Madalynn Adams had to travel about 100 miles once a week to see her counselor in Canton, Ohio.
The 17-year-old from Zanesville, on the Muskingum River and west of Columbus, Ohio, suffers from anxiety and depression and has executive dysfunction – a condition that disrupts her ability to control her emotions.
It started in sixth grade when Madalynn Adams first showed signs that she was suicidal, which is when her mother, Breann Adams, knew she needed to find a counselor quickly for her daughter.
Breann Adams got her daughter into counseling at Akron Children’s Hospital, despite the two-hour drive once a week for every appointment, counseling was successful for Madalynn Adams until a new problem occurred: the counselor left. The family then had to restart the process again to find a counselor.
“(We) couldn't find anything local because there's a lot of counselors for adults and not a lot for teens,” Breann Adams said. “And so (we) could not find a fit for her, and then she attempted suicide again.”
Madalynn Adams took time away from receiving counseling after multiple failed attempts to find a nearby counselor who meshed well with her. When she was 16 years old, she attempted to end her life again.
Suicides among young Ohioans are unfortunately widespread. According to a 2022 Ohio Health Department report, suicide was the second-leading cause of death among 10-14-year-old Ohioans.
The report found that on average, there are 15 deaths by suicide per 100,000 Ohioans. According to OHD, death by suicide for young people between ages 10-24 in 2022 was at a rate of 11.8 per 100,000. That's an increase of 3%.
Six counties in Southeast Ohio – Perry, Hocking, Vinton, Gallia, Lawrence and Monroe – were in the range of highest suicide rates, according to the OHD.
The OHD report found that Vinton County had the highest average suicide death rate, 38.8 per 100,000, between 2020-2022; Muskingum County, where Zanesville is located, had an average rate of 15.3.
In the rural region, education and access to mental health services are two stark barriers parents have to navigate around if they are trying to get help for their children, specifically in Southeast Ohio.
Kristen Chamberlain, assistant professor of instruction in counseling and higher education at Ohio University, is a licensed clinical mental health counselor in Ohio, a licensed school counselor and a registered nurse. She also earned her Ph.D. in counselor education and supervision from OU.
“If we don't have the social infrastructure and the support infrastructure there, again, people fall through the cracks, and we wonder why,” Chamberlain said. “That's one piece to it, but (those things) increase people's stress and anxiety and depression. There's a systemic organizational piece to this, too.”
Lack of trained mental health professionals
In 2022, 47% of the U.S. population was living in a mental health workforce shortage area, and some states needed up to 700 more practitioners to remove this designation, according to data from the Kaiser Family Foundation.
The Association of American Medical Colleges reported that 33% of adults said they had symptoms of depression or anxiety in 2022.
There are many mental health organizations but not enough licensed counselors to fill those roles; trouble accessing professionals and services in the fields is common for rural residents, according to the American Counseling Association.
“While the number of people in the workforce is declining, the need has significantly increased for mental behavioral health services. They're moving in opposite directions, which has created a peak impact of this,” Cory Cronin, an associate professor in the Department of Social and Public Health at OU, and the co-director of the Institute to Advance Health Equity, said.
Breann Adams said the root problem is the short staff of trained mental health professionals. Last year when her daughter was harming herself, she rushed her one hour west to Nationwide Children’s Hospital in Columbus, Ohio, in hopes of getting immediate help, but the Adams family was mistaken.
Even though the hospital knew Madalynn Adams was suicidal, she did not receive any medical attention or receive an evaluation for 12 hours, her mother said.
Eventually, Madalynn Adams was admitted, but all the beds were filled. The hospital’s next best solution was to put her in the overflow unit without any counseling until a bed became available, which could have been up to a week, Breann Adams said.
“They expected a teenager who's suicidal to wait in a 12 by 12 room for up to a week with no therapy,” she said. “That's not helpful, that's even more traumatic.”
After 32 hours, Breann Adams felt frustrated and wanted an alternative, so she decided to have her daughter discharged.
“There's a lack of education, there's a lack of understanding and there's a lack of skilled professionals to help because they're underpaid, understaffed and overworked,” she said.
Chamberlain said there have been limited providers in the area for many years. She said geographical isolation, pay and compensation contribute to why professionals are not coming to the region to work, making it more difficult for residents to receive adequate mental health help.
“Sometimes the expectation of income and the reality of that (in the region is) a distinct mismatch,” she said.
Chamberlain explained obtaining a counseling license can be extraneous. The first step to getting a license is completing a master's in Clinical Mental Health Counseling and taking the licensure exam to become a Licensed Professional Counselor (LPC).
A Licensed Professional Clinical Counselor (LPCC) can diagnose and treat clients, but that license requires 3,000 work hours under a supervisor (LPCC-S) and 150 hours of training supervision.
Chamberlain said upgrading to an LPCC inherently pays more and when professionals dedicate all that time to their professional education to advance and achieve more counseling qualifications, they expect to get paid more.
Jamie McGrew, director of community outreach and programming at the Mental Health and Recovery Services Board, works with six Southeast Ohio counties—Coshocton, Guernsey, Morgan, Muskingum, Noble and Perry—to assist people in providing information on where and how to access alcohol and drug addiction and mental health services.
McGrew said it’s extremely difficult to respond quickly when a child is having a crisis because there are limited adolescent counselors in the region. She said there aren’t enough licensed professionals to respond to those children's needs at 2 a.m.
“Because there's a shortage of counselors … the wait time for an initial evaluation can be months,” Breann Adams said. “Then by the time they get to that, who knows what could happen? A person could go back to their substances, a person could commit suicide– there's lots of things that can happen because we have to wait three months to get the evaluation.”
Limited services
In Madalynn Adams’ case, Nationwide allowed her to leave the hospital if she agreed to return for the next six weeks and attend group therapy sessions. Even though she was suicidal, the hospital was unable to offer one-on-one counseling sessions.
Chamberlain said although more agencies are offering mental health services across the region than before, such as Hopewell Health Centers, Integrated Services for Behavioral Health and Anew Behavioral Health, they are insufficient to meet everyone's needs. She said people should expect to be seen by practitioners at these organizations once a month due to scheduling issues.
Hopewell offers behavioral health services such as outpatient counseling, psychiatric treatment, crisis services and school-based services in Athens, Gallia, Hocking, Jackson, Meigs, Vinton and Washington Counties; Integrated Services offers a variety of behavioral health and general well-being to adults and children in 16 counties in Southeast Ohio; Anew is an outpatient behavioral health provider that assists individuals in things like mental health in Athens, Lawrence, Pike and Scioto Counties.
Chamberlain said there are also private practitioners in the area, but they might not accept insurance or a range of insurance carriers, which can limit people from those services.
“I'd like to see more counselors in the area,” she said. “I'd like to see more resources embedded in these small communities, so they're more accessible to people, so it's not so much of a tax financially (or) time-wise.”
As part of the agreement with the hospital, Breann Adams drove her daughter one hour to Columbus, Ohio, for a group therapy session with other young kids and their parents. Unfortunately, she said Madalynn Adams received no productive counseling help because the kids in the group didn’t care or want to be there.
After six weeks, the hospital set the Adams family on their way; the family received no support or additional help for Madalynn Adams from Nationwide.
“There was no follow-up from Children's, no follow-up from anybody, no handouts on, ‘Hey, here's your resources. Here's your local resources. Here's how we can help you. Here's where we can help you. How can we move forward?’ I had to find counseling for her,” Breann Adams said.
According to the U.S. Department of Health & Human Services, 12 mental health facilities are within a 25-mile radius of Muskingum County. Each of these facilities lists mental health treatment and serious emotional disturbance in children as services.
Time was against Breann Adams who scrambled to find an agency that would quickly treat Madalynn Adams. She said Allwell Behavioral Health Services and Muskingum Behavioral Health, two facilities near them, generally require doctor’s referrals and months-long waitlists for an evaluation.
Rather than wait six to eight weeks for an evaluation at a mental health facility, Breann Adams found a faith-based therapy group in Canton, Ohio, that could offer her daughter more immediate help.
“For several months, I would drive her to Canton once a week for counseling, and it helped, and it did wonders for her, but there was nothing locally like that,” she said.
Chamberlain said finding nearby and immediate specialized services in the region is an even greater challenge. She said residents needing specialized care would likely have to travel to bigger cities like Columbus or Cleveland.
“It’s just some of those resource offerings that we are not always able to provide,” Chamberlain said.
Stigma and community education
Breann Adams is also the executive director of NAMI Six County, an affiliate of the National Alliance on Mental Illness which is a grassroots, self-help support and advocacy organization for families and friends of persons with mental illness, only having been in the position for about three months.
From a recommendation, she decided to go through classes to be certified as a family peer support specialist. She said she primarily went through the 40-hour training process and state certification to better educate herself on mental health and advocate for her daughter.
“There was a lot of stuff I had to do on my own because I didn't have the support from really anybody,” Breann Adams said.
In 2022, McGrew and others from the Board collaborated with OU to conduct a community needs assessment about how people perceive the services available to them. The assessment’s main takeaway was that people are unaware of the mental health services and providers accessible.
The assessment was a voluntary survey that the Board promoted at each of the six county fairs through emails, social media and its website. McGrew said there were 677 participants.
“We really have a lot of resources,” she said. “We have a lot of services available. People don't always know that they're there, and, unfortunately, we don't have specialized services. It's really hard to find adolescent and youth treatment that is a gap that we found.”
Cronin said although there are mental health organizations in the region, individuals may be reluctant to seek those services because they run the risk of being seen or judged by others.
“You've got the stigma layer that maybe physically there is a building or services, but in these small communities, there's just a different level of knowing people,” he said. “I believe somebody may be wanting to seek treatment and services, but being held back by ‘What will others think if they know I'm going to these types of services?’”
It’s common for residents to be familiar with one another in small communities. Chamberlain said if the person seeking mental health services knows the provider or a passerby recognizes the person, then it may be less appealing to go there.
“There's a reluctance to seek out help,” McGrew said. “In general, Appalachia is prideful. We work. We take care of our own. You don't talk about things that happen in the home that stay at home.”
Sara Conroy, coordinator for school-based therapy and treatment services at Hopewell – focusing on Athens County – said stigma can be generational.
Even if children or young people want to seek out mental health services, parents or guardians may only discuss mental health with a negative connotation. When guardians present mental health inaccurately or misleadingly, then children inherently are more likely to adopt similar ideas, such as stereotypes or prejudices that people with mental illness are weak or incompetent.
"‘We help each other out. We're very family-oriented. We don't talk to people about our problems,’” Conroy recalled from what families have said.
However, she said there are still young people in the area who are committed to talking about suicide prevention and educating others. Before the start of the Fall 2024 academic year, a student at Nelsonville York High School died by suicide. As a response, students rallied together to embed suicide prevention educational efforts throughout homecoming.
Chamberlain said another solution to reducing stigma is changing the message about mental health and how people talk about it. She said people should not feel like they can only seek services when they are experiencing all-time low feelings, rather it should be an integrated health service people tend to.
“Community programming is so wildly important because it starts to normalize the conversation that it's OK to first talk about your mental health,” Chamberlain said.
She said professionals need to inform the community they serve about what they do and offer. Chamberlain said mental health is health and people need to know they don’t need to experience mental health struggles alone.
“We know the therapeutic relationship in itself is where the magic happens,” Chamberlain said.
Madilyn Francis is a second-year student in the Counseling and Higher Education graduate program, specializing in clinical mental health and clinical rehabilitation counseling at OU and an intern at Hopewell working with the child and adolescent team, providing clinic-based and school-based services to children.
She said from her studies and working in Southeast Ohio she noticed Appalachia has a lot of stigma surrounding mental health and that may be due to a lack of education about it.
Francis said she doesn’t think the stigma around mental health will fully dissolve, but promoting mental health advocacy could offset its damaging effects on Southeast Ohio residents. She said resources may be hidden from people, which could make people feel isolated to receive help. She suggested resources making themselves more visible for people to utilize.
“Mental health is for everyone,” Francis said. “Just because of your abilities or lack of abilities, there's no way that you just can't receive it.”
Moving forward
Things are improving for Madalynn Adams after over a 5-year battle. She is 17 years old, has a job, can drive and is looking into attending cosmetology school.
Despite her improvement, Breann Adams said it took her daughter 1.5 years to be OK and some days, she still struggles.
“Some days I can tell when she's spiraling. I can see the red flags, and we have to do some prevention (and ask questions like) ‘What's going on? What do we need to do? What do you not need to do?’” Breann Adams said.
Madalynn Adams does not currently go to Canton, Ohio, for faith-based counseling. Breann Adams said Madalynn Adams switched to counseling via Telehealth – a way to receive healthcare services remotely through electronic devices – but it wasn’t as personable. Madalynn Adams periodically checks in with a counselor, but oftentimes she communicates with her mother to address how she’s feeling.
Breann Adams said Madalynn Adams is considering taking NAMI’s youth courses to become a youth-to-youth advocate at the organization.
“She's doing better, but it took a lot of fight on my end to get her the help she needed,” Breann Adams said.
If you or someone you know is experiencing mental health concerns, call or text 988 for support or contact the NAMI helpline at 1-800-950-NAMI (6264). Refer to NAMI Athens for additional resources.
