Editor’s note: This is part of a project in which The Dispatch looks at how the COVID-19 pandemic has affected the mental health of children. See also: How poverty and racism exacerbate mental health issues and How to recognize warning signs in children.
WELLSTON — Destiny Whiting understands what it’s like to wake up with a quiet dread that keeps her head pinned to the pillow, struggling to encourage herself to get up, face the day and beat back a recent wave of despair.
The 17-year-old, who lost her father to suicide when she was 7, and her mother to a battle with pancreatic cancer five years later, juggles her grief, depression and anxiety amid a chorus of small-town pressures.
With her parents gone too soon, Destiny desperately wants to be the young woman they would be proud of while trying not to burden the 75-year-old grandmothershe lives with and the older brother and sister who worry about her.
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“I feel the need to be perfect for everyone else and please everyone else before I take a step back and say, ‘Is this really what you want?'” she said.
Many in Destiny’s Appalachian town in Jackson County dismiss serious mental health struggles for angst, she said. Teenagers are unequipped and not encouraged to address those challenges.
While Destiny watches her peers at Wellston High School in Jackson County play sports and attend classes, counseling remains taboo even after a classmate overdosed in the school bathroom in 2018, and several other suicide attempts before and after, that rocked the community.
“If we don’t talk about it, it doesn’t exist,” Destiny said in describing how mental health issues are rationalized.
Ohio University study: Jackson County has fourth highest suicide rate in Ohio
The discrimination surrounding mental health challenges is not unique to Appalachian communities, but the consequences of not shifting those attitudes can be deadly for some people in the region, said Robin Harris, the executive director of the Gallia-Jackson-Meigs Board of Alcohol, Drug Addiction & Mental Health Services.
It has a direct impact on Appalachian Ohio’s high suicide rates: Jackson County has the fourth-highest rate among Ohio’s 88 counties, according to an Ohio University study.
The OU study, which measured suicides adjusted per population between 2008-2017, says Jackson County’s rate is 20 per 100,000 people. The three counties with the highest suicide rates are Meigs, Gallia and Adams, all rural and part of Appalachian Ohio.
Almost half of Ohio’s 32 Appalachian counties reported higher rates than the state’s average: 14 per 100,000, according to the data, which compiles statistics from suburban, metropolitan and non-Appalachian rural Ohio.
“We can’t ignore the influences of culture, geography, of poverty, and even workforce issues,” Harris said.
High turnover in the mental health system, disproportional school funding, poverty, generational trauma inflicted by the opioid crisis and now the COVID-19 pandemic have exacerbated the lack of supports for the region’s future: it’s children.
“It’s like this perfect storm of factors,” Harris said.
COVID-19 pandemic adds to strain
Destiny knows firsthand how difficult it is to seek help when you’re already beaten down.
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The soft-spoken teen was lucky enough to have the support of her mom after her dad died, and her brother and sister to help her find a counselor after her mom died, but the idea of “trying to talk to someone” was overwhelming, she said, especially in a region where there is a significant lack of resources.
Burnout has for decades taxed mental health care professionals in Appalachian Ohio. But when COVID-19 struck, the need for services — and the income those services generated — dropped, said Sherry Shamblin, a chief strategy officer at Hopewell Health Centers in Athens.
One of the largest health care providers in southeast Ohio, Hopewell serves nine counties. It also is a pioneer, she said, in trauma-informed care, meaning that it specializes in treating kids with the understanding they may have experienced physical, sexual or emotional abuse at some point in their lives.
Shamblin supervises a team focused on early childhood and said that Hopewell serves more than 20 school districts. Prior to COVID-19, the agency provided on-site support workers to assist schools and encourage teachers and counselors to recognize trauma, she said.
Hopewell partners with school districts to adopt social-emotional learning curriculum and promote resiliencein grades K-12 by encouraging kids to manage their time, develop relationships and make responsible decisions while teaching other life skills, said Erin Lucas, the organization’s director of early childhood programs.
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But when schools closed because of the pandemic, there was a decline in the number of patients Hopewell served. In 2019, there were 150 children enrolled inthe health center’s statewide early intervention program aimed at supporting children up to 3 years old with mental health care.
“That’s the hard part about COVID: Yes, there was less demand, but if I cut my structure in half, because it’s so small to begin with, I don’t lose people, I lose programs,” Lucas said.
In 2020, the number of children who were referred, admitted and evaluated for this program by Hopewell dropped, and only 132 total children were enrolled,a 12% decrease over 2019, according to an internal report.
Shamblin said she anticipates that Hopewell’s number will bump back up by the end of 2021, but she also recognizes the pandemic has only exacerbated the industry’s much larger issue: the lack of therapists and counselors.
Throughout the region, there are more than 300 positions available for mental health care professionals, and 130,000 school-aged children who need access to behavioral health services, experts estimate.
“One of the biggest barriers we face is really the workforce shortages,” and not just funding, Shamblin said.
Transportation issues and many low-income families’ reliance on Medicaid, which makes it harder to access specialty psychiatric services, threaten the ability of providers such as Hopewell to recruit and retain employees, Shamblin said.
In turn, families face wait lists for counselors that last months and their children have little to no opportunity to receive in-patient care.
In communities such as Wellston, where Destiny Whiting lives, that means high school counselors come and go while a teenager’s chances of finding an affordable and available therapist outside of school remains a challenge.
Rural providers have fewer people to recruit from than those in more urban areas of the state and few financial resources to retain consultants to staff schools, Lucas said.
“I always have to think: What’s the most I can do with the least amount of money?” she said.
Ohio fights to reprioritize kids’ mental health
In the absence of an equitable mental health care system, schools have become de facto providers for children across Ohio, but especially in rural counties, including Appalachia.
More than 24 years ago, the Ohio Supreme Court ruled the state’s method for funding public education, which drew on property tax revenue, was unconstitutional.
Ohio has largely relied on a disproportionate, constantly fluctuating method to fund schools during the past two decades, butthe state’s new biennial budget will implement a version of lawmakers’ Fair School Funding Plan that bases the cost-per-pupil formula on a district’s actual expenses. Some state representatives have advocated this for years.
Those changes will see tens, if not hundreds of millions of dollars flow to the region toward rural school districts.
But Gov. Mike DeWine’s $1 billion request for wraparound services, such as counseling and after-school programming for at-risk students, was denied by lawmakers and folded into their increase in the overall funding formula.
The new budget also allocates $2.5 million to the Appalachian Children’s Coalition to establish a training and retention program for children’s mental health workers. It also appropriates $84 million for child behavioral health projects, an enormous step forward for a region devastated by the lack of in-patient treatment for children, said Randy Leite, the coalition’s executive director.
“Taking care of kids is really about creating the next generation of productive Americans for our nation,” he said. “This is an acknowledgment on the part of our political leaders that there’s a need to provide.”
While DeWine’s administration has championed state investment in children’s mental health services across the state, rural professionals remain skeptical about how effective his previous measures have been and those in the future will be.
The $675 million in wraparound services earmarked in the 2020-2021 state budget and the historic investments in southeastern Ohio in the new budget are a step in the right direction, Robin Harris said, but she remains leery.
Harris, the executive directorof the Alcohol, Drug, Addiction and Mental Health board in Gallia, Jackson and Meigs counties, said more time is needed to judge the impact of those funds.
“I need to see how that plays out,” she said. “The disruptions of COVID-19 have made that hard to determine.”
Dick Murray, the executive director of the Coalition of Rural and Appalachian Schools, said he is still not certain that a one-size-fits-all approach to the state budget process, which does address school funding, the mental health care void and the lack of broadband, will solve the kind of systemic poverty plaguing the region.
He said that the coalition, which is composed of as many as 80 regional superintendents, will lobby DeWine’s administration to ensure that the state measures the effectiveness of these new educational and mental health initiatives.
Grace Schoessow agrees. She is an early child mental health consultant, with a background as a practitioner in infant mental health, in Greene County in rural southwest Ohio. She said the flexibility of wraparound dollars is a moot point if there’s no way to measure how they are spent.
“It just feels sometimes like the Wild West,” Schoessow added. “There are experiments being run all around, which does allow for a lot of innovation, but it also creates confusion and competition within under-resourced areas within the mental health system.”
It also means well-intentioned state funding still falls short of reaching rural school districts such as Wellston, where students such as Destiny are left filling the role of mental health support.
In Wellston High’s counseling void, Destiny tells her friends who are struggling that she’s always just a phone call away.
“Nothing’s insignificant,” she said.
Hope abounds in spite of trauma
Two days after her mom died in 2016, Destiny decided to go back to school. She didn’t begin to know how to address her grief, and finding the strength not to succumb to her depression and anxiety was too much to bear.
Destiny’s grades started slipping, she hid out in the bathroom during class, and she started experiencing severe panic attacks. And the pull of her bed in the early morning grew increasingly stronger.
“I felt like I was watching my life through a movie, someone else,” she said.
There is an almost ingrained sense in our society that anyone struggling should be able to “pull themselves up by their bootstraps,” she said.
It’s an attitude shared by some parents in her small community of Wellston, Destiny said, who don’t want to believe there’s anything wrong with their kids and teachers without the training or resources who brush concerns under the rug.
“I realized I’m not the only one who struggles with it,” she said.
Destiny has little time for wallowing. She sees the world through the eyes of nieces Kinsley, 11, and Tenley, 10, who give her a reason to share her story and help others learn to handle their emotions.
It’s a needed perspective check, she said.
“Eventually, it’s going to be OK,” she said. You’re not alone. If you think you’re the only one feeling these things, you’re not alone.”
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For now, the incoming senior at Wellston High School is determined to raise awareness regarding the mental struggles she and her classmates face. She wants students and parents to attend mental health awareness meetings more than once year and for the issue to receive attention beyond another suicide hotline poster placed in a hallway.
And she recognizes that some days — and some weeks — are worse than others.
“I’ve learned to speak up and say, ‘Hey, I need help,'” Destiny said. “I worry about the girls not admitting to themselves that they need help.”
If you or someone you know is experiencing a behavioral health crisis, you can reach Ohio’s 24/7 Crisis Text Line by texting 4HOPE to 741741, or call the Franklin County Suicide Prevention Hotline at 614-221-5445; the Teen Suicide Prevention Hotline at 614-294-3300; or the national Suicide Prevention Lifeline at 1-800-273-8255/TALK (1-888-628-9454 for Spanish speakers).
Céilí Doyle is a Report for America corps member and covers rural issues in Ohio for The Dispatch. Your donation to match our RFA grant helps keep her writing stories like this one. Please consider making a tax-deductible donation at https://bit.ly/3fNsGaZ.