People suffering from debilitating mental illness call it the “dent-in-the-seat-cushion” syndrome.

Overwhelmed by their illness, they spend their days watching TV in a dark room or hunkering down in bed with the covers over their heads, rarely venturing into the outside world.

Until two years ago, that described Tamara Moulai, a Withlachoochee River Electric Cooperative (WREC) member.

“She isolated herself and had no friends. She had me, but that was it,” says Diane Krueger of her 43-year-old daughter, who also has cognitive disabilities. “She’d make some progress but would only get so far and then bottom out. I’ve spent 20 years searching and fighting for something that would help her grow.”

Moulai is finally getting that support from Vincent House Hernando, a community-based mental health facility that the Dade City co-op was instrumental in opening in 2017.

“I’m more outgoing, and living on my own makes me feel good. I have a place here,” says Moulai, who now lives in her own apartment and works at Vincent House.

Until the Hernando program opened in this hardscrabble part of rural Florida, there were no places to help residents like Moulai toward more meaningful lives with purpose. By using its political clout and its access to financing, WREC helped make the Hernando facility a reality and recently broke ground on a Vincent House in another part of its service area.

At the groundbreaking, WREC General Manager Billy E. Brown said such ambitious efforts are well within the guiding principles of electric cooperatives.

“That’s the co-op’s business: Get out there and improve the lives of people in our area,” he said. “There is a lot of need out there.”

The numbers

In central Florida and elsewhere in rural America, that need often involves access to health care.

Shrinking populations, declining incomes, and staffing challenges, among other factors, are driving more and more clinics, hospitals, and practitioners out of rural areas, opening a widening rural/urban divide in the availability and quality of care.

“Florida ranks 50th in the nation” in mental health funding, says David Lambert, the co-op’s manager of member relations. “Our counties had ranked almost dead last in funding too.”

About 60 percent of “health professional shortage areas” are concentrated in rural counties, according to government estimates. Other recent federal surveys found there are around 40 primary care doctors for every 100,000 people in rural areas compared to 53 in cities; 22 rural dentists versus 30 urban, and a whopping 263 urban specialists per 100,000 versus just 30 specialists in rural areas.

The chances of finding a mental health services provider in rural areas are equally slim. According to a 2018 study in the American Journal of Preventative Medicine, two-thirds of rural counties don’t have a psychiatrist, 47 percent lack a psychologist, and 81 percent don’t have a psychiatric nurse practitioner.

And government numbers show that lack of access to care is having a broad effect on rural quality of life.

Rural Americans are at greater risk of death from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke, according to a 2017 report by the Centers for Disease Control and Prevention.

“It’s safe to say that the disparity in access has taken a toll on the health of rural residents,” says Alan Morgan, CEO of the National Rural Health Association. “Overall life expectancy has begun to drop nationwide in recent years, led by rural, largely the result of deaths related to the opioid crisis.

“Any partnerships looking at innovative approaches to health care delivery in rural areas is the direction in which we need to be headed,” Morgan says.

Vincent House

WREC has leveraged its vast civic and political network to pave the way for Vincent House facilities in Hernando and Pasco counties, two of the five counties it serves.

Vincent House provides transitional job training and placement by partnering with local businesses. Individuals like Moulai also build social and organizational skills by participating in various structured activities.

Pasco Sheriff Chris Nocco spoke at the Pasco facility groundbreaking and emphasized the link between mental illness and crime.

“Eleven percent of our calls for service are mental health related, but that’s just what’s documented. We know it’s much higher,” he said. “We want to divert them from ever being in the criminal justice system. If you have a place like Vincent House providing people hope and opportunity, our community will be a lot better off.”

For the Pasco Vincent House, WREC secured $1 million in a state budget allocation to help with construction. The U.S. Department of Housing and Urban Development awarded about $770,000 in grants, and another $150,000 came from private foundations. A grassroots campaign has pulled in about $291,000, with more on the way.

Withlacoochee began focusing on mental health five years ago after a United Way community survey found residents ranked the issue as their top concern. Lambert says the co-op considered several models before settling on the Clubhouse International concept, which Vincent House follows.

Clubhouse facilities don’t provide psychiatric care, but offer memberships in community-based centers, which number about 320 nationwide and serve about 100,000 people. Members gain autonomy through transitional employment and overcome isolation by helping run the clubhouses.

“It provides recovery through work … in which people come and get job training and other skills to reintegrate into society,” Lambert says. “Once they become members, they’re members for life. Almost like a co-op.”

Each clubhouse has its own referral and application process, but most members learn about the program through a health professional.

Leveraging REDLG in Arizona

For decades, co-ops have leveraged the federal Rural Economic Development Loan and Grant (REDLG) Program to provide funding for medical facilities and equipment in rural America.

Administered through the U.S. Department of Agriculture, REDLG provides funding for projects that create or retain employment in rural areas. Local utilities pass through zero-interest loans to local businesses or create revolving loan funds with grants.

Over the past year, REDLG allocations supporting medical and dental care have surged, from $6.4 million in 2017 to $14.6 million last year, according to an NRECA analysis. Most of that increase has been in loans to help build health care facilities.

“Rural communities struggle to maintain quality health care, and these programs have really made a difference,” says Geoff Oldfather, communications and public relations manager at Arizona G&T Cooperatives (AzGT).

With local partner Southeast Arizona Economic Development Group, the Benson-based G&T cooperative facilitated a $400,000 loan to Benson Regional Hospital to build a family health clinic and a physical, occupational, and speech therapy center.

The facility means patients won’t have to trek 50 miles to Tucson or 160 to Phoenix “for those everyday medical issues that a family doctor would take care of,” Oldfather says.

The board of directors of AzGT member co-op Sulphur Springs Valley Electric Cooperative was involved in the loan approval process for the Benson hospital facilities and another $300,000 loan to nearby Northern Cochise Community Hospital. That funding went toward a system to digitize patient records in its emergency room and other departments, an upgrade that has helped the facility meet federal and state requirements and streamline processes.

“Having patients’ medical history available quickly helps not only with determining a current diagnosis but also by saving time for ER providers,” says Dr. Willard Vannostrand, an emergency room physician. “Otherwise, we have to collect and re-enter all of that medical history into our records.”

Digital health technology

If primary care doctors are in short supply in small towns, high-tech digital diagnostic technologies may as well be on the moon. But in Wyoming, one of the nation’s least populous states, two co-ops are participating in a pilot program that could bring advanced medical imaging technology to every co-op headquarters office in the state.

Powder River Energy Corp. in Sundance and High West Energy in Pine Bluffs will soon install permanent body scanners at their headquarters. The non-invasive devices use 3-D sensors, computers, and artificial intelligence to capture and analyze data points and body and posture measurements. Results are sent to employees and physicians for evaluation and follow-up care.

“We want to be more proactive when it comes to employee wellness,” says Brian Heithoff, CEO and general manager of High West Energy, which in August will make the service available for employees at the co-op and two subsidiaries. “I see it as a way to reduce worker’s comp and health insurance claims over time, in addition to just having a healthier organization.”

Project partners include the Wyoming Department of Health and Wyoming Health Fairs, a nonprofit health service provider, and the Wyoming Rural Electric Association (WREA; statewide).

WREA is helping connect other member co-ops to the project partners through a working group.

“Initially, we thought about doing it just for our employees, but then looked at the bigger picture of what we could offer to not only our members, but even those folks in rural communities not served by us,” says Shawn Taylor, WREA’s executive director.

Joel Corcoran, executive director of Clubhouse International, says such co-op efforts to improve rural health care have impacts that far outlast any immediate need.

“What you’re doing here is not only going to help people in this community today but people being born in the hospital today and next year,” he told the gathering at the Vincent House groundbreaking in Florida. “You are changing this community forever.”

Listen to a recent podcast on co-ops and rural health care: