Therapy for the Uninsured and Rural

January 12, 2010 7:35 AM

I have occasional depression. I live in a rural area. How do I find treatment without health insurance? Or are there alternative methods besides one-on-one counselling?

I've never seen a therapist or taken medication. In college, I went to a psychiatrist once or twice who diagnosed me with 'dysthymia', after only one visit and recommended medication. I didn't follow up. I'm usually pretty content and positive about my life in general, and I think I usually give myself pretty good advice. However, I'm in my mid-twenties and lately I've begun to think that my problems with recurrent depression aren't going to go away. A family member died recently, I've had some relationship problems, and I have winter blues. I am plagued by body anxiety issues, feelings of dread, and (this is the scariest, I guess) sudden violent unbidden thoughts. Not in a scary homicidal way, but in a woah-bad-things-could-happen-at-any-time way. I exercise regularly, I have a good diet, and I have a job that I enjoy and find challenging. However, fairly often my mood just turns, well, foul... I replay old hurts, can't think clearly about problems, I'm plagued by self-doubt and small trivial tasks seems insurmountable. I'm usually a little scatterbrained, but it gets a lot worse when my mood is low. Every once a year or so, I tend to take a more severe turn for the worse.

I want to seek therapy. But I am not covered by health insurance and I live in the middle of rural West Virginia near very few mental health resources. There's not even a psychiatrist listing in my entire county. There are some in a couple of cities a few hours away, but the cost of driving and paying for therapy appointments is just about dang impossible in my life right now.

So, what are my options? Alternative, online therapy? One-time visit for medication? Programs designed for low-income, uninsured people living in rural areas?

I guess one of the reasons I didn't return to the therapist in college was that I didn't like how eager he was to proscribe me medication. I've always been of the 'change your lifestyle' variety of thought, but I'm not sure what else I could do to improve myself.

I travel to Vermont twice a year for nine days, also. Don't know if that would make a solution more apparent.

Thanks in advance for advice and help. I'm open to ideas and realize my situation isn't ideal. I am looking into health insurance. I work outdoors and that makes a huge difference in my outlook, but even so it still seems to be a problem in my life. Ask MeFi has always been a great resource for me, although I realize that it is not therapy, no one is a qualified professional, and I definitely need to look into health insurance. So that's my disclaimer.

Thanks.

posted by anonymous to health & fitness (15 answers total)

Hmmmm, rural mental health is sort of its own bag and not really in my professional experience but I will give this a shot.

I would recommend directing your inquiry to practitioners within your state because they will know the local landscape of resources. Try plugging your geographical info into the National Social Worker Finder and start calling some people in your state and tell them you have a question about accessing mental health resources. Also, check the faculty pages at the West Virginia University School of Social Work, find someone who has a mental health interest and email them directly with your question. Don't feel weird about emailing or calling random social workers, I guarantee someone will step up and try to get you some information. There may be outpatient resources or a therapist somewhere nearer to you that you're just not finding.

Also, realize that for the purpose of obtaining medication for depression you may be able to see a general practitioner. I'm sure there are doctors near you, see one and see what they say.

In the meantime go to your county assistance office and apply for Medicaid, if you qualify for it you should be able to obtain some mental health outpatient services and psychiatric medication once you've found a place to get it from.
posted by The Straightener at 7:58 AM on January 12, 2010 [1 favorite]

Have you thought about getting a daylight bulb? If you're suffering from a lack of light, which may be helping your depression, then you should get one. I think they use them loads in the artic circle when there's hardely any light.
posted by Jazzwick at 8:05 AM on January 12, 2010

One alternative therapy that you failed to mention here is daily cardiovascular exercise. This has been scientifically proven over and over again to help ameliorate depression. Seriously, try it - exercise the demons out of you.
posted by sickinthehead at 8:08 AM on January 12, 2010 [1 favorite]

second The Straightener. WVU will probably be your most sophisticated mental health outlet in the Wild Wonderful.

sickinthehead also has a great point about daily exercise. you cannot believe how much better it makes you feel until you try it.
posted by toodleydoodley at 8:17 AM on January 12, 2010

There is a free UK course on Cognitive Behavioural Therapy (CBT). You could check it out at http://www.livinglifetothefull.com/. The British medical system seems to like Cognitive Behavioural Therapy, since it gets results.

If you prefer books, I think you would find Feeling Good: The New Mood Therapy by D M Burns to be very helpful. Once again it is about CBT.

I agree with an earlier poster that you might benefit from bright lights if you tend to depression in the winter.

Exercise, social interaction, stress-management, nutrition (some people swear by omega 3 oil and Vitamin D) are all good things. You might find meditation worth trying.

Good luck.
posted by PickeringPete at 8:20 AM on January 12, 2010

Nthing what has been said above.

1) try to see a GP or local walk-in clinic for meds; they will also be the most knowledgeable about locally available mental health services
2) may be easier to find a social worker than a psychiatrist in your area
3) try getting a light box and sitting in front of it for 30-40 mins per day
4) exercise, eat well, take vitamins
posted by melissasaurus at 8:24 AM on January 12, 2010

It sounds like you have not completely ruled out the possibility of medication, so I'll point out that you can visit a GP to get a 'script to try out antidepressants. Explain that you are uninsured: generic versions of prozac and celexa, for example, are available through Walmart's $4 generic prescription program, but zoloft (which is also available as a generic) is not.

Two resources that you might look into for a self-help approach to cognitive behavioral therapy is David Burn's The Feeling Good Handbook and the online self-guided program MoodGYM. Both have been recommended repeatedly on askmefi.
posted by drlith at 8:29 AM on January 12, 2010 [1 favorite]

Look for a support group. Also, I see someone has recommended Feeling Good up above. I cannot recommend that book enough. It's excellent, especially if therapy isn't an option. Do the assignments, and keep it around for when you need it.

Also, this may not be 100% related to your question, but try baby steps when you're feeling down but need to get stuff done. Just break tasks down to their simplest components like "Walk down the hall" or "Open the refridgerator door." That will help you work around the psycho-motor retardation that makes depression so crippling when it is more severe. It may not make you feel better, but when you do feel better, you won't have to deal with the aftermath of not functioning at all for a few days.
posted by mccarty.tim at 8:31 AM on January 12, 2010

Although this is not a substitute for therapy or medication, consider keeping a journal. Simply writing down the negative thoughts in my head has really helped me in my lowest moments.
posted by mmmbacon at 9:46 AM on January 12, 2010

Seconding MoodGym: Ever since I found MoodGym here on AskMeFi, I've been recommending it everywhere - it's been working great for me with just a few weeks using it.

Also seconding (thirding?) a daylight bulb and cardio. Exercise is your friend.
posted by _paegan_ at 9:46 AM on January 12, 2010

Just to re-emphasize the cardiovascular workout as a way to treat depression - that is exactly what was prescribed to me by a therapist years back. It works but make sure you are consistent about working out. You can't just go for a jog when you're feeling down, you have to go for a jog a few times a week... forever.
posted by pwally at 10:23 AM on January 12, 2010 [1 favorite]

Have you ever been allergy tested? If not, I would suggest putting yourself on a Allergy Elimination Diet. (Google has lots of links to them.) It's basically restricting your eating to a few foods that are generally regarded as non-allergenic, and then adding one new common allergen every few days, and see how you react to them.

I can't quote sources, but I have seen studies that showed that a surprising amount of depression (and anti-social and/or violent behavior, for that matter) is caused by untreated allergies. And I can attest to this myself. I suffered from varying degrees of depression all my life - I remember being suicidal as a 5 year old. At the age of 38 I discovered that I'm allergic to more things than you'd care to hear about, including a lot of different foods. One day, about two years after I had cut all those things from my diet, I suddenly realized I hadn't been depressed in all that time!

It's now been more than 10 years since I discovered my allergies, and the only time I get depressed is when I cheat and have dairy products. Incidentally, dairy allergies seem to be a common culprit for causing depression, so if you're hesitant to do the entire elimination diet, try just cutting out dairy products and see what happens.

If you try this, be sure to read labels, because they hide things like dairy, soy and corn in products you'd never expect to find them.

Oh, and you mentioned getting scatterbrained. I always tell people that dairy gives me a raging case of the stupids. I become unable to focus on anything for more than a few minutes, and I seriously sometimes can't remember things long enough to even write them down.

The other thing I would suggest is VERY short sessions in a tanning bed, if you have access. I'm dead-set against them in principal, but when I used to work nights and therefore rarely saw the sun, a once-a-week dose made a tremendous difference in my general mood. Taking Vitamin D supplements doesn't seem to have the same effect.
posted by fairywench at 10:47 AM on January 12, 2010

also nthing lightbox/bulb/bed/whatever suggesters, just remembering that wherever you are in WV, your day is probably shorter than pretty much anybody's, what with the mountains.
posted by toodleydoodley at 6:36 AM on January 13, 2010

Check out your county mental health department.
posted by cass at 7:59 AM on January 13, 2010

Nthing lightbox if funds allow. Nthing exercise REALLY REALLY HARD; it's free or cheap, depending on what you do, and makes a huge difference. I recommend walking as a start. I think moving through your environment with your head up under your own power is very helpful.

I take three nutritional supplements that I think are as important, and maybe more important, than my antidepressant. One is fish oil, for the Omega-3 fatty acids. One is an iron supplement (Floradix), because when I don't take it I start to experience a bone-deep fatigue that my back-brain interprets as depression-induced lassitude and hopelessness. I've repeatedly proved and re-proved the necessity of those two to myself by running out and waiting too long to restock. The third is vitamin D, which I started taking after having mine tested and finding it to be really low. Since starting it I feel like I have maybe 50% more energy than I did before.

I would also suggest picking up a copy of The Depression Book by American Zen teacher Cheri Huber, and also her book (Regardless of What You Were Taught to Believe) There Is Nothing Wrong with You: Going Beyond Self-Hate. I recommend her books rather a lot because they've been so unbelievably helpful to me in learning to live with the depression I've been dealing with for something like 30+ years now. Several years ago I was suicidal and wanted nothing more than to be dead; these days I feel content and often downright happy much of the time.
posted by Lexica at 7:02 PM on January 13, 2010