Interchurch Ministries of Nebraska
With the vast majority of federal and state mental health funding targeted toward persons with serious and persistent mental illness, providing support to farmers and other rural residents at increased risk for mental disorder due to "farm stress" has proved difficult. The Nebraska Counseling, Outreach and Mental Health Therapy (COMHT) program is designed to make cost-free, confidential mental health counseling available to persons affected by the current rural crisis. The program is not limited to farmers. Any rural person who is negatively affected by the rural crisis can apply. This includes farm family members, people working in agriculture-related businesses and small town businesses dependent on the agricultural economy, and other rural residents.
Persons calling Nebraska's Farm Hotline (1-800-464-0258) who appear to be in need of professional mental health treatment are informed of the COMHT program. If they express an interest in pursuing counseling, Hotline staff mail them a voucher and the names and contact information for several mental health providers in their geographic area. Each voucher pays for one outpatient session. The caller has 30 days to redeem the voucher by receiving counseling from a COMHT mental health provider. If more than one session is needed, additional vouchers for therapist prescribed sessions can be obtained by calling the Hotline. Some people call the Hotline for the express purpose of receiving a voucher because they have heard about the program or have been referred by a mental health practitioner.
Mental health providers are reimbursed at the rate of $50.00 for each 50-60 minute session provided under COMHT. The providers have 30 days to request reimbursement and are required to submit a Demographic Data Form for each session provided under the program. Mental health providers have been very supportive of this program and very accommodating to the special needs of COMHT clients. For many mental health professionals the reimbursement rate of $50.00 per session is substantially below what they normally charge for this service. In addition, there have been several instances where mental health providers have provided additional "pro bono" services to COMHT clients. Providers have also agreed to meet with clients in neutral (less stigmatizing) settings such as churches.
Mental health provider participation in the COMHT program is voluntary. Currently, more than 100 licensed (a requirement) mental health providers in every part of the state have signed on to provide services under COMHT. Mental health providers include persons in private practice, community health centers, and other social
service agencies. A large number of providers have strong farm backgrounds and an understanding of rural culture.
The original COMHT program evolved out of the ongoing "farm crisis response" efforts of a state-level partnership between the state agencies responsible for mental health, labor, and social services, Interchurch Ministries of Nebraska, University of Nebraska Extension, and the Nebraska Center for Children, Families, and the Law. COMHT was an addition to the services offered by the Nebraska Farm Hotline (in continuous operation since 1984) and a direct response to the continuing Farm Crisis of the 1980s and the weather-related disasters of the early 1990s. Other Hotline services include crisis counseling, financial counseling, legal assistance, outreach to families in crisis, and information/referral. The COMHT program was originally funded out of monies from the 1990 Farm Bill and Federal Emergency Management Agency disaster relief funds. These monies ran out after a few years and the program was discontinued.
The COMHT program was re-implemented in 1999 in response to the recent problems of the farm economy. Currently the COMHT program represents a partnership between the Interchurch Ministries of Nebraska Farm Crisis Council and the Nebraska Health and Human Services System. Funds to support the Hotline and the COMHT program come from the Nebraska Health and Human Services System and the Federal Office of Rural Health Policy. The program is administered by Interchurch Ministries of Nebraska.
The number of Hotline callers receiving mental health counseling continues to increase. From July 1, 1999 to April 30, 2000 the Hotline received 2,983 calls and distributed 1,228 vouchers. According to Michelle Soll, Hotline coordinator, "We are issuing more vouchers than we thought we would. The stress is still there." Those receiving counseling include farmers, ranchers, spouses, children, and others who are directly affected by the current farm crisis. Demographic data reports show that women received the highest number of counseling sessions, followed by men. Joint counseling for husbands and wives ranked third and services to families as a whole ranked fourth.
People receiving help from the COMHT program are not only those whose problems are the direct result of the "rural crisis." There are, of course, persons with a pre-existing mental disorder who would have had to stop treatment because they could no longer afford to pay for it and those whose conditions worsened (or were "triggered") due to the stress of the "rural crisis."
During the current fiscal year, COMHT program users were asked to rate the services as very helpful, somewhat helpful, and not helpful. All persons responding except one rated the services as "very helpful." The one exception rated the services "somewhat helpful" and no one rated the services as "not helpful." A young farmer who received six counseling sessions said, "This was literally a lifesaver. I didn't know what I was going to do. I couldn't handle anything. Now I am back on track, my family is strong again. COMHT didn't affect the economic crisis, but it has helped me cope with the situation and move on." A woman commented: "You are marvelous people and the counseling is helping tremendously, you people are more than just a life line for me and I owe you for everything." This program continues to touch the hearts of all those involved. As Michelle Soll says, "Proud men who have farmed for many years call us all choked up with emotion, almost crying, to say thanks and tell us how much this program has helped them and their family. The rewards I experience in working through the Hotline are tremendous."
Federal and state funding of the COMHT program is expected to continue at the current levels through the next fiscal year. However, the increasing demand for vouchers and the prospects for a deepening of the rural crisis due to prolonged drought conditions have raised concerns about running out of vouchers. In addition, the long-term support of the program is uncertain. Currently the primary partners in the COMHT program are working to build a coalition of additional partners and establish a sustainable "rural response" program that will continue to assist rural people under stress well into the future.