know,
many people are retiring. How can we really begin
to-are we addressing that as we look forward to
providing better services in the rural community?
I want to start with you, Mary.
Well, I mean it's a real issue because the work that
we're talking about doing is very difficult work and
it is typically low pay so that it is a matter of
de-stigmatizing the provision of services so that people
are willing to go into service provision because what
we need is for the older folks like me to be able to
pass on what we have learned from our mentors,
and if we don't have another generation, that can't
happen and there will be an even greater
workforce issue than there is now and that would
be catastrophic.
Well, talking about those resources, are there any
resources Anne Helene that you can think of in
terms of developing the workforce within Indian
Country or outside the Indian Country within the
rural communities?
And when you and Mary talk about it's tough work,
it's not really well paid and, of course, we never
became counselors to be rich. We became counselors-
If we did, we goofed.
Yes. We became counselors because we were
committed and I think that commitment is very
important for us to nurture, and I believe in giving
as many opportunities for support and clinical
supervision and interactions with other
professionals as possible in addition to training
because, of course, training is important but it's
those heart-wrenching situations when you are
faced with someone who is suicidal or have a very
bad family crisis, it's very hard to leave that
situation if you can't talk to somebody about what
you experienced.
Absolutely. Walter, Indian Health Service, are we
doing anything related to workforce development?
We are. We've got a couple of programs. We've
got a loan repayment program and we've also got a
recruitment program as well and so we try to go
out, find the folks, and see, you know, come on in.
I think part of the challenge is if you can get
somebody that's from that community, they'll stay
in that community. And so trying to nurture and
build that as well is always kind of an important task
I think. And congratulations on 22 years.
Thank you.
That's awesome. I think those are the people, too,
when we start looking at who are the ones that are
in recovery that have been successful that maybe
have some sort of passion, and see if we can't figure
out a way to identify those folks and bring them
along because you don't want to lose the institution
of knowledge.
But also, I now have a drug court graduate who just
finished her MSW. Paying for that and supporting
someone while they do that is fabulous. She was
able to do that which is just magnificent.
But I think there's one thing we tend to forget and
that's recruitment, because if we think back about
when we were teenagers ourselves, we didn't wake
up one morning and say, I am going to be a
substance abuse counselor or a mental health
counselor. You have to really think about ways to
engaging adolescents, high school students, in the
idea of becoming a counselor.
Absolutely, and not only that; it's really getting to
the youth and young adults that are in the schools
themselves and we're doing that through a
program through NAADAC. In certain communities,
we're going out and talking to sophomores and
juniors and freshmen about this field and hoping of
engaging them. I think this has been a great
opportunity to approach this subject and I want to
thank you for being here and I want to remind our
audience that September is National Recovery
Month. You can get more information at
recoverymonth.gov and we want you to be
engaged, be supportive and to list all of the events
and activities throughout the year that you're
engaged in related to recovery at
recoverymonth.gov. I want to thank you for being
here. It's been a great show. Thank you.
[Music]
To watch this program or other programs in the
Road to Recovery series, visit the website at
recoverymonth.gov.
[Music]
My story is yours. I am a mother.
I am a father, a son,
A daughter. I am in recovery from a mental illness.
A substance use disorder.
With support from family and community
We are victorious!
Join the voices for recovery.
Our families, our stories, our recovery!
For confidential information on mental and
substance use disorders, including prevention and
treatment referral for you or someone you know,
call 1-800-662-HELP. Brought to you by the U.S
Department of Health and Human Services
[Music]
Every September, National Recovery Month
provides an opportunity for communities like yours
to raise awareness of mental and substance use
disorders, to highlight the effectiveness of
prevention, treatment and recovery services, and
show that people can and do recover. In order to
help you plan events and activities in
commemoration of this year's Recovery Month
observance, the free online Recovery Month kit
offers ideas, materials, and tools for planning,
organizing, and realizing an event or outreach
campaign that matches your goals and resources.
To obtain an electronic copy of this year's Recovery
Month kit and access other free publications and
materials on prevention, recovery, and treatment
services, visit the Recovery Month website at
recoverymonth.gov, or call 1-800-662-HELP.
[Music]
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