“When you’re in a county of less than 7,000 individuals, and you’re hearing about numerous teen suicides, there’s an issue,” said April Anzaldua, director of community services and development with the Community Action Corporation of South Texas.

Anzaldua said her organization first became alarmed when, about two months ago, they heard about yet another suicide in South Texas.

“The thing is the graduating classes are less than a hundred in these communities,” she said. “There’s one high school. So, it really hits the entire adolescent population when they lose a friend and peer, because truly everyone knows everyone there.”

It’s an issue that is facing rural communities across the country.

Recently, the U.S. Surgeon General Dr. Vivek Murthy issued an advisory on youth mental health, saying the pandemic has increased mental health issues in the country’s children.

The report said living in rural areas and having limited access to school or accessing mental health services puts rural children at greater risk of having mental health challenges.

“Since the pandemic began, rates of psychological distress among young people, including symptoms of anxiety, depression, and other mental health disorders, have increased,” the advisory said.

That’s why, Anzaldua said, it was important to create Behavioral Health Outreach and Leadership Development Project, or BHold, a three-year project funded by the Hogg Foundation for Mental Health’s Collaborative Approaches to Well-Being in Rural Communities. Working with Brooks County, the CAC was able to establish a facility that not only provided area residents with healthcare but also provided a place for adolescents to go for mental health and behavioral health treatment.

The project started by creating a coalition to address teen mental health that included teens. After creating a strategic plan around mental health and wellness, the group entered into a partnership with Texas A&M- College Station and Brooks County where the county provided the group with a building, rent-free.

Once they had the building, they had to address the issue of the stigma of mental health in teens. Currently, they have a counselor two days a week, and the schedule is full.

According to the U.S. Surgeon General’s advisory, recent research into 80,000 youth has found that anxiety and depression has increased in teens during the pandemic. As much as 25% of youth reported experiencing depressive symptoms and 20% reported experiencing symptoms of anxiety. Other negative emotions or behaviors, like impulsivity and irritability, also appear to have increased, the research found.

Data also shows that in early 2021 emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls and 4% higher in adolescent boys.

“When we first started this, we knew there was a need,” she said. “When we provided the two days, they were immediately filled up. We truly believe that we could do another day or two and it would fill up. Right now, we have one counselor that travels to two and sometimes three different sites across the counties to provide services to these rural areas.”

Jose Palacios, BHold’s counselor, said he sees first-hand the effects of the Covid-19 pandemic on adolescents.

“After consulting with the parents and child, it emerges that the child is just not coping as best they can with the ongoing Covid concerns,” he said. “Knowing that their whole community is compromised, knowing that their friends could be there one day and be gone the next… just having that awareness coupled with other pressures that any adolescent would have is hard on them.”

Rural adolescents face additional hurdles, he said. Many times, being so far from metropolitan areas with more mental health and behavioral health services means not having access to services. Additionally, rural areas still grapple with significant stigma surrounding mental health issues.

Palacios said he’s able to bridge some of that stigma because of one simple fact – he’s not from around there.

“There’s already the stigma associated with having to see a counselor in general,” he said. “But also, because it is a small community, there aren’t too many outlets… because there aren’t too many counselors here, if (they’re) seeing a counselor, more than likely somebody knows about it. That’s what helps – I’m not from here. I can give that comfort to the folks that I see that I’m not going to take it out into the community.”

Anzaldua said the program seeks to make counseling more accessible to teens in other ways – like making counseling more affordable, decorating the waiting room in a way that makes teens feel comfortable, and providing patients with transportation to counseling during school hours, if necessary and applicable.

Already, she said, some changes are manifesting in the community.

“It’s slowly becoming normalized here,” she said. “Before, in this huge Hispanic culture that we have, you know, you don’t show your feelings, you don’t talk about your feelings. You kind of suck it up. And when kids were reaching out, to family members saying, ‘hey, I need help.’ they would wash them off. So, I think… that this little community is starting to embrace mental health, and that it’s okay to not be okay.”

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