It’s time to talk about rural mental health challenges

In farming, you often have to work even when you're not feeling well. There are no options to call off or get substitutes when you need time off. The strong work ethic passed down from fathers to sons (and daughters in many cases) is admirable, but it can lead to medical issues if not managed properly.
Photo: Melissa Mayes/PEXELS

by Tim Ditman
OSF Healthcare
ALTON - While living in Greene County, Illinois, in the 1980s and 1990s, Lea Anne Varble took a gut punch each time she heard about a suicide in her community. Eight to 10 in total in 15 years, she says.

“It just took me aback,” she says.

What the tragedies had in common: the person faced mental health challenges common to a rural setting.

Lea Anne Varble
Varble, a clinical psychotherapist at OSF HealthCare, knew she had to do something about it. So not only did she devote higher education time to studying the problem, but she’s also now getting the word out about the resources available.

The issues
Varble says stress and isolation are often experienced by people living in a rural setting, such as a farmer. There’s also a desire to be self-sufficient – a trope associated with farmers and other rural residents for decades.

“People living rurally often are independent. So, when stress comes, they want to handle it on their own,” Varble says.

Varble also knows the issues – stress, anxiety and even depression – of planting and harvest season.

“Hours and hours,” in the field, she says. “You’re expected to keep working even if you don’t feel well. Even if the stress is getting to you. You have to get up and do it again. Or at least that’s what your father before you did and his father before him.”

The work ethic can be admirable, but it can lead to medical issues if left unchecked.

And, the heads of some rural households are caring for two generations: their kids and their parents. School, chronic illnesses and advanced care planning are just more things to add to the to-do list. Varble adds that older adults in a rural setting are more likely to see themselves as a burden and choose to end their life.

Treatment
Varble says getting better starts simply with noticing the problem and talking about it with a trusted adult, like a friend, family member, faith leader or a medical professional.

The good news is that mental health professionals have made strides in this area, such as telemedicine and mobile health services. And society is more willing to talk about mental health. Farming magazines have articles on mental health, for example.

Other ways to help that Varble has picked up over the years:

  • Get to know your neighbors and local organizations, like churches and businesses. Then, lean on them for help when the stress gets to be too much.
  • Look into resources offered by state or federal agencies. In Illinois, where Varble works, the Family Farm Resource Initiative operates a 24/7 hotline and email.

    “Individuals can receive support from trained professionals who understand the unique challenges faced by those in the agricultural sector,” the initiative website states. “The helpline offers specialized assistance, including mental health resources and agriculture-related support, ensuring that farm families have access to the help they need.”
     

  • Health care professionals should encourage people with rural backgrounds to become therapists.

“It’s someone from their community who understands what’s going on,” Varble says.


Read our latest health and medical news

Can an AI therapist help you through the day?

by Ben Rein

Would you let an AI chatbot be your therapist?

A recent study wanted to know if this would work, so they asked AI about 200 questions from the “Ask the Doctors” page on Reddit. Then they put those answers next to responses from real human doctors and asked healthcare providers to judge which was better, without knowing which one was AI. What do you think happened? They rated the chatbot’s answers as better 78% of the time and found that they were more likely to be empathetic.

But this raises a key point: empathy.

Everybody knows that ChatGPT can’t feel emotions. Therefore, it’s not capable of empathy, because it can’t really understand what you feel. And some scientists think that this is where AI loses: Chatbots will never work as therapists because humans won’t accept or appreciate empathy from a robot.

@dr.brein Can an AI chatbot really be your therapist? ________ This video was supported by the Pulitzer Center through the Truth Decay Grant Initiative, in collaboration with OpenMind Magazine. To read more about this topic, check out the accompanying article on OpenMind’s website, found in my bio 🔗. #PulitzerCenter #neuroscience #AI #therapy #empathy ♬ Mysterious and sad BGM(1120058) - S and N

When a real company, Koko, tried using chatbots, it didn’t work because people knew they were chatbots. The patients didn’t care when the chatbot said, “I understand how you’re feeling” because they knew it was an empty, emotionless statement.

But it makes me wonder, if chatbots continue gaining in use and acceptance, and we come to respect them more, this could change. And I’m curious how you’d feel about that.

If 100 years from now, AI chatbots are considered trained psychiatrists, would this be good or bad for society? It might seem ridiculous, but it’s real life. Right now, we essentially hold that decision in our hands. We are the first humans to coexist with these large language models, and we actively vote as consumers—with our clicks and our wallets—to determine the future of AI. In what capacity will we come to embrace AI? Where do we draw the line? It’s something to think about as we navigate this new virtual world. Thank you for your interest, and please follow for more science.


This story originally appeared on OpenMind, a digital magazine tackling science controversies and deceptions.

What's up, Doc? Staff therapists could be a competitive advantage for restaurants

The death by suicide of the charismatic Bourdain ... resonated with many restaurant workers.

Restaurant jobs have always been difficult, but the mental stress has gotten worse during the pandemic as restaurants closed or cut hours — or became ground zero for the fight over mask-wearing.

"It is totally nerve-wracking sometimes because all of my tables I’m interacting with aren’t wearing their masks," said Nikki Perri, a server at French 75, a restaurant in downtown Denver. "I am within 6 feet of people who are maskless."


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Perri is 23, a DJ, and a music producer. And she’s not just worrying about her own health.

"I’m more nervous about my partner. He’s disabled. He doesn’t have the greatest immune system," she said.

After the initial shutdown, French 75 was having problems finding employees when it reopened. So were other restaurants.

"We put a Survey Monkey out and pay was No. 3," said chef and owner Frank Bonanno. "Mental health was No. 1. Employees wanted security, and mental health, and then pay."

His company, Bonanno Concepts, runs 10 Denver restaurants including French 75, Mizuna, and Denver Milk Market. The survey went out to employees of all 10. Bonanno said these jobs offer competitive pay and good health insurance, but the mental health benefits aren’t very good.

"Most such psychologists and psychiatrists are out-of-pocket for people to go to. And we were looking for a way to make our employees happy," he said.

That, according to his wife and co-owner, Jacqueline, was when they had a revelation: Let’s hire a full-time mental health clinician.

"I know of no other restaurants that are doing this, groups or individual restaurants," she said. "It’s a pretty big leap of faith."

It took a little while to figure out what exactly employees wanted and what would be most helpful. Focus groups began in summer 2021 and they made a hire in October 2021.

Qiana Torres Flores, a licensed professional counselor, took on the new and unusual role. Her title is "wellness director." She’d previously worked one-on-one with clients and in community mental health. She said she jumped at the chance to carve out a profession within the restaurant world.

"Especially in the restaurant and hospitality industry, that stress bucket is really full a lot of the time. So I think having someone in this kind of capacity, just accessible and approachable, can be really useful," she said.

Traveling among the 10 restaurants, Flores has led group sessions and mediated conflicts between employees. She has taught the company’s 400 employees techniques to cope with stress, and put on Santa’s Mental Health Workshop to help with holiday-related sadness and grief. She has done one-on-one counseling and referred some employees to more specific types of therapy.

"Not only is there help, but it’s literally 5 feet away from you and it’s free and it’s confidential. And it’s only for you," Flores said.

The owners say her presence gives them a competitive advantage and hope it helps them retain their employees.

Restaurant staff members often work difficult hours and can be prone to substance use issues — a grind-it-out mentality is part of the job culture. Many workers either don’t ask for help or don’t always see mental self-care as important.

"It has been a really important option and a resource for our team right now," said Abby Hoffman, general manager of French 75. "I was just overjoyed when I found out that this program was starting."

She gives the effort high marks, and said it builds on earlier efforts to recognize the psychological toll of restaurant jobs.

"I think the conversation really started around the death of Anthony Bourdain, knowing how important mental health and caring for ourselves was," Hoffman said.

The death by suicide of the charismatic Bourdain, a celebrity chef who openly struggled with addiction and mental illness, resonated with many restaurant workers.

Bourdain died in mid-2018. Then, Hoffman said, came the pandemic, which helped relaunch tough conversations about the psychological impacts of their jobs: "We were, again, able to say, ‘This is so stressful and scary, and we need to be able to talk about this.’"

Voicing these concerns, she speaks for an entire industry. The Colorado Restaurant Association recently conducted a survey, and a spokesperson says more than 80% of its members reported an increase in the stress levels of their staff over the past year. A third of the restaurants fielded requests for mental health services or resources from employees in the past year. More than 3 in 4 restaurants reported a rise in customer aggression toward staff members.

Denise Mickelsen, a spokesperson for Colorado’s restaurant association, said she’s unaware of other restaurants or groups hiring a full-time staffer dedicated to health and wellness.

"It’s fair to call what they’re doing fairly unique and/or innovative," said Vanessa Sink, director of media relations for the National Restaurant Association. "It’s something that some of the larger chains have been trying but is not widespread."

Other projects in a similar vein are springing up. One is called Fair Kitchens. It describes itself as a "movement fighting for a more resilient and sustainable foodservice and hospitality industry, calling for change by showing that a healthier culture makes for a healthier business." It cited research by Britain-based Unilever Food Solutions that found most chefs were "sleep deprived to the point of exhaustion" and "felt depressed."

Back in Denver, the server Perri said she’s grateful her employers see workers as more than anonymous, interchangeable vessels who bring the food and drinks "and actually do care about us and see us as humans. I think that’s great. And I think other places should catch up and follow on cue here."

And if that happens, she said, it could be a positive legacy from an otherwise tough time.

This story is part of a partnership that includes Colorado Public Radio, NPR and KHN.

Therapeutic recreation and healing, a path to personal growth

A group of canoes sliced through the water on a warm summer afternoon, laughter filling the air as Rosecrance staff and clients relaxed in nature’s beauty. With a sudden burst of energy, one client sped up to leaders and, with a wide grin, exclaimed, "I think I’ve found my passion!"

After several weeks of working through a variety of therapy modalities, the getaway connected with the client in a way that nothing else had. This activity showed the client how the skills they learned made a difference in everyday life and could give them positive interests to pursue long after leaving treatment.

Yoga is great way to learn mindfulness
Photo by Sarah Pflug/Burst


"The look of hope is a beautiful thing," said therapeutic recreation specialist Matt Larson. "It is awe-inspiring when clients find new ways to connect with themselves, and realize that if they can do this one challenge we give them, then there are so many other things they can do."

Therapeutic recreation is one important way residential clients find healing at Rosecrance. It is woven into the fabric of treatment program at all sites because it possesses a power to connect with clients in unique ways. Based in experience or action, what may seem like fun and games actually is a critical technique that teaches clients how to navigate life using what they learned on the basketball court, a canoe trip, in a greenhouse, and in other experiential learning settings. Data show that this improves stress, anxiety, emotional regulation, engagement with others, and knowledge of life skills.

Therapies are designed to give clients opportunities to grow in safe stress situations. By working through issues while completing a painting or doing a teambuilding exercise, clients discover that they can manage everyday life using what they learned in these settings.

"We create safe spaces where they can take risks and show vulnerabilities," said Therapeutic Recreation Coordinator Abby Nelson. "Therapeutic recreation can’t live in treatment. They have to take it home with them. It’s huge when they the can verbalize what they are going to do when they leave Rosecrance."

Rosecrance offers clients a multi-faceted range of activities such as art, horticulture, fitness, sports, yoga, meditation and mindfulness, labyrinth and sensory room, team building exercises, and more. Seasonal events add to the variety with events such as hiking, canoeing, the Heart Art show in February, and Haunted Woods in October.

"We know everyone has a different passion, and that is why we incorporate so many therapies into our treatment," said therapeutic recreation specialist Paul Fasano. "For some, that may be yoga, and others may be drawn to something like art or outdoors activities. Whatever it is, it’s always satisfying to see clients find their niche."

Staff help create a healing environment by participating in activities with clients to show what is possible. They are side-by-side lifting weights, meditating, and painting to model what is possible in life. It also gives therapeutic recreation staff opportunities to continuously grow through challenges such as training for half-marathons together.

"It’s important that we demonstrate skills ourselves, whether we’re at work or at home," said therapeutic recreation specialist Alyssa Newton. "That makes things that might seem intimidating at first a lot more accessible. We can point out our progress and highlight when we see clients taking big steps forward."