Ask anyone suffering or recovering from mental illness or dealing with substance abuse how they feel — that’s your answer.
Those in an urban setting will tell you they feel alone in a crowd, while those in rural areas are just terribly, achingly alone.
Start with the stigma.
Mental health issues are still largely held at arm’s length by the general population.
People with chronic depression are told to “just cheer up,” while those with schizophrenia or bipolar disorder are ostracized or advised to “just stay on your meds.”
Alcoholics and drug addicts come under fire for not straightening themselves out or not having enough willpower to stop, and so often continue down a dark path.
Confusion and despair run rampant, but they are met head-on by organizations like the Helen Ross McNabb Center.
Since 1948, it has offered help, healing and hope in Knoxville and the surrounding areas.
Now it is focusing its efforts on the more rural areas of East Tennessee, where the most basic services for traditional health care are often missing, to say nothing of aid for mental health and substance abuse issues.
“We began as one of the very first mental health providers in the state, and we have evolved to become a comprehensive provider of mental health, addiction and social services,” says Jerry Vagnier, president and chief executive officer.
“I refer to it as four pillars:
- mental health
- social services and
- crisis services.”
That’s meant everything from three separate hotlines for domestic violence, sexual assault and psychiatric crisis to a merger almost 20 years ago with a regional provider for addiction-recovery services.
Attention for rural areas
Another Helen Ross McNabb goal is an integrated care model, which the state is pursuing through TennCare.
This would be in the form of behavioral-health umbrella coordination, where a single provider would coordinate all the care of its members.
There are savings opportunities, and it is something that could help the state’s underserved rural communities.
“In 2013, we began working on geographic expansion in our region, specifically in Hamblen and Sevier counties,” Vagnier says.
“We built a new facility in Morristown, and purchased and renovated a facility in Sevierville. Both are actively providing mental health services, and have become access points and hubs of service for the surrounding counties.
“We are seeing roughly 1,500 people a year at each site.”
From these central locations, other outreach programs are being planned and implemented.
They include limited housing facilities to care for those with serious mental illness, as well as a growing corps of psychiatrists and nurse navigators to treat clients.
“We’re already seeing the fruits of our labor,” Vagnier says.
“We are actively renovating a facility for housing, and we’ve also been able to attract a psychiatrist to one site because of the awareness that resources were becoming more available.
“But we have a long way to go in terms of providing adequate mental-health care, as well as substance abuse treatment, in our rural communities. Urban areas have some systems in place, however limited; the small communities, in many cases, have nothing and so the cycle will repeat itself through families until treatment is there to help.”
Michael Cole will be the first person to tell you that getting no sleep for more than a week is no way to live.
But when you don’t know what to do, or what’s going on, it’s hard to take action.
Cole tried, though, and spent some time in a psychiatric facility and ended up on multiple medications.
Then he lost his mother, and he reached out for help again and wound up at the CenterPointe Crisis Stabilization Unit in Knoxville.
Now, thanks to his caseworkers and therapists at Helen Ross McNabb Center – Sevier County, the Gatlinburg resident is sleeping much easier, and is forging a more active, involved life.
“When I was leaving the unit, they asked me if I would like an appointment in their Sevierville office,” Cole says.
“I sure did, because I live in Gatlinburg and don’t drive. Getting from there to Sevierville can be a challenge, but going any farther was almost impossible. They have treated me really well, and in the last three years have adjusted my medication, getting me off a lot of things and onto some others that work better.
“I have a therapist, a case manager and resources I never had before. I’m functioning now like I was 15 or 20 years ago.
“They’ve basically saved my life.”
“I don’t know what I would have done, or would do, without continuing mental-health treatment.”
Cole also gets help from the center for multiple physical ailments, including diabetes and a blood disorder.
During his weekly visits, he sees many other people in the Sevierville center who are similarly reliant on it being close by.
“I can’t overstate what a good thing it is, having the facility here,” Cole says.
“I just wish they could open even more offices in the area, so they could help even more people. I guess time will tell, but they have sure made a difference for hundreds of people like me who come here.”
A feeling that nobody’s listening, or nobody cares, is a complaint that mental-health providers hear many times every day.
At Helen Ross McNabb Center – Hamilton County, Allyson Neal and the other care providers are all ears.
“I do a psychiatric evaluation of patients who are new to our system,” says Neal, who holds a doctorate of nursing practice, or DNP, degree. “A therapist does an initial evaluation of the person, gathering family information and symptoms, and then I dig a little deeper.”
She sees clients who are dealing with anxiety, depression, mood disorders, ADHD, bipolar disorder, schizophrenia and much more.
But the largest part of her caseload, about 70 percent, are people who have co-presenting conditions that range from physical health concerns to financial and family issues that create additional stress and impede treatment of the underlying mental health problems.
“Some of these people have been punched from every side,” Neal says.
“I am interested in their story. They can trust me with it.
“Their problems didn’t start overnight, and they won’t be fixed overnight, but they know we want to work with them and find the most important thing to address, then work on the next two or three. It’s like peeling an onion, and I tell them to hang in there with me and we’ll lighten their load.”
As an example, she talks about one man who has been seeing her for about a year.
It would be easy to chalk up his primary issue as one of anger management, but there was so much more.
“He was so angry that first visit he became tearful,” she recalls. “He was saying that nothing mattered, that he didn’t even know why he was here.
“I told him that if he would give me a chance, that I would listen to him every time he walked through the doors. Now he is doing so well; his life is not perfect, but he has someone who listens to him.
When I see a patient doing better than the last time, and recognize that’s because of our work as a team, that’s what makes all the difference.”
Carrie Hicks doesn’t mince words when she talks about her case managers and therapists at the Helen Ross McNabb Center in Morristown.
“They are always there. I can call them day or night, and they are always there to help us,” she says. “It doesn’t matter what is going on, they always help.”
For Hicks and her family, that help comes in many forms. A survivor of domestic abuse with four children, Hicks suffers from agoraphobia and crippling bouts of depression.
Her children have grief and anger-management issues, and there are physical problems in play as well.
Before the advent of the McNabb facility, Hicks didn’t have a lot of options in her White Pine community.
In fact, she had none.
“Carrie doesn’t have a driver’s license, so she had a lot of trouble keeping a job,” says Rebekah Robinson, team leader for the Hamblen County office, who was Hicks’ case manager for three years.
“But we’ve helped her with transportation for her appointments with us, and now she’s held a job for several months. Her case manager helps her with budgeting and keeps an eye on her so that if her depression kicks in and she’s really down, she doesn’t call out of work and she is able to care for her family.”
Were it not for McNabb, Robinson notes, “She’d have to go to Knoxville for this kind of help, instead of about 10 miles from her house.
“We serve 11 counties out of this office, and there are a lot of ‘Carries’ out here. We not only provide specialized mental health and other services to them, but make them aware of local resources, like food banks and clothing allotments, that they may not be aware of.
“A lot of those aren’t advertised, and we’re in the know so we can pass that along. For someone like Carrie with limited social support, we can help them with the small steps first and then move on to the big steps.”
That means the world to Hicks and so many other rural Tennesseans who have found a lifeline through Helen Ross McNabb.
“I really don’t remember if we had anything before we started seeing them,” she says. “Now I can see the therapist, and the kids have regular appointments. So does their stepdad.
“It’s just huge for us that they are so close by, and they care about all of us.
“I can call them day or night. No matter what is going on, they are always there to help.”
“They didn’t just come in here to make money or do a job. They want people to get better.”