Barrow, Alaska, is America’s northernmost city. The town of nearly 4,400 people is accessible only by airplane or boat. Because of its remoteness, Barrow wants to make sure it never faces a shortage of mental health workers. Last summer, the Alaska Area Health Education Center held a weeklong academy in Barrow for 19 high school students from 14 villages around the state to teach them about mental health.
The center is part of the Alaska Health Workforce Coalition, which is made up of several state entities, including the Department of Health and Social Services, the Department of Labor and Workforce Development, and the University of Alaska. The goal of programs like the academy is to get kids interested in pursuing careers in mental health and interested in coming back to rural parts of Alaska to practice it. “There’s a real homegrown nature to it,” says the coalition’s director, Kathy Craft. “We’re keeping our talent inside Alaska.”
Barrow may be an extreme example of isolation, but the problem it faces is all too familiar across the nation’s rural landscape. Rates of mental illness are higher in rural and remote areas, a product of factors that include isolation, more conservative attitudes toward seeking help for mental health problems and a lower concentration of mental health professionals.
The numbers bear this out. Paul Mackie, president of the National Association for Rural Mental Health, found in a study that for every 10 miles you move from a city, it becomes 3 percent more difficult to find a behavioral health worker. “So if you’re, say, a hundred miles from an urban center, you can only imagine how hard it is to get that kind of help if you need it,” he says.
The need is especially great in Alaska, which has the nation’s second-highest suicide rate: almost 23.3 per 100,000 people in 2013. (Montana has the highest rate, 23.9 per 100,000.) Rural areas in general tend to have higher rates of suicide -- for youth, the rate is almost double that of urban areas -- so placing mental health workers in the most remote areas can have a particularly strong impact.
Mackie thinks the stigma in rural areas regarding people who seek mental health care is diminishing. But even so, the difficulty of finding mental health workers remains. And a potential bright spot in rural mental health care, telemedicine, has its downsides. Of the 19 million Americans without access to high-speed Internet, Mackie points out, 13.5 million live in rural areas. Additionally, telemedicine hardware and software require IT support, so even if a community health clinic gets a compatible device, it’s useless when something goes wrong. “I can’t tell you the number of clinics I’ve seen with expensive telehealth equipment collecting dust,” says Dennis Mohatt, vice president for behavioral health at the Western Interstate Commission for Higher Education. “It’s broken and they simply can’t find anyone to fix it.”
Nevertheless, experts think telemedicine can have an impact on rural mental health issues, but say it should be done in conjunction with finding and training community mental health workers, as the Alaska Health Workforce Coalition is trying to do.
The initiatives the coalition puts together involve governmental organizations working together to create more holistic approaches, and, in one respect at least, Alaska’s sparse population may work to its advantage by making it easier to break through bureaucratic silos. “Everyone knows everyone,” Craft says. “If we want a state legislator to act on something, we can just call them directly. That’s a nice advantage of being so rural.”