Resources to Navigate the Mental Health Treatment Maze

Navigate the Treatment Maze

Among numerous options, teletherapy could be a viable, confidential solution for receiving mental health support in rural areas. (elena, Getty Images)

Cheyenne Watson (name changed to protect her identity) grew up in a small town in western South Dakota, helping her parents work the family farm when she wasn't in school.

She spent summers with her dad in the tractor or combine on their crop farm while also taking care of the family's chickens.

"It was a great childhood; I loved every minute of my time working on the farm," she says. "I have amazing memories of those days."

And, while she says her family discussed many topics at the dinner table or during family gatherings, no one ever talked about mental health beyond mentions of someone in town being "crazy."

"It just wasn't talked about, especially if anyone in our family was ever struggling with mental health," she says.

That all changed when, as a teenager, Watson's uncle, Mike (name changed to protect his identity), who farmed in a neighboring community, showed visible signs of depression following the loss of a large crop.

She says the small town he lived in, while friendly and filled with charm, had limited mental health resources -- plus, he believed strongly that it wasn't "a big deal," and he could "handle it himself."

The nearest mental health clinic was miles away, and transportation was a constant hurdle. Fortunately, he confided in his personal doctor, who helped him find online and mental telehealth services until he could make it to a neighboring town with in-person assistance.


For people living and working in rural areas, Watson's story isn't unique. Mental health services and resources are often sparse, and those that are available could be hours and miles away. Add in the stigma surrounding mental health and the fear of people knowing your business, and it can deter many from seeking help.

So, how do you know when it's time to seek the help of a mental health professional? And, how do you go about finding that help?

Linnea Harvey, The Rural Renewal Initiative coordinator, Department of Agricultural Education, Communications and Leadership at Oklahoma State University, says there are two things that contribute to someone's willingness to get help.

"First, stress simply becomes too much, and they have someone in their life they can say that to without being judged," explains Harvey, who grew up on a farm in Wisconsin. "Telling someone else is the first step in seeking professional help, and if you don't have that 'someone' you feel comfortable talking to, you're less likely to seek help on your own.

"The second is that there are a lot of adverse childhood experiences in rural areas," she continues. "These experiences often lead to mental health issues coupled with substance abuse. If people get to a place where they're serious about rehab or getting clean, often that's the time they address their mental health, as well; otherwise, they're more likely to relapse."


Signs of mental illness can vary, but there are some common indicators to observe.

"The classic signs I know are decreased interest in normal activities, signs of stress in the individual and in the family members, changes in routine, decline in personal care and care of property," Harvey says.

Some signs to look for in yourself as well as those close to you may include:

-- Social Isolation: withdrawal from social activities and isolation from friends, family and community

-- Substance Abuse: increased use of drugs or alcohol as a coping mechanism

-- Increased Agitation or Irritability: noticeable changes in behavior, such as persistent anger, irritability or aggression

-- Changes in Sleep Patterns: significant alterations in sleep patterns, such as insomnia or excessive sleep

-- Poor Performance or Attendance in Work or School: decline in job or academic performance, frequent absences or difficulty concentrating

-- Physical Health Issues: Unexplained physical ailments, chronic pain or worsening existing health conditions.

In her experience as the Panhandle co-director of the Behavioral Health Education Center of Nebraska (BHECN), psychologist Cate Jones-Hazledine views changes in behavior, feelings of anger or irritability, and changes in sleep and appetite as signs that mental struggles may require attention. BHECN was established in 2009 by the state legislature to help meet behavioral health needs in rural Nebraska.

It's the identification of these characteristics and feelings -- and their degrees of severity -- that may or may not need professional assistance.

"Everyone gets 'down' sometimes, but if this is more severe than normal or lasts longer, that is a sign that it might be something more," she says. "And (always), any thoughts of suicide or self-harm should be taken seriously, and help should be sought immediately."


If you live in a rural area, finding mental health help may require some additional effort, but there are still options.

-- Primary-care providers: They can play a crucial role in identifying and managing mental health concerns. While they may not specialize in mental health, they can provide initial evaluations, prescribe medications, if necessary, and refer individuals to available resources.

-- Local hospitals or clinics: Contact them to inquire about mental health services they provide or for a recommendation for local mental health professionals.

-- National helplines: Reach out to helplines such as the 988 National Suicide Prevention Lifeline (call or text 988, or chat online at or the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline (1-800-662-HELP) for guidance and support.

-- Support groups: Look for local support groups or online communities where you can connect with others who may be experiencing similar challenges.

-- Self-help resources: In the absence of professional therapy, individuals may turn to self-help resources such as books, online articles, videos and podcasts. These resources offer guidance, coping strategies and information about managing mental health.

-- Faith and spirituality: Religious and spiritual beliefs can play a significant role in rural communities. Many individuals turn to faith for comfort and support during times of mental distress.

-- Teletherapy and online support: Although broadband internet service can be spotty in rural areas, teletherapy has become more accessible, allowing individuals to receive mental health support remotely. Online support groups and forums also provide a sense of community and connection.


When having to choose between paying for a new tractor or seeing a mental health practitioner, in rural America, more often than not, the tractor wins.

"While some see the circular aspect of it, 'If I take care of myself, I am going to be a more successful farmer/rancher,' I think the majority of the individuals are going to place needs of the farm/ranch over their own needs," says Tara Wilson, associate professor, counseling, at Chadron State College and co-director of the BHECN Panhandle.

"For example, a farmer might need a knee replacement but keeps putting it off because he cannot take time away from the farm. The same is true for mental health. Often, our mental health is not as visibly seen, so they place an emphasis on the more obvious needs," points out Wilson, who is a licensed mental health practitioner and nationally certified counselor.

Despite the costs of mental health services, insurance is an option to cover some or most of the expenses -- and it is just as important to know how to navigate the process.

Self-employed individuals can deduct health insurance premiums as an adjustment to their income on their federal income tax returns. This deduction is available for self-employed individuals, including sole proprietors, partners in a partnership and more.

To qualify for the deduction, the health insurance plan must be established under your business and must cover either yourself, your spouse, your dependents or your children under the age of 27 at the end of the tax year. The insurance plan can be in your name or in the name of your business.



-- Search for mental health resources by state and resource type on the American Farm Bureau Farm State of Mind Resource Directory:…

-- Click on a map to open a printable PDF document listing mental health resources in that state at the American Soybean Association #SOYHELP State-by-State Resources site:…

-- Find a professional who knows about farmer mental health. A search menu allows you to search by name, keyword and your location on the AgriSafe Network AgriStress Provider Directory:…


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