Earlier this spring, a multi-disciplinary forum at Greenville’s Fletcher Warren Civic Center brought in professionals and others from around the region to discuss how to work together to improve the quality of mental health care services in Northeast Texas. The event was organized and hosted by the Counseling Center at Texas A&M University-Commerce. KETR visited with Counseling Center director Nick Patras, who described how the forum went and what the next steps could be.
Nick Patras: So we hosted the first or the inaugural rural Mental Health Forum, in Greenville, comprised of about seven or eight counties, everyone from hospitals, law enforcement, community agencies, obviously many folks from the university, private practitioners, almost anyone that you can think of, in the mental health field was represented in the room discussing kind of the state of rural mental health in Northeast Texas.
Mark Haslett 00:36: So what did the -- as far as the rundown of what specifically happened during the day there, you had a keynote speaker, and then there was a panel. And then after the lunch break, there were some small breakout sessions. So if you could just briefly describe how that went.
Patras 00:54: Okay. So we started with a very inspirational keynoter Taylor Toynes, who is the Executive Director of For Oak Cliff -- amazing work, community organizer, former first year school teacher whose students inspired him to do greater things. And we could think of no one better to kind of kick off what is going to take some community organizing, if we want to make a difference in rural mental health, here in Northeast Texas.
So after Taylor spoke and inspired us, we had sort of some subject matter experts ranging from our provost, who is overall of the academic units of the university, and many of those units, social work, counseling, psychology, nursing, kind of have a direct impact on this challenge and this problem, and so we wanted Dr. (Tammi) Vacha-Haase to be in the room, and she's a former clinician, as well. So she, she kind of wears both hats.
We had the behavioral health director for all of Lakes Regional community agency, they cover 26 counties in this part of the state and deal with rural mental health. So James, was in the room, James Woods. We also had a couple of panelists who were on our planning committee, Shirley Weddell provide provided and provides suicide prevention, training, free suicide prevention, training anywhere, anytime, anyone will allow her to provide the training. And unfortunately, Shirley lost their only son to suicide. And so she's passionate about that work. And Dr. Tony Dickensheets serves as a volunteer for Soldiers’ Angels, working closely with veterans, so a really nice, diverse group of folks on the panel.
And then from that, that was that was the icebreaker, if you will, to sort of get the subject matter started. And then after our lunch break, we broke into 19 different tabletop discussions with very specific themes that ranged from post-hospitalization care, lack of access to care, technology and how that impacts care, veterans’ issues with transportation, in particular. Preparedness for a national disaster or some sort of traumatic event, and how we how we would handle that, and how that impacts mental health. Those are just some of the topics. Detailed, deep discussions from a very diverse group of people at each table, we were very intentional about who was who was seated at the table, so that you had a law enforcement person and maybe a nurse practitioner, or a counselor, you might have had someone from the university, you know, a professor or dean. And so that that nice mixture of folks and then we had students at every table. And as I said in the room that day, those 55 students that were in the room represent the future of how we can better scale the help that's needed in rural Northeast Texas around mental health.
Haslett 04:34: Because there are so many different aspects to this situation -- you mentioned everything from transportation, to actually finding people to provide the services to providing a place to provide the services to providing the systems that would allow people to access the service CES and get matched with what meets their situation. There are so many large aspects to this, I'm sure it was a little bit difficult to boil down what your takeaways from the event were. But even if you can't list all of the takeaways, what were some of the major points that you and your team came across when you were reviewing everything yesterday and taking a look?
Patras 05:27: Yeah, I think that and we're going to do a much deeper dive into the, into the data that we took away from the event. But probably, first and foremost, is the lack of providers in rural communities. People graduate with their master's degree, they go into private practice, they go to work for a hospital, they go to work for an agency, and most of those places are not in the small rural communities. And so, in particular, the smaller communities are often left with no providers. And even though we now have telemedicine and teletherapy, you still have to have providers who are willing to work in the rural areas.
And so I think, first and foremost is, finding ways to train and encourage clinicians to stay in the rural communities and serve those communities. And then what does that look like, you know, how to how to use technology, how to use, you know, the different services maybe a clinician serves multiple small communities will how to how does that happen? So I think that's, that's one area.
And then another thing that was expressed by number, of people in the room, there are a lot of services available, but no one knows about them. And so without knowledge, you can't access that care. And so a campaign to make our citizens aware of all of the different services that are available currently. And then we would like to look for where areas could be improved. I suspect that that you know, there are some areas that could be improved. And then, you know, and then lastly, how do we begin to fill the gaps once we've identified what the gaps are?
Haslett 07:31: So what are some of the existing services that maybe people don't know about?
Patras 07:39: Probably for the last 40 years, mental health has been removed from more institutional base services, to community based services. And so we are served by Lakes Regional, which is one of those entities, many in the state of Texas, but lakes regional serves 26 counties, all of the listening area for KETR is served by Lakes Regional. And so they have standalone mental health clinics where people can get counseling, they do have some services that are restricted to certain diagnoses. And I'm by far not an expert on community mental health requirements. But there are some that are restricted. And so I think it gives us an opportunity to look at what is being provided and funded by the state through these local and regional community agencies, and then are there ways that that can be improved to make it even more accessible.
The VA has tons of services for veterans, but a lot of it is that lack of technology. So getting broadband in every home, training our veterans, on how to use technology, so that they can be more connected to services that that currently exist, but they have no way to connect with them. And just, I think, taking the time to fully sort of do a needs analysis of what already exists, what are the barriers to folks accessing those services? And then where are the other areas where services are still needed that just simply aren't in place? And then how do we advocate for the funding to create those types of services?
Haslett 09:35: So what's the next step for all of the various stakeholders who participated both the organizers and also folks who attended on Tuesday?
Patras 09:45: But as I shared in the room the other day, you know, this thing has been five years in the making, and now we've had it and it's that's an excellent question that you've asked, Mark. What do we do next? We're going to have a lot I have information, we have about 175 people who, through their attendance, expressed an interest in changing things, we there were some folks that were identified that should have been in the room that weren't in the room. So I think the next step is to contact each and every person that participated. And get some level of commitment to a frequency of meetings, and then also closely on behind that would be providing them with the information that we collected the day of. So here's all of the information, I think we would like to narrow it down to three to four major areas of focus first, and then then come up with a frequency of how often to host these forums.
And we already know that, you know, it probably can't be an all-day event every time. I think that the level of commitment, and that's just not going to be possible. So what does it look like? Do we have some evening forums and move them around in the region, and so we might have been the Love Center in Paris, one evening, or in Sulphur Springs, or, you know, but move around our regional area. We do hope to expand this a little bit. Like I say, we were really focused on seven or eight counties, primarily. But rural Northeast Texas is much, much larger than that. We have in many of the counties, higher suicide rates. And so there's so much work to be done. It was great to have a representative from Health and Human Services. They are working on rural mental health there, it's not as if they don't recognize that there's a problem. But how do we get plugged into that work as well, so that we as a coalition, and and I guess, the short answer, Mark would be forming a permanent coalition of people committed to do this work. And then deciding now, how does this work get done? How often do we do we do it?
Haslett 12:21: What are some of the short term goals that you think you might be able to accomplish within the next year or so outside of the creation of this permanent coalition?
Patras 12:31: Excellent question. I think, first and foremost, through the Rotary Club that Shirley Weddell is a part of they offer free mental health first aid to any community, any organization, any school that wants to host it. And so I think, doing our best to get as many of those training programs conducted over a certain period of time, would be would be kind of primary goal number one is just is just to access those services. The second thing is there are sort of training the trainer programs that that Shirley can also and her organization can provide, which trains other people on a sort of a deeper lay people who can provide help when a licensed professional maybe isn't available. And that would I think, be this the second thing. And then and probably third is identify all of the existing services and really launch a very strong awareness campaign of “Did you know, do you know, this, this, this, and this already exists?” I think those would be my top three things.
Haslett 13:57: Those all sound like, useful but challenging, but definitely doable as well. One of the thing I'd like to ask about and I don't know if this was mentioned on Tuesday, but in rural areas, there are fewer shared institutions in general, whether we're talking about actual public institutions or private nonprofits or whatever, there's just kind of less going on in general now, maybe not proportionally. There are lots of rural communities that probably have more happening proportionally than some cities or some areas in the urban areas.
But at the same time, there is a situation where it is easy to be socially isolated out here. Lots of people don't have much contact with the world outside of family and work, and in the case of many people, their church or their house of worship. And so you have some folks, maybe they don't have much family or they don't get along with them, which happens. Maybe they don't work anymore. Or maybe they don't work at all. Maybe they're retired. Or maybe even though their job is okay, it's not a social place for them. And that leaves the churches. And so you mentioned how lay people can pitch in and support the professionals who are doing this kind of work. What would you say if someone, for example, is a leader? Or just someone who's involved in their church? How could they help support y'all and what y'all are doing?
Patras 15:41: That's a that's a great question. I learned through one of our planning committee members, Tony Dickensheets, who is involved with the Methodist church, I did not know until until we started working together, Tony, on the planning committee with us, that the United Methodist Church has, as part of its mission, a mental health Initiative, a very, very broad initiative to support community mental health. I had no idea that that existed. And I suspect there are other denominations that may have something similar as part of their mission work.
And so I think, finding either those denominations or local, independent churches, if they're not a part of a larger denomination, that have a passion for this kind of work, and then training them on the levels of support, and recognition when people are in trouble or struggling, or may be struggling and not willing to reach out. But getting those folks trained. Because we can all be helpers, we don't necessarily have to have a license and a master's degree to be a helper, there's different levels of being a helper.
And I think that's what that's the other thing that I hope comes from this work is that we recognize everyone in the community can play a part in this. And what I hope the pandemic taught us is how easy it is to feel isolated. And then oftentimes that isolation is part of the pre-determinate of people might be struggling with mental health problem is they are more and more and more isolated. And so the more folks that we can, can have in these communities, supporting people recognizing when people are very isolated, and then ultimately getting someone to the help if they need more professional help. But it might just be, Hey, let's go have a cup of coffee. Let's, you know, let's go take a walk this morning and just chat. And so it doesn't have to be always professional mental health care, it might just be creating some new friendships in your in your small community.
Haslett 18:07: Before we're done, I want to step back from the specific aspect of what's going on here in Northeast Texas. And just talk briefly, some very, very general things about -- I'd like to demystify a few things for folks who might not be familiar with some of these topics. So I want to go back to like super basic 101 with a lot of this stuff, and answer some common layperson questions. For example, what is the difference between a psychiatrist and a psychologist and what is the difference between counseling and therapy? Are these terms interchangeable? What do they mean?
Patras 18:52: Excellent, excellent. Often, they're interchangeable. Every licensure has probably a different educational requirement. And a lot of times it's battling over turf of my specialization or my unique educational degree. A psychiatrist is a medical doctor. So a psychiatrist is trained in medicine and specifically emotional and behavioral health and they can prescribe medication. A psychologist, a counselor, a therapist, a social worker, typically provide therapeutic services -- different approaches, but basically we can put the put that under the umbrella of therapeutic you know, approaches. So providing therapy, providing counseling, each with a little bit different take or slant on how they get there. The consumer probably isn't going to be as worried or concerned about that as long as there is a connection made with that professional who is helping them. But the psychiatrists are, you know, they are medical doctors, everyone else is typically has a minimum of a master's degree, many of us might have a doctorate. But kind of specialize in the approaches based upon whether you have followed a counseling track a social work track or a psychology track.
Haslett 20:34: When it comes to people who might want to access some sort of help, an obstacle is the stereotype of what that therapeutic setting looks like. I mean, you can almost think of like it being a New Yorker cartoon, or something where you have the lawn couch, and the person is looking up at the ceiling as they bare their soul on this couch, and they're laying down. And then there's somebody who not coincidentally, looks like Sigmund Freud who's sitting over there in the corner in this big sort of regal chair, taking notes, and maybe not saying anything, or maybe passing all sorts of judgment. So what -- we know that that's not true, that's not what the therapeutic setting looks like. So what does it look like?
Patras 21:29: Wow, great. And that just for the listening audience, I do not look like Sigmund Freud. So and I'm not sitting behind you listening to every word you're saying. I often tell -- obviously, I work on a college campus with my colleagues. And but I often tell students, we have no couches in our offices, if we do, they are very small loveseats, and no one can stretch out and lay on them. A typical counseling setting is a very comfortable office that has a couple of very comfortable easy chairs. Where it would be like you would be in your own living room having a conversation with a family member or friend. It's a setting that is conducive to comfortable conversations. There are practicing analysts who do have sofas that actually do sit at the head of that sofa where the or the patient, which they refer to them as patients cannot see them. That is not what 99% of us would interact with in seeking therapeutic services.
Haslett 22:47: One last thing, and this is another sort of big picture question. When it comes to mental health conditions, they tend to not be like an acute medical illness. In other words, if you come down with shingles or the flu or something, you're sick for a while, you get some treatment, and then you get over it, and then it's gone. When it comes to mental health conditions, I'm sure there are some people who may be make dramatic transformations through whatever sort of treatment they receive. But for many folks, it's a matter of just understanding yourself, understanding your behaviors and your emotions and thoughts and managing them better. So what can people realistically hope to get out of treatment? Because I think that some folks might -- we are a quick fix society, we like things to be fixed right away. And when we’re paying something we really expect it to be efficient. And so if someone is approaching therapy, with the idea that they're going to completely get rid of whatever it is that ails them, depression, anxiety, substance abuse, any of the various very common things that people struggle with, how would you mitigate those expectations for a quick fix, but while at the same time, giving folks the courage and the optimism to embark on a path towards wellness.
Patras 24:36: I think in our in our society, and in particular, after the pandemic, where we were isolated for quite some time. Most everyone recognizes and recognize the importance of, of having relationships and working with someone in counseling or therapy is about a professional relationship that provides a level of support that we often may or may not get from family or friends. It may be even inappropriate to expect that a family member could provide that level of complete -- in that therapy hour, the professional and the client are in a professional relationship that is solely focused on the patient, the client. And most of us don't get that in our personal lives from other people, no matter how loving or caring they are, they can't be that and provide that. And so I think what people can begin with if they seek care is to know before they ever walk in the door, what is it I hope to get here? If it's a life filled with no anxiety, and no down days, and no difficulties that that necessitate, we have to learn how to cope with things that maybe we don't lie. That might be an unrealistic expectation. So I start every one of my sessions is what would you like to accomplish in here? Why are you here? And then let's see if we can work on that together. Yes, I have the training, but you are the expert on your life. And that's how I work with everyone that I work with. You are the expert on you. Yes, I have some specialized training, and I can help you with your anxiety, your depression, you know, past traumatic experiences, you know, and so on. But it kind of starts with recognizing the boundaries of the relationship. It is not a friendship, it's not you now have a new best friend. It is a professional relationship. But it is a very connected and empowering relationship that we probably don't find in our everyday lives, because it's just not, we're not, we're not able to have family members to be there in that way, all the time.
Haslett 27:28: Is there anything else you'd like to mention before we wrap up today, of course, there's all kinds of topics, and maybe we'll be able to hit some more of them in another conversation. But for the purposes of today, and then going back to our more particular topic of these initiatives here in Northeast Texas, anything else you'd like to pass along?
Patras 27:48: I think just having the stigma around mental health reduced, and the only way we can do that is to talk about it and to normalize it. If I fell on the steps in front of this building today, I would not hesitate at all to go get my broken leg or broken arm repaired. But people who might have a mental health challenge, a condition, still, in some cases fell a stigma of asking for help. And so I think for us to do this work and reduce it to working here in rural Northeast Texas, and I want us to work in that space of what is the intersection between the greatest needs in our area and really identifying them. And then how can we as a rural university, training various professionals that can provide direct and immediate help and support -- how can we bring that intersection together? And so that's my hope for this work, what I'm hoping we will do.
