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The Hidden Crisis in Rural America: A Lack of Mental-Health Services

It’s prohibitively difficult to access mental-health services in rural America. That’s because, relative to urban areas, rural counties have so few mental-health professionals. The majority of nonmetropolitan counties in the U.S. don’t have a psychiatrist, and almost half lack a psychologist. The paucity has resulted in a public-health crisis—rural Americans suffering from a psychiatric condition are more likely to encounter police than receive treatment. Each year, 2 million mentally ill Americans, most of whom aren’t violent criminals, end up in jail.

This is the case in Cochise County, Arizona, a sprawling area nearly the size of Rhode Island and Connecticut combined, but with 3.8 million fewer residents. Many 911 calls in the area involve people with mental-health issues, and according to Mark Dannels, a local sheriff, 67 percent of the people in Cochise County Jail were diagnosed with a mental-health condition.

In the short documentary Out of Sight, Out of Mind, directed by James Burns for PBS Independent Lens, Dannels and other residents of Cochise speak to the alarming implications of the area’s lack of psychiatric resources.

“There’s an increasing demand for mental-health services across the board, and we can’t keep up,” Dr. James Reed says in the film. Reed is one of just two mental-health professionals serving the entirety of Cochise County.

“With the lack of resources in a county like Cochise, it is a revolving door [to prison],” Dannels says. “The options are limited … one option that remains constant is the arrest. I’ll be the first tell you, that’s not the answer.”

Burns, who has personal experience with the criminal-justice system, told me that when a county is already struggling financially, mental-health care is often pushed to the bottom of the list of concerns. “It’s seen as a luxury, yet oftentimes it’s those with the least access to it that need it the most,” the filmmaker said.

“Cochise is an acute example of how the crisis manifests,” Burns continued. “It is so remote that people are physically unable to travel the distances they would need to go to get help. That’s emblematic of the story playing out in rural areas all over the country.”

In a recent speech at the National Institute of Mental Health, Dennis Mohatt, vice president of rural mental-health research, said that rural America often eludes the public consciousness.

“What most people think about when they picture persons with mental illness are people sitting on a city street, homeless,” Mohatt said. “They think of an out-of-control teenager in a large metropolitan school. They think of a person locked in a psychiatric hospital ward. They think about people making poor choices.”

“What few Americans picture,” Mohatt continued, “is a farmer or a rancher with serious depression. They don’t think about the stress associated with a changing rural economy … they certainly don’t think about the refugees and the migrants that travel across this country harvesting the food that we all eat. They don’t think about rural America.”

This film is an Independent Lens “Stories for Justice” production in association with Terry Greene Sterling and the Arizona Center for Investigative Reporting.

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