“I just need a referral to a pediatric psychiatrist for my child.” This was the most common request I received at a rural health clinic in Joshua Tree, California. The nearest emergency pediatric mental health service facility was approximately two hours away. Although an urgent care center was nearby, it only specialized in treating adults.
Working in a rural health clinic as a Pediatric Nurse Practitioner is no joke. While the surrounding desert, littered with majestic Joshua Trees, may be beautiful, the challenges are significant. Lack of specialty-trained providers, scarce resources, and, of course, little or no access to mental health services are just some of the daily concerns that I faced.
Residents in Rural Areas Have Higher Health Risks
There are approximately 61 million Americans who live in rural areas, which include Tribal, frontier, and regions that are geographically isolated areas. In the past, most people who lived in rural areas were older and in a lower socioeconomic bracket. A 2020 Gallup poll study found that 31% of Americans prefer to live in a rural area versus an urban city. During the COVID pandemic and the ability for many people to work remotely, several families moved from big cities into rural, small-town communities like Joshua Tree, California.
According to the Centers for Disease (CDC), people who live in rural areas experience higher rates of cigarette smoking, high blood pressure, and obesity. The five most common leading causes of death in rural areas include:
– Heart Disease
– Stroke
– Cancer
– Chronic Lower Respiratory Disease
– Unintentional Injury
Maternal and Infant Health Concerns
Approximately 18 million women of reproductive age live in rural areas in the U.S. Closures of maternal health units and hospitals, as well as a decrease in the number of maternal health providers in rural areas; all contribute to increasing maternal and infant health disparities. Premature births, low infant birth weight, postpartum depression, increased maternal mortality, and severe maternal morbidity are crucial circumstances that contribute to the health and well-being of both newborn infants and their mothers.
An extensive 30-year background in pediatrics and maternal child health came in handy working in a rural clinic. My most significant focus with newborns and new moms was breastfeeding and newborn care. I would spend at least an hour with new moms and newborns. I would also assess the postpartum mom’s mental health and make sure she had enough support at home, and often gave the new mom’s my personal phone number as a resource in case they had any questions.
Mental Health: The Number One Health Disparity in Rural Healthcare
Access to mental health services is the number one health disparity facing rural communities in the United States. Suicide rates in rural areas are higher, partly due to lower public funding and limited access to mental health services. Some of the contributing factors include:
– Isolation
– Loneliness
– Decreased access to transportation.
– Access to firearms
– Lack of specialty services
– Cultural competency to aid diverse populations.
Elevated Cannabis Use in Adolescents
Cannabinoid hyperemesis syndrome in adolescents and young adult patients was a common diagnosis seen in my rural pediatric clinic in Joshua Tree. It often involved adolescents who complained of abdominal pain, nausea, and vomiting due to excessive marijuana use. All too often, the parents of these teens were in denial of the teens smoking “too much marijuana” and would find it challenging to have the teens stop smoking due to their friend groups.
The rural pediatric population has multiple risk factors that increase their vulnerability to adverse consequences as cannabis legalization expands across the United States.
Some concerns include:
– Increased Access and Use
– Greater Mental Health Risk
– Cognitive and Academic Impact
Rural areas tend to have decreased resources for intervention and education to alleviate these risks. I personally spent lots of time educating teens and their parents regarding marijuana addiction. Handouts with online and community resources were given to patients and their families, which emphasized the mental health risks and cognitive impairments of long-term marijuana use and abuse.
High Risk of Opioid Use Disorders
Drug overdoses are the leading cause of injury-related deaths in the United States. According to the CDC, in 2021, there were 106,699 drug overdose deaths in the country. The number of drug overdose deaths is rising in rural areas, where they now occur more frequently than in urban areas. The book and movie ‘DopeSick’ highlighted the detrimental effects of excessive opiate use in rural areas like the Appalachian Mountains.
Increased Need for Psychiatrists and Psychiatric NPs
The need for psychiatric mental health providers has been growing in rural areas. It is estimated that up to 65% of nonmetropolitan counties lack psychiatrists and psychiatric NPs. Over 60% of rural Americans live in areas designated as having a shortage of mental health providers. Some of the reasons include:
– Escalating mental health care needs: suicide, alcohol and substance abuse, opiate addiction, depression, and domestic violence are on the rise in rural areas.
– Role of Psychiatric Mental Health Care Nurse Practitioners (PMHNP): PMHNP can help bridge this gap by providing comprehensive mental health care, including diagnosis, treatment, and medication management. Their ability to practice independently is crucial in areas with limited healthcare providers.
– Telepsychiatry: PMHNPs play a big role in telepsychiatry enabling them to provide patient care and mental health services in remote locations.
-Policy Support: There’s increasing support for PMHNPs to address the various issues that exist in rural areas and work in the fullest capacity of their education and training.
Working in a rural health clinic has been a challenging and gratifying experience. I was able to spend unlimited time with my patients, ensuring they received the patient education and care that they needed. However, at times, I felt helpless due to the lack of mental health and substance abuse facilities in Joshua Tree, CA.