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Our Work is Not 'Dunn' - Examining Mental Health, Health Equity, & Community Recovery in Dunn Co.

Autumn Cernohous | Public Health Educator - Emergency Preparedness

Table of Contents

Introduction

Understanding the Issue

Health Dunn Right and the Community Health Needs Assessment

SAMSHA Disaster Framework/Model on Mental and Behavioral Health

Health Equity

The Connection between Mental Health and Health Equity

Concluding Remarks

Further Actions You Can Take Locally

References



Image Accessibility: A group of people joining hands in the center.


My first interactions with the Dunn County community were held earlier this year, at a local nonprofit working to provide food, shelter, and support to all individuals and families in need. The need for these services has become exacerbated, or has seen a large increase, because of many factors in recent months—these factors may include: changes or loss of employment status because of COVID-19, inflation – or the price increases for fewer amounts of products that you may have previously been able to purchase at that price point, which you noticed as you fill your gas tank or purchase groceries for the week, the lack of availability of affordable housing units, etc.; people are now struggling to fulfil their most basic, fundamental needs to get by every day. Unsurprisingly, when people struggle to afford basic needs like food, their life changes and it can become distressing. Food insecurity is an issue here in Dunn County. However, because not all people are struggling, it can seem as though this struggle is not applicable, or is not happening in the Dunn County community. I urge you to reconsider that even if your economic stability is unaffected at this time, to not dismiss the very real possibility that someone you know has been greatly affected. Our community is seeing these effects in real time.

Fortunately though, Dunn County is also home to fierce advocates and gracious volunteers. Many residents of the county are selflessly giving service to others, in order to help others in time of need. Often, the work that these volunteers do for community organizations falls outside the practical day-to-day tasks that hired staff can complete; therefore, without the help of volunteers, the ability for organizations to function becomes impaired or diminished. Services that are once offered can be thrown under the rug where there are insufficient staff or volunteers to run these programs. To all of the volunteers of Dunn County – I thank you for being change makers. I applaud you for standing in solidary with your neighbors, coworkers, and other peers, to show us how Dunn County values togetherness and community. These values cannot be ignored when we consider solutions for the ways in which our community is struggling.

This blog may look a bit unique from previous Health Dunn Right posts. It is my hope to unpack some of the collective, shared experiences held by Dunn County residents from the COVID-19 pandemic in an easily understandable manner, and to offer some encouragement for us all to rebound into a more resilient community.

Understanding the Issue

There are two crucial news headers you may have missed in recent months that are crucial in understanding the grave outlook on our Nation’s mental and behavioral health. In early fall of 2022, the U.S. Preventive Services Task Force released a major recommendation that significantly impacts the lives of all Americans. In this recommendation, it is suggested that persons 18 to 64 years-old should be screened for anxiety (U.S. Preventive Services Task Force 1, 2022). Furthermore, following this recommendation, in October 2022, another recommendation was released, which extended this recommendation to 8-year-olds through 18-year-olds (U.S. Preventive Services Task Force 2, 2022. So let me reiterate – this National recommendation states that children through middle aged people are at great risk for experiencing clinically-significant levels of anxiety. WOW! The chances that someone you know could be experiencing a mental health crisis is quite high.

Health Dunn Right and the Community Health Needs Assessment

But let’s examine this on a more local scale. If you have been following @Health Dunn Right, you may have read our newest report—the 2022 Community Health Needs Assessment (abbreviated as CHNA). This report is intended to determine which threats are most impactful on the whole community achieving optimal health. Like the 2019 report indicates, in 2022, 4 out of every 5 – or nearly all – Dunn County residents are concerned by the county’s overall mental health and wellness (CHNA, 2022, p. 20). A challenge that is also present in the community is the lack of mental health practitioners and providers; Dunn County has a provider-to-resident ratio of 600:1, which is far worse than the state average (CHNA, 2022, p. 20). This means that the demand for mental health services in Dunn County far exceeds one practitioners’ ability to serve those affected by mental illness. When there is a need for something that is greater than our ability to offer solutions to the presenting issue, then our community experiences suffering.

The SAMSHA Disaster Framework/Model on Mental and Behavioral Health

Sure, so there is data out there that says we have a big problem in our community….what can be done about it?

I recently learned about a way to conceptualize, or a means of understanding, a general pattern of the human impact of disasters of all types (e.g., hurricanes, fires, etc.) that beautifully captures what can resonate with many community members on their own personal experiences during the pandemic. Pause to view the two graphics included below. What you will notice is that for every disaster that occurs, no matter the type of disaster, the community affected by the disaster will experience many ups and downs throughout the disaster process; ongoing efforts to rebuild from a disaster require a community to be resilient, or to work through these challenges while also addressing feelings of loss for pre-disaster circumstances. So that’s a lot to unpack, right? Essentially, we have to face the discomfort that arises during disaster to be able to move forward from it.


Image Accessibility: A graph from the Substance Abuse and Mental Health Services Administration (SAMSHA), which depicts the shifts in common human experiences during the occurrence of any type of disaster. You may click the image to learn more.

Image Accessibility: Similar the SAMSHA graph above, this rendition is specific to examining COVID-19 and the human impact of various variants. You may click the image to learn more.

Because the COVID-19 pandemic has been occurring in much longer duration than a mere winter weather advisory, for example, community reconstruction is delayed and complicated. Blizzard conditions or cold temperatures certainly affect communities, but usually, these effects are minimized within a few days of the storm. With COVID-19, such a short rebound in some kind of normalcy is not there. Importantly, what this means for us is the immense impact on human wellbeing from ongoing communicable disease outbreak disasters.

Could this perhaps explain the uptick in demand for mental health services in Dunn County?

Health Equity

Equity, or health equity, have become buzzwords in the healthcare, public health, and social justice professions alike within the past 5 years, but may not be discussed in the everyday work of other folks in our community. So what does equity really mean?

You might have seen a few renditions of the ‘Equity vs. Equality vs. Justice’ graphic floating around the internet; commonly, the differences between these terms are sometimes depicted through people trying to grab apples from the top of an apple tree, or people observing a baseball game (see image below).


Image Accessibility: An infographic shared by Boston University, original to @Restoringracialjustice on Instagram, which compares common buzzwords related to health equity.

At its core, equity is this practice of removing barriers that exist for people to achieve optimal health that is greatly individualized – because we all unique human beings, we all face different things that may stand in the way of us living healthy lives that are sometimes define by our own choices, while other times, are determined by things beyond our control. Equity is not the same as equality. Rather than equality, where all people receive the same supports, equity acknowledges that not all people need the same level of supports to reach optimal outcomes. Often, our society has not worked to shift to an equity lens, let alone justice – where all barriers are removed and no additional supports are required for people to experience similar outcomes.

The Connection between Mental Health and Health Equity

With consideration of what health equity truly means – the set of factors that influence where people are “born, grow, live, work, play, and age” (WHO, n.d.)—take yourself back to thinking about the mental health crisis occurring presently in Dunn County. Aside from the mental health practitioner shortage in the field – or vacancies of qualified folks to work in MH practice, what other factors are preventing folks from achieving mental health and wellness?

One example of a barrier would be inequitable – or a different experience based on your own identity – access to mental health services. Again, the CHNA presents another issue in the community; widely, Dunn County residents are either uninsured, or underinsured for health care insurance (Data USA, n.d.). In fact, only about half of Dunn County residents are insured at all (Data USA, n.d.). Without health insurance, people may not have the means to seek services due to cost. This does not even consider the unique set of circumstances that co-concurringly affect that family’s ability to seek care (e.g., a disability limiting transportation access, insufficient childcare during the daytime to access traditional business hour appointments).

So what does all of this mean? When we stop outside this frame of believing that the whole community is heterogeneous – or all the same – we dismiss the opportunity to acknowledge how health disparities impact our friends, family, neighbors, etc.. The absence of health equity is present in Dunn County and is affecting the mental health crisis.

Concluding Remarks

The harsh reality is that people are so burned out by the mere glimpse of the word “COVID-19,” which creates opposition to even shift to our community rebuilding to life following a major communicable disease pandemic event. Many people are suffering in unforeseen ways, and it is far too reckless to not consider the human impact of disaster in the context of COVID-19. In order to truly move forward, even with cases of Influenza, RSV, COVID-19, and other respiratory viruses surging already this fall, the Dunn County community must reconnect together and rally with one another to advance to post-disaster life.

Further Actions You Can Take Locally

Before I conclude, I want to close by offering a few ways in which you can engage in local health equity-related work, if you are feeling impassioned by the discussions in this article. Please explore the following opportunities:

  • Join a Health Dunn Right Action Team: there are 5 groups serving unique topics – 1) Mental Health and Wellness (MH&W), 2) Chronic Disease Prevention (CDP), 3) Housing Action Team, 4) Healthy Environment Action Team (HEAT), and 5) Alcohol, Nicotine, and Other Drugs (AND). Visit this link to learn more about participation in these groups.

  • Volunteer at a local nonprofit agency in the community: Dunn County has many excellent organizations in the community meant to serve YOU! To explore volunteer opportunities, please visit the online Dunn County Community Resource Guide and select ‘Organizations.’

  • The Kaleidoscope Center, a facet of the Wisconsin Milkweed Alliance, located at 800 Wilson Avenue, Room 41, Menomonie, WI 54751, is soon-to-be offering the Green Bandana Project, which is an initiative to support mental health and wellness in the community. By pledging to support mental health and be present for others who may be experiencing a mental health crisis, you can proudly display your bandana to signal to others you are a safe person to talk to.

  • Take a NAMI Chippewa Valley class, such as NAMI Family-to-Family course, meant to help support families of adults living with a mental illness. More details can be found here.

  • Attend events such as the early 2023 Library Movie/Mental Health Practitioner Forum sponsored by the MH&W team. More details are to come.

Today, I encourage you to take one step to supporting our community address these widely-shared concerns.

Our work here is not ‘Dunn.’

 

References

  1. U.S. Preventive Services Task Force.1 (2022, September 20). Draft Recommendation Statement: Screening for Anxiety in Adults. https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening

  2. U.S. Preventive Services Task Force. (2022, October 11). Final Recommendation Statement: Anxiety in Children and Adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents#:~:text=The%20USPSTF%20recommends%20screening%20for,aged%208%20to%2018%20years.&text=The%20USPSTF%20concludes%20that%20the,children%207%20years%20or%20younger

  3. Health Dunn Right. (2022). Dunn County: Community Health Needs Report. https://drive.google.com/file/d/18Jl7lt6l8hIHfRRRagytp4sWR8fgf6TK/view

  4. Mauseth, Kira. (2022, December 6). When is the Crisis Really Over? Resilience for Crisis Line Staff and Teams [PowerPoint slides]. Northwest MHTTC. https://mhttcnetwork.org/sites/mhttc/files/2022-12/12-6-22%20PRESENTER%20SLIDES%20When%20Is%20the%20crisis%20really%20over%20Crisis%20Line%20Staff%20%26%20Teams.pdf

  5. Boston University – Diversity & Inclusion (n.d.). [Infographic originally posted by @Restoringracialjustice on Instagram, depicts the differences between “reality, equality, equity, and justice”]. Retrieved December 30, 2022, from https://www.bu.edu/diversity/resource-toolkit/inequity-equality-equity-and-justice/

  6. World Health Organization (WHO). (n.d.). Health Equity. https://www.who.int/health-topics/health-equity#tab=tab_1

  7. Data USA (n.d.). Dunn County, WI. https://datausa.io/profile/geo/dunn-county-wi

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