BAXTER — While there are struggles to function around a severe workforce shortage, the current state of rural mental health care is all the more concerning with a deepening crisis of mental illness that afflicts small towns, remote communities and agricultural hubs throughout Greater Minnesota.
In an effort to chip away at the issue, nurses, psychiatrists and other mental health experts gathered at Nystrom & Associates in Baxter to convene a conference for psych/mental health advanced practice registered nurses.
Organizers billed the gathering as a means for nurses to network and share tips and lessons from their own work. The event also served to encourage nurses to pursue jobs in rural care, internships, and doctorates with an emphasis in mental health to meet those shortages in Greater Minnesota.
Participants took part in workshops, panel discussions, seminars and social periods throughout the day Friday, March 13. Roughly 35 health care professionals from across outstate Minnesota attended — up from 18 at a similar conference in Staples during 2019.
Among those in attendance were professionals from the University of Minnesota, including Laurissa Stigen, director of nursing school/campus partnerships; Candace Nelson, a clinical research supervisor; and Merrie Kaas, a professor of nursing. The conference was a much-needed step forward, they said, and one rural mental health experts have been pushing for years.
“There's a lot of similarities between urban and rural health care, but there's also a lot of differences in uniqueness,” Stigen said. “Which is why we’re bringing all of the APRNs (advanced practice registered nurses) together so they can have their own supportive network that they can ask questions or share resources, talk about challenges, things like that.”
“You feel pretty isolated sometimes,” Kaas said. “Getting together in that conference was really important, and people want to do it again. We're looking to find opportunities to replicate this conference next year, because people today just said how important it was to bring conferences to the rural areas and not have to take days and hours to drive to the Cities to go to someplace.”
Aside from the Twin Cities metro and portions of southeastern Minnesota — where Mayo Clinic is located — the state is facing a shortage in mental health care providers, Nelson said, both institutionally and within the workforce, which has exacerbated a looming crisis of mental illness, addiction and social isolation that’s especially prevalent in rural areas.
“It's not unique to Minnesota — this is across the nation, too — but rural areas are more
disproportionately affected by not having access to services. In some areas, there's less access, there's transportation issues, there's more uninsured, there's an aging population,” Stigen observed. “So, there's some special nuances related to being a provider in a rural area that you wouldn't see in a metro area or an urban area.”
That, and there’s the stigma. While mental health care has progressed leaps and bounds in terms of its place in the public consciousness, there’s still a lingering stigma against people seeking care, Nelson said, and this also disproportionately affects rural areas where the populace skews older and people are more likely to personally know their neighbors and what they do, which may include stops by the local clinic.
And, while pay for positions in rural areas is often very competitive with the metro, attracting nurses to outstate Minnesota has proven difficult. The federal Health Resources and Services Administration has provided Minnesota a $2 million grant to create a larger, more robust workforce in rural mental health, Kaas said, but translating those dollars into larger numbers of nurses in sparsely populated areas is easier said than done.
“I think it's not knowing what the rural areas provide and the positive aspects of living in a rural area,” she said. “That's one of the things that we're trying to do with our students is to give them exposure to the rural areas in short-term experiences and then matching them with advanced practice nurses in rural areas that they can do their clinical work with.”
And, as health care professionals pack up and return to their homes across the state with an outbreak of the coronavirus on the horizon, President Donald Trump’s national emergency may highlight structural obstacles as well, Kaas said. A willing workforce of nurses is paramount, she added, but their effectiveness in rural areas will be significantly hampered if there aren’t enough care facilities, if there isn’t affordable housing or affordable child care, or if there isn’t viable broadband in place to provide information, communication and telecare. Then, she said, disparities between urban and rural mental health care will remain.