Coal towns struggle for good mental health care
Lack of access, economic downturn put patients in limbo
PINEVILLE , W.VA. Every other month, Tanya Nelson travels 32 miles from the heart of Appalachia’s coal country for an appointment with the nearest psychiatrist for therapy and to renew prescriptions. But the commute, which should take less than an hour through the mountain roads of southern West Virginia, consumes her entire day.
Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she does not drive, so she must use a van service to keep her appointments. It makes numerous stops along the highway, picking up other travelers, and usually doesn’t return to her home in New Richmond, W.Va., until day’s end.
“I’ll call and tell them I’m ready (after my appointment), but they tell me they’re waiting for someone else,” Nelson said as she described a typical trip.
Getting mental health services here is fraught with challenges. But the need is great.
There are no psychiatrists in Wyoming County. A handful of small, general medical practices and a few behavioral health specialists handle services for the 21,763 residents. Patients’ issues — from depression, anxiety, addiction and other mental health concerns — are aggravated by the local economic downturn.
Joanna Bailey, who practices family medicine and treats patients covered by Medicaid, said the lack of mental health care access puts her patients at a disadvantage.
“As a family doctor, I’m doing way more psychiatry than I am comfortable with,” Bailey said. She sends patients such as Nelson who need more specialized help to the closest psychiatrist in Beckley, W.Va. In addition to the transportation hurdle, it can take a month or more to get an appointment.
Bailey practices in Wyoming and McDowell counties — Appalachian areas once fueled by a booming coal industry. Today, much of the local economy relies on tourists coming to use the area’s ATV trails. Infrastructure has been neglected. Shops have been boarded up and abandoned.
She said about 30% of her caseload is treatment for mental health issues. As someone who was born and raised in Wyoming County and has witnessed the economic slide, Bailey understands many of her patients’ issues.
The coal industry, which was once king in this region, has been declining for years. “So, we’ve lost a lot of people, and that’s depressing,” Bailey said. “We haven’t had growth and a lot of people are unemployed right now. That’s traumatic to families on every level.”
When parents with mental health disorders go untreated, a “vicious cycle” is set in motion, she said. “Those children grow up with the same mental health issues because they’ve watched the same unhealthy relationships their whole life,” Bailey said. “It’s just a cycle of abuse and trauma.”
One resource for patients is the Southern Highlands Community Mental Health Center, which also accepts Medicaid patients. The Wyoming county location serves about 400 people, said clinic administrator Rebecca Marsh. It offers therapy sessions and counseling among other services.
Research released in August by the Appalachian Regional Commission showed the area has fewer health care professionals compared with the rest of the country, specifically mental health care providers.
Bailey said some cases make her nervous about whether she has the background to provide sufficient care. One of those is depression in adolescents.
She said she prescribed one patient the antidepressant Prozac but fears that a bad reaction to the drug led the teen to attempt suicide.
Since that episode, “it makes me more nervous,” Bailey said. “But you know at this point, I’m a month out of being able to get people in (to see a psychiatrist), unless I’m sending somebody to the hospital.”