Canaries in the Coal Mine: The Importance of Eliminating the Separation Between Psychiatric Care and Addiction Treatment in Appalachia
Canaries were used for decades in the coal mines as sacrificial carbon monoxide detectors for the coal miners plunging into the depths to earn a living. These birds would serve as an omen of something that was invisible and deadly. As an ode to Appalachian folklore, Appalachian communities have very much become a canary in a coal mine for pharmaceutical companies and, dare I say, insurance companies, as the disposable and invisible birds to prey on for profit. And now, Rust Belt and Appalachian communities are still left tending to that damage and witnessing its’ evolution.
As we reach late stages of the opioid epidemic as a nation, the severity of substance use disorders have only increased because the duration of the disease has lengthened for those that have not died or crawled out of the trenches. Scioto County specifically has been assigned as a “distressed county” per the Appalachia Regional Commission (COSSAP Demonstration Projects, 2022), due to the severity in impact of the ongoing opioid epidemic and the need for response and resources. As this continues to be the trajectory, the ongoing separation that is made between mental health and addiction is an assumption that contains a lack of knowledge and understanding about the progression and enmeshment of the two. There is a distinction that is applied to separating SUD and other mental health diagnoses and needs that should not exist. Now more than ever, there is an increased need for accessibility to mental health/psychiatric services.
Historically, Appalachia is underfunded and forgotten. The unavoidable spotlight on the epidemic has changed that, yet when funding is received, it feels like a lot of times it is just a temporary moment to come up for air, but no one ever has enough resources to get ahead of the current. Sustaining the epidemic and continued severity in the future with the psychiatric care services that are offered at this stage is akin to pushing our heads down deeper into the water in an already drowning system. This is a need that resonates on a national level, and is felt ten-fold in Appalachia with the crossroads of severity, lack of resources, and medical professionals to reduce recidivism and reduce the domino effect of overwhelming other community resources.
Recently, there were fears that SOMC’s plan to restructure their departments included the elimination of psychiatric care services. After reaching out to SOMC, this has been clarified that this is not a decision that was made and that they deeply understand the importance of continuing to serve the community through providing crisis intervention and short term psychiatric services with medication management to assist providers and individuals in the area with getting care they cannot otherwise receive at local mental health agencies. Yet the fear exists, that the progression of the epidemic, toppled with the effects of Covid-19 exacerbating mental health symptoms will create a bubble on top of the opioid epidemic bubble and overwhelm these services that will eventually need assistance in expanding to serve the increased needs of what is to inevitably come.
COSSAP Demonstration Projects. (n.d.). Portsmouth City Health Department. Rural Responses to the Opioid Epidemic. Retrieved March 11, 2022, from https://rural.cossapresources.org/Sites/PortsmouthCity