Collaboration is key to improving behavioral health in communities.
And the markers of a healthy community are far more than suicide rates or obesity levels. Voting rates can communicate the health of a place, and the location of coffee shops bring people together and play a role.
"We believe that it's important to address the concept of human wellness, not as the absence of disease or symptoms, but as a much more holistic concept," said Rick van den Pol, a research professor at the University of Montana.
Friday, UM hosted for the first time an interagency gathering of federal officials who share concerns about rural health and rural behavioral health, said van den Pol, in the Office of the Vice President for Research and Creative Scholarship.
Missoula Mayor John Engen welcomed the group, and he said the speakers and participants who were working to improve mental health were helping communities invest in themselves and reach their highest potential.
Engen said he'd been elected four times and has seen successes in building a desirable and thriving city. But he's also a depressive and alcoholic in recovery, and to address his mental health, he had access to resources, some money, and a lot of help. He knows that many others don't have similar support.
"How many people in our community do not realize their own potential? How many do not get to participate fully?" Engen said.
The summit included representatives from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Western Interstate Commission for Higher Education (WICHE), the U.S. Department of Agriculture (USDA), the Office for Civil Rights in the U.S. Department of Health and Human Services, and the U.S. Department of Housing and Urban Development (HUD), among others.
At the forum, federal officials shared their perspectives on health challenges and grant opportunities with participants including faculty researchers, legislative representatives and community health partners. Faculty researchers in turn shared the work they were doing in behavioral health.
Health problems in rural areas are wide-ranging, from high suicide rates to misunderstandings about access to medical records. Veterans face unique challenges, and tribal members need better access to care.
David Van Behren, with the USDA, said hunger and nutrition are both threats in rural areas. A tourist passing through a rural area might stop at a gas station and not realize its convenience store is the only source of reliable food for the people who live there "in the middle of a food desert."
Those stores are full of foods that are high in fats and sugars and salt, he said: "How often do you see fresh fruits? Do you ever see fresh vegetables?"
Andrea Oliver, regional manger for the Office of Civil Rights, said her office is inundated with complaints from people who are not able to access their own medical records because providers misunderstand HIPAA, the Health Insurance Portability and Accountability Act.
"We're seeing excessive fees being charged for those records," Oliver said.
At times, patients who have outstanding medical bills aren't allowed to access their files, she said. To respond to the problem, she said her office issued detailed guidelines last year about when records can be released.
Erik Amundson, with HUD, said unhealthy housing is a problem in rural areas, and issues include mold, leaky plumbing, insufficient heating, and pests. However, Amundson also said HUD isn't looking at housing issues in isolation.
When Secretary Ben Carson received the nomination to lead the agency, people questioned his lack of credentials in housing. But Amundson said the medical doctor and former head of pediatric neurosurgery at the Johns Hopkins Children’s Center has taken a holistic approach to the work.
He said Carson is stressing a conclusion by researchers that the physical health of housing is a strong predictor of its residents' behavioral and emotional health. Soon, he said smoking will not be allowed in public housing, and cleaning up mold is a priority.
"I think it's really taken a positive direction in the last year at HUD," Amundson said.
Stigma remains a challenge in behavioral health, although mental health and substance abuse are coming out of the shadows, said Charlie Smith, a regional administrator with SAMHSA.
"Health is health is health, and we don't have to separate the mind and the body," Smith said.
Rather, he said it's important to talk about the wellness of the whole body, a person's emotional, spiritual, occupational, financial, social, physical, intellectual and environmental dimensions.
He said it's also important to be realistic when discussing goals in mental health. "Zero suicide" is an initiative being rolled out in many states, he said, and it's an emotionally compelling target, but not necessarily a realistic one.
Smallpox is the only illness that's been completely eradicated, and he said it's important to think about the language used when setting targets.
But mental illness is a pressing concern on college campuses, said Liza Tupa, a director for WICHE. An estimated 11 percent to 20 percent of students are diagnosed with mental illness, and of those, 64 percent withdraw, she said.
Imagine if 5 percent to 10 percent of students were dropping out due to another health crisis, such as vision, Tupa said. She figured campuses would act expeditiously.
"They would immediately get going with vision screenings and assistance for treatment and glasses and you name it. But it's not happening. It's not being talked about at this level," Tupa said.
In higher education, she said stigma reduction is necessary and basic public awareness campaigns "can work wonders."
Scott Whittenburg, vice president for research at UM, said the challenges in rural areas are great, with populations that tend to be sicker and older, and access to care more difficult. He said UM hosted the summit because it has many researchers addressing those matters.
"These are important issues for our state and for our region, but fortunately I think for us is we have a large number of faculty on our campus ... working in these areas," Whittenburg said.
One key is addressing a deficient workforce, Smith said. Rural areas don't have enough trained people or access points, and he leveled a challenge that UM ensure a strong connection between clinical training and practice in the field.
"Are we training individuals in the right things that they'll be doing out in the community?" Smith said.
The way forward for those working in mental health and substance abuse is together, he said. To be effective, representatives from different agencies need to find the places their interests intersect.
"It's not a single agency's responsibility. What brings us together? What are the bridges?"