Rural Communities Lack Ancillary Services

By: Pamela L. Mulder, Ph.D.

Published in: The Family Psychologist, 18(1), 7-9. © The Family Psychologist, Div. 43. Posted by Permission

 

Urban psychologists rely upon various ancillary, or “wrap around,” services – AA meetings, public libraries, local support groups, public transportation, rehabilitation programs, reduced fee health and/or legal clinics, and even community colleges. But these common amenities, often taken for granted by urbanites, are simply nonexistent in rural and frontier communities.

Consider the “Smith” household in rural southern West Virginia, consisting of six persons, Carol (age 48), her husband Bob (age 56), their son Rick (age 14), their daughter Jane (age 19), Jane’s daughter Mary (age 18 months), and Carol’s mother, Sue (age 68). The Smiths live in a 3 bedroom mobile home in an isolated, mountainous hollow served by one tertiary [gravel] road. The nearest neighbor lives three miles up the hill. The nearest town is at the base of the hill, 8 miles down the road.

Carol, presenting with moderate depression, is a high school graduate, but has never been employed outside the home. Bob receives monthly disability payments in the amount of $423 for a back injury sustained three years earlier. The family’s only other source of income is Sue’s $221 monthly social security payment.

Bob has been unemployed since his injury. He began drinking heavily at about the time of the injury and typically consumes nearly a case of beer daily. DUI arrests resulted in suspension of his driver’s license two years ago, at about the same time the family’s old car finally became too costly to repair or replace, leaving the family without access to an automobile.

Rick frequently skips school and makes failing grades when he attends. Carol believes he may be learning disabled or attention deficit, diagnoses which she knows would qualify for disability benefits. Although Rick repeated both 6th and 7th grades, he has never been assessed. He reportedly drinks alcohol to the point of intoxication several times a week; he has been arrested twice for underage drinking and once for vandalism.

Sue, diagnosed with Alzheimer’s three years ago, moved into Carol’s home with the expectation that Carol would provide her care. She has deteriorated rapidly and requires constant supervision and frequent emergency medical intervention.

Jane became pregnant at 16 and quit school to marry the father. She left her husband, claiming abuse, and moved back into her parents’ home with her daughter. Jane is not employed and cannot afford the cost of filing for divorce.

An urban family could access a variety services including therapy, day treatment, and respite services at a community mental health center, hospice and childcare facilities, AA meetings, after school tutoring programs, low income health and legal clinics, a public library, a state employment office; and access to public transportation and social services.

But the Smiths live in a very rural region. There is one small combination convenience store / pharmacy / post office in the nearest town. The community mental health center, regional hospital, and social services offices are all at least 40 miles away, in another county.

The county EMS team can reach Carol’s home within 30 minutes – if the driver on duty knows the area. Only 25% of the county roads are paved; fewer still are marked and mapped, hampering emergency services. There is no 911 service; 2 of 10 homes in the county lack telephone service. A school nurse is available at Rick’s school 4 days each month but no other medical care is available within a 30 mile radius.

There are two sheriff’s deputies on duty at any given time, sharing a single vehicle, to cover the county. There are no local legal services and the county courthouse is 23 miles away. There is no public library, no public access to computers, and absolutely no public transportation.

There are no after school programs because rural students travel long distances to their isolated homes and there are very few school buses which serve the need of the large county. There are no movie theaters, bowling alleys, malls, public pools, or YMCA facilities. There are no adult education programs.

Unemployment is very high; the jobs available are usually limited to labor intensive mining and logging work. There are no day care centers where working women can enroll their young children; some of the women in the community do care for children in their homes, but openings are very rare.

Anonymity is entirely lacking in this small, close knit community. For example, Jane’s brother-in-law was the law enforcement officer dispatched when she was beaten by her husband. And there used to be “safe house” for abused women in the area – before it closed, almost anyone could have given a newcomer the address.

There is one weekly AA meeting; it is held at Carol’s church. The minister frequently exhorts her to try to convince Bob to attend a meeting and indicates several men he is sure Bob knows who would be there to make him feel welcome. Carol’s neighbor, who knows Rick’s teacher, told Carol that Rick’s turn to be assessed for a learning disability was probably still a few months away, considering the waiting list for services. And Mr. Jones, the elderly pharmacist who owns the small convenience / drug store, phoned Carol a few weeks earlier to let her know that Rick and his friends tried to purchase some condoms. Mr. Jones had refused to sell the condoms to the boys, but thought their parents should know.

As the only psychologist in the area, what resources would you have for serving the needs of this family?

Rural practice requires sensitivity to the unique social, economic, and cultural dynamics of rural environments which distinguish these settings from more urban ones and also vary from one rural community to another.

Clinicians should be prepared to meet the common challenges of rural practice, including those discussed in this article. But solutions will depend on identifying the socio-cultural strengths of the rural community and factors which facilitate resiliency, then creatively applying these in the service of rural families.

© The Family Psychologist, Div. 43

 
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