Editor’s note: Please enjoy this Dr. Rosmann column from 2014.
A farmer who is the major caregiver for his wife when she has episodes of bipolar disorder telephoned me after reading recent “Farm and Ranch Life” columns about bipolar disorder. He wished to share what has been helpful for his wife and their situation.
Persons who have learned from their own experiences often are our best teachers. I appreciate that this man helped me realize many people needed more information than the previous articles contained about resources for individuals struggling with chronic mental illness and ideas for their caregivers as well.
This article will refer to bipolar disorder as a “mental illness” because it is the commonly used term. Many people prefer the term “behavioral health problem” because it is less stigmatizing.
The term “chronic” does not mean continuous. Most persons with chronic mental illness have periods when symptoms clear up partially or entirely for a while.
Let’s also remember that what works for one person or situation doesn’t work for everyone. We have much yet to learn.
The most common chronic mental illnesses include schizophrenia, which affects approximately 2.4 million Americans age 18 and older, according to the National Institute of Mental Health, and bipolar disorder, which affects about 5.7 million American adults. Individuals with these illnesses almost always require psychotropic medication and a network of caregivers to protect and support them during crises.
The intensity and duration of these and other recurring mental illnesses, such as personality disorders like antisocial and borderline personality disorder, can vary greatly but usually are lifelong conditions. That’s why they are called chronic mental illnesses. Many addictions also are chronic.
Some persons with chronic mental illness need legal guardians and conservators who can step in during illness flare-ups. In some states Psychiatric Advance Directives can be crafted by the person with the illness during a well-functioning period.
The farmer who called me said his wife agreed to his appointment by court to step in if she cannot manage her affairs and to have their adult children as alternates.
In some states persons with addictions can be court ordered to allow blood tests for illicit drugs and mentally ill persons on necessary medications can be required to submit for blood analyses to gauge if therapeutic levels of psychotropic medications are being maintained.
Rural residents often have more difficulty finding professional behavioral healthcare providers than urban and suburban residents. The number of psychiatrists and psychologists per 100,000 persons in rural areas is half that of urban areas of the U.S.; other behavioral health professionals are fewer also.
Likewise, peer support groups and family support groups supervised by properly trained persons are fewer in rural areas and often require considerable travel. The farmer who called me said he and his wife attend family support meetings that are about an hour’s drive from their home.
There also are fewer supportive employment and community living options in rural areas than in areas with more residents. The Affordable Care Act seeks to expand peer supports and supportive community living programs; it also forms care teams for persons with chronic mental illnesses that include case managers, health professionals, family and others who can offer assistance.
Resources that individuals and caregivers needing assistance can contact besides those available through community mental health centers and county/state agencies (e.g., Department of Human Services) vary from state to state.
All counties in some states have mental health/developmental disability coordinators whose duties include helping residents find the resources they need. They are usually listed in the county government section of the local phone book or on the county government website.
Mental Health America (www.mentalhealthamerica.net; phone 1-800-969-6642) has 240 affiliates in 41 states that are “dedicated to promoting mental health, preventing mental and substance use conditions and achieving victory over mental illness and addictions through advocacy, education, research and service.” Many affiliates offer support groups to individuals, families and friends.
National Alliance on Mental Illness (www.nami.org; phone 1-800-950-6264) has programs in every state and over 1,000 community affiliates. The alliance “offers an array of support and education programs that help build better lives for the millions of Americans affected by mental illness.”
The Karla Smith Foundation (www.karlasmithfoundation.org; phone 1-618-624-5771) “supports families affected by mental illness and suicide.” The program offers support groups, which are listed on the website, in Illinois, Michigan, Missouri and Wisconsin. The farmer who contacted me and his wife found help in one of their support groups.
Finding satisfactory supports is difficult. Telemedicine services and on-line support for recovery are becoming more widely available for rural areas.
There probably are other support programs that I don’t know about and which may be of assistance to rural residents with mental illness. Please share your recommendations with me.
Persistence in finding the right options pays off by saving lives and relationships, and to maintaining the dignity of – and respect for – the ill person.
Dr. Rosmann directed a community mental health center at Harlan, Iowa, where he lives. To contact him, visit the website www.agbehavioralhealth.com.
Dr. Rosmann lives on a family farm near Harlan, Iowa. He is a psychologist who has directed behavioral health programs in response to disasters of all types, Contact him at firstname.lastname@example.org.