National Association of Rural Mental Health

Wilmington, NC, June 01

I boarded a 6:20 AM flight in San Jose and was settling into my seat when we were all asked to deplane for an equipment change. That made us an hour late getting into Dallas-Fort Worth, I was advised to walk not take the tram, and I strode not walked, and did make my connection and had my aerobics for the day. When I arrived in Wilmington, I was struck by rocking chairs for passengers in the waiting area at the gate and the smell of pipe smoke - this is tobacco country and there is lots more public smoking than I am used to.

Others at the conference had travel delayed by east coast thunder storms, some spending the night en route and not arriving in Wilmington ‘til the next morning.

I went for an early morning walk before I would be uncomfortable in the mugginess and heat. The hotel is in a historic neighborhood, charming old buildings, trees, a peacefulness where the morning chirping birds compete with extruded air-conditioners and waterfront diesels. The Hilton tested its fire-alarm system while I was getting ready - I heard sirens and saw bright flashing lights in my room, but felt no sense of urgency. I went into the hall and other guests were also standing there listening and not evacuating. I was reminded of how no one reacts when store alarms and car alarms begin to sound and wondered about all these systems.

About 150 people here. People Who from Vermont - Marty Roberts and Jessy Parker; from New Mexico - Sheila Cooper and Sarah Brown, and from North Carolina - Marie Strom and some I didn’t meet.

Swartz, the keynote from Duke, spoke about ROADS: Rural Outreach Advocacy and Direct Services, which is another name for ACT/PACT though that was smoothed over and force wasn’t mentioned. The teams travel with a file of places the client is apt to be if not at home; the forms the teams care include lab sheets, releases, and commitment papers; they use local resources beyond the "obvious ones" like pharmacists and police; and we saw a smooth and well done marketing video from Duke about this program, the pilot of which was funded by NIMH, CMHS, and the Ivey Foundation. There are no rural/urban differences in lifetime prevalence of aggregate mental disorder.

The battleship North Carolina is moored across the river and we were ferried over for a tour and reception. During the second ferry, clouds hung curtains of rain for 20 minutes and many were drenched.

The hotel fire alarm just went off again this morning. This time I saw guest actually going for the stairs and a woman who had thought to take an extra-large ziploc bag of medications containers. This time, very quickly the loudspeaker system said it was a false alarm, no problems.

I took a fascinating adventure walking tour and learned wonderful bits and lore about Wilmington, and that the Wilmingtonian Inn is the place to stay. The leader was wearing denim shorts so often laundered that almost everywhere they had bleached to a light robin’s egg blue. I asked him about the treatment of people with psychiatric disability - he said we care for our own, we take them with us, we don’t hide them away. He also talked of the love of language in this area and how there was an encoding that people used to say-without-saying and I thought about how People Who who speak in a way that a professional listener doesn’t understand are diagnosed and wonder what would happen to, for instance, to a North Carolinian in a NYC psych ward. Context matters.

Sheila Cooper, from New Mexico, won the NARMH Howery Award, given for significant contributions to the field of rural mental health. Sheila and I met on the NAPS Board and now serve together as representatives of people with psychiatric disabilities on the WSDSG.

Chris Pederson, introducing Sheila said she is "the longest and strongest voice for strengthening the rural consumer voice in NARMH." Insights learned from Sheila: Integrating behavioral health into primary care; complementary, holistic, alternative approach to health; power of peer support and self-help including Internet support.

Cooper: "NARMH has given me a voice; they have heard our stories, and then awarded me." Sheila told the story of her experiences powerfully; I was moved to deep tears I reached out to hold the hand of Sarah Brown, sitting next to me. Sheila said, "Where I’m going is more important than where I’ve been." Sheila made the link between healthy sustainable communities and individual recovery. "Restorative solutions are grounded in connections." Sheila urged the broadening of the behavioral health agendas to include community issues and prevention. She closed with: Ghandi "We must become the change we want to see" and received a standing ovation.

Goulding: There is no clear delineation between mental illness and adaptive spiritual practice.

Sinkus: Study: people who are more intrinsically religious recover faster from depression. Quality of life, improved functioning, and absence of family psychiatric history also correlate with faster recovery. Treatment with anti-depressants was not statistically significant in improvement.

Polls find that 95% of Americans believe in God and only half the population of m h practitioners also believe. The mental health practitioner population has a different set of beliefs from the people we have charged ourselves to treat. We may have stilted interpretations.

An article in the spring 01 issue of Rural Mental Health about homeless lists 10 common concerns and 10 potential rural resources. Housing is seventh on the list.

Overheard: Assisted Outpatient Treatment (AOT - Kendra’s Law) is mostly used in NYC, not in the rural areas. Speculation that it is the psychiatrist training in local medical schools that is encouraging forced medication.

Overheard: Lilly has funded two from Australia to be here and learn about PACT which Lilly will help them import there for implementing n rural Australia.

Vermont Recovery Education Project,

Principles of recovery: hope, personal responsibility, self advocacy, support, education, building self esteem. Program components: daily maintenance, identify triggers and what to do if they occur, identify early warning signs and what to do if they occur, pre-crisis plan, crisis plan, medical care and management, support system, healthy lifestyle, suicide prevention, beginning steps to deal with trauma, durable power of attorney or how to make your crisis plan legal.

South Carolina is implementing rural assertive case (management, an outreach program that is related to act. Where are the boundaries between outreach and invasive/coercive interventions? S.)

Gossip: A TX Hispanic woman psychiatrist, oriented towards meds and coercion, is being named SAMHSA administrator and Bernie Arons will leave. <shrug>

2002 NARMH meeting is in Santa Fe, NM August 26 - 29. Reply to Call is due September 21. Theme is alternative and complementary medicine and integration of behavioral health services into primary care. Presenters encouraged to co-present with rural consumers and consumers encouraged to answer the call. NARMH’s intent is inclusiveness. Good opportunities to participate here by joining yourself ($30 for consumers) or asking your member organization to assign you one of their memberships.

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