Overcoming Regional Barriers: Navigating Rural Mental Health Care

I was 13 years old the first time my doctor told me I was close to dying. My eating disorder had only developed six months prior, but the constant restricting, bingeing and purging had led to significant heart problems caused by electrolyte imbalances.

It was after this experience that my family and I realized how much I desperately needed help. However, it soon became clear just how difficult it would be to access the help I needed, as we lived in a rural area with an inadequate mental health care system.

My Location Was a Consistent Barrier to Care

In 2011, Montana, my home state, offered no specialized treatment for severe eating disorders. My best option was to see a therapist specializing in substance use — a therapist who was not trauma-informed, LGBTQIA+ friendly or knowledgeable about eating disorders. They advised me to simply “drink more milk” and even suggested that I was weak or trying to punish my parents with my eating disorder. I was shocked by how inadequate the care was.

Unsurprisingly, I only continued to get sicker until it was clear I needed a much higher level of care. After weeks of fighting with insurance, my mother eventually found me an inpatient treatment center out of state, where I could receive six weeks of intensive treatment.

I suffered from a severe eating disorder until I was 23 years old, and in that time, I went to treatment eight separate times. My admissions into treatment centers were only covered by insurance once I was hospitalized, so each step forward presented a new financial strain.

Even then, it was a battle to find a treatment center out of state that would accept my insurance. Often, insurance companies either refuse to cover any treatment, or they cut coverage too soon. The magnitude of the stress and heartache this caused my family cannot be captured in words. They felt helpless and eventually started mourning my death because it seemed impossible to find care that could help me.

My Location Determined the Quality of My Care

Access to care, my family quickly learned, is about as complex as eating disorders are. I was incredibly fortunate to find a treatment center while so many others don’t even get this baseline of care. However, there is a difference between access to a treatment center and access to comprehensive, adequate care. Admission to a mental health facility does not mean the care you are receiving is even close to adequate, and it often does not address the root cause of mental illness.

Eventually, after an extensive search, I was able to find a therapist skilled in the complexity of eating disorders and a facility with a team of compassionate providers that understood that healing and wellness involve time.

Even though I eventually found a facility and a therapist, my recovery was a decade-long battle that, I believe, would have been very different had I been able to access care close to home. Local, effective care would have allowed me to receive treatment for the duration it takes to unravel the complexities of an eating disorder. Additionally, my family would have been able to participate more fully in my care, without the stress of navigating insurance “rules” or using vacation and sick leave to attend sessions states away so that insurance would continue to pay. This, unfortunately, was not our experience.

This is a pain that no family should ever have to go through. Things desperately need to change in our mental health care system so people can get the help they need where they live. Families and individuals battling mental illness should be able to focus on their healing, not constantly fighting bureaucracy and worrying about how they can access crucial treatment.

What Needs to Change

It is my hope that providers, legislators and insurance companies take action to make treatment for mental health conditions more accessible. Perhaps these steps could include having resources available that are income-based and more geographically and financially accessible.

Other critical measures include ensuring that practitioners receive culturally proficient and trauma-informed training and providers acknowledge the barriers that exist for rural and marginalized communities. Access to comprehensive mental health care is a right that should be available to everyone. Within the current system, the strain of lacking resources and insufficient care compound the hardship people with mental illness face.

I was fortunate to receive the care I needed (eventually), but not everyone is as lucky. Where you live should not determine your access to healing.

Maggie Hammond lives in Bozeman, Mont., where she is finishing up her college degree and working at a local wellness clinic. A commitment to therapy, medical visits and daily self-care strategies keeps her well.