Residents sometimes travel hours to get mental-health care
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 winding mountain roads of southern West Virginia, consumes her entire day.
Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she doesn’t 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, West Virginia, until day’s end.
Nelson is among many area residents who do not drive. Patricia Hagerman, 63, of nearby War, West Virginia, has relied on her sister for the past 11 years to drive her about an hour each way to the nearest psychiatrist — in Princeton. She makes the trip once every two months for depression and anxiety treatment.
Getting mental-health services in this area of West Virginia, about 85 miles south of the capital of Charleston, 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 — ranging from depression, anxiety, addiction and other mental-health concerns — are aggravated by the local economic downturn.
Dr. Joanna Bailey, who practices family medicine in Pineville and treats patients covered by Medicaid, said the lack of mental-health care 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, a 45-minute car drive. In addition to the transportation hurdle, it can take a month or more to get an appointment.
Bailey practices in both 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. Medicaid enrollment is roughly 35 percent in Wyoming County and 48 percent in McDowell County.
Bailey said about 30 percent 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 the issues her patients face.
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.”
Joy Butcher-Winfree works alongside Bailey as the sole clinical psychologist within their practice. She usually handles about nine behavioral-health cases each day.
“I only have so much time and only so much energy,” Butcher-Winfree said. “It’s very overwhelming most all the time. … If someone is in a crisis, they need more than that 15-, 30- or 45-minute slot.”
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.”