Rural towns need psychologists, social workers and substance abuse counselors, but there is a chronic shortage. The U.S. needs about 2,700 more clinicians to catch up to demand, according to the Department of Health and Human Services.
Outside of metropolitan areas there just aren't enough providers to go around.
"It's quite serious because, in Nebraska, 88 out of 93 counties are federally designated as underserved areas for mental health," says Howard Liu, a psychologist at the University of Nebraska Medical Center and director of the college's Behavioral Health Education Center.
Liu says physicians in rural areas are often willing to treat some conditions, like ADHD. "But if it's ADHD plus something like, maybe, depression, I can guarantee you they're probably not comfortable," Liu says.
To receive the care they need, he says people often wait for weeks to see one of the few psychologists in rural areas, or drive hundreds of miles to see someone in the city.
Winnebago, a small town on the reservation of the Winnebago tribe in northeast Nebraska, knows what that shortage feels like. The town often has luck attracting mental health providers, but they often leave, too.
"We can bring providers in who will be here for a while, but once they, maybe, get their scholarships repaid then they leave," says Anitra Warrior, a psychologist from Lincoln, Nebraska.
Warrior is helping organize a program to change that track record in Winnebago. Instead of coaxing urban graduates with loan payments, Warrior wants to start with students who are already nearby.
"It would be really nice to have people from the community, who understand the community, know the community, and want to stay," Warrior says.
This is the goal of FARM CAMP, the Frontier Area Rural Mental Health Camp and Mentorship Program. The program started in the northwest Nebraska town of Rushville in 2013, where behavioral health workers are also in short supply. Winnebago held its second camp this summer.
The camp is a way to plant the idea of a behavioral health career with hometown students and encourage them to grow into local professionals.
For five days in July, Anitra Warrior led a group of six high school juniors and seniors through college-credit classes. They learned about psychology, mental illness, substance abuse and different careers in behavioral health.
The students also learned about local culture. Anitra Warrior says she's learned first-hand that clients in rural towns, and on the reservation, expect providers to know their culture and engage with the community. That wasn't really part of her training.
"But it was very much something that was almost a demand," Warrior says. "That you have that very warm and welcoming feeling to the service."
FARM CAMP places an emphasis on connecting with community culture. It also puts a lot of effort into making early and lasting connections with students through mentoring. After the week is over, organizers will keep in close contact.
"We're still in-touch with every student who's ever gone through these camps, and I think that's important because in both communities many of these campers don't have easy lives," says psychologist Catherine Jones-Hazledine, who originated FARM CAMP in Rushville, Nebraska. "This idea of the future can give hope to students who are struggling. They don't need to know what they're going to do. They just need to know they have support."
FARM CAMP is an example of how some states are trying to catch students earlier to steer them toward the field of behavioral health because shortages like the ones around Rushville and Winnebago persist throughout rural America.
Psychologist Howard Liu says only a handful of kids need to follow through from a program like this to make a big difference for rural treatment.
“One or two people placed in a certain community in rural Nebraska can have a 300- or 500-mile impact,” Liu says. “It’s the difference between a family having to drive eight hours to Omaha versus half-an-hour to someone in their own community.”
At the end of the week, the Winnebago students pitched community improvement ideas to the Tribal Council and leaders from other programs. There was a wide range of proposals: enforce the curfew, round up stray dogs, and expand athletic programs. Jonna Price suggested more culture and language classes in school.
Price says she wants to go to college, but then she wants to come back to Winnebago.
“I want to be a social worker,” Price says. “So I’m definitely taking a lot out of this and learning about mental health and how much of a change it brings to peoples’ lives.”