Rural Mental Health Crisis: Barriers to Care & Solutions with NAMI Northwoods

In this episode, I sit down with Tracy Schlegel, Executive Director of NAMI Northwoods (National Alliance on Mental Illness), to explore the unique mental health challenges facing rural communities.

From limited access to care and workforce shortages to stigma and isolation, rural populations often experience significant barriers to receiving mental health support. Tracy shares insights from the frontlines, and discusses solutions for underserved areas.

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Rise Above: a podcast from Rogers Behavioral Health takes listeners on a journey of education and inspiration as we sit down with mental health and addiction experts and past patients who are changing how the world views mental health and addiction.

Tracy Schlegel: 00:01

We help our neighbors. We do good things. And this is one of those things that we can help our neighbors through also.

Andy Meddaugh: 00:11

You're listening to Rise Above, a Rogers Behavioral Health Podcast, where we sit down with Rogers experts who are changing the way the world views mental health and addiction. Hello listeners. Welcome to another episode of Rise Above, a podcast from Rogers Behavioral Health. I know on this podcast we talk a lot about stigma when it comes to mental health programs, but what we don't really consider is the stigma that comes with living in a rural community. Now one thing I know about rural communities is that strength is often defined by self reliance, by pushing through and handling things on your own and not letting others see when you are struggling.

Andy Meddaugh: 01:02

But that mindset can also make it a lot harder to talk openly about mental health. And that stigma when you're in a close knit community can make barriers to getting help feel even heavier. To talk more about that today, I'm joined by Tracy Schlegel, Executive Director of NAMI Northwoods. It's an organization dedicated to eliminating mental health stigma and building understanding, connection and hope across rural communities. Tracy brings years of experience working alongside individuals, families and communities to create meaningful, locally grounded change.

Andy Meddaugh: 01:34

Tracy, thank you so much for joining me today.

Tracy Schlegel: 01:37

Thank you for having me.

Andy Meddaugh: 01:39

So before we get started, let's talk about NAMI in general. Can you explain NAMI?

Tracy Schlegel: 01:45

Sure. NAMI is the National Alliance on Mental Illness. NAMI Northwoods is an affiliate in Wisconsin that services Marathon, Lincoln and Langley Counties. NAMI is an organization who envisions everyone that lives with mental illness or loves someone with mental illness can lead a healthy and fulfilling life. And we do that by supporting people through support groups.

Tracy Schlegel: 02:14

We educate family members and people that live with mental illness and communities, and we advocate for fair treatment of people that live with mental illness. And by doing all of these things, we really try to raise awareness in communities to help ideally eliminate stigma.

Andy Meddaugh: 02:36

Great. And now speaking of stigma, alright, can you maybe break down stigma in mental health? What is the general stigma around mental health?

Tracy Schlegel: 02:47

There's a lot to break through with stigma when it comes to people that live with mental illness. A lot of times, I personally live with mental illness. I have since I was a child. When I was initially diagnosed when I was 13 in 1984. So I'm 54 years old.

Tracy Schlegel: 03:06

I don't want anybody to have to do any math. But it's you know, back in the eighties, you didn't talk about mental health. You didn't talk about mental illness. And we still see a lot of that today with my generation, which is Gen X and older. And a lot of that is, we were taught to just handle things.

Tracy Schlegel: 03:28

One of my favorite expressions is, just rub some dirt on it, eat fine. A lot of people have, even if they don't realize it, they have bias and beliefs that they've heard since they were young, that maybe mental illness is actually a keratzla. Someone's just lazy or just lying. And that's a lot to have to face when you think you might need treatment for mental illness.

Andy Meddaugh: 04:01

And today we're talking about stigma in rural communities. Is it different in rural communities or are there specific challenges that we find in rural communities that we don't find in more urban settings?

Tracy Schlegel: 04:15

Well, I think that one of the biggest challenges when you're talking about rural mental health is that everyone really does know everyone else. And so you're really very visible to other people. And if you've grown up or a lot of people that live in rural Wisconsin have lived there forever. So if you've grown up in that, it's hard to go somewhere where someone might see your car parked outside a therapist's office or, you know, maybe your therapist would know your kid's teacher, you know, you have kids in the same class, things like that. So there's a lot more visibility to asking for help and seeking help in rural communities.

Andy Meddaugh: 05:07

And would you say that that results in people not seeking help?

Tracy Schlegel: 05:13

I think that's one of the big reasons. A lot of people just handle it. They just deal with it. Unfortunately, sometimes it gets to a point where that's just not enough and you do need professional intervention. In rural communities, self reliance is a big thing.

Tracy Schlegel: 05:35

You know, when we when we think of rural Wisconsin, we're thinking of farming, we're thinking of, you know, small town living kind of things. And a lot lot of the time there just isn't any access to any kind of services, at least within a reasonable drive. Or, you know, there's a big push for telehealth, but, you know, there are a lot of Northern Wisconsin locations that don't even have stoplights, let alone broadband. Stigma is a big one, but there are a lot of access reasons also.

Andy Meddaugh: 06:14

And I would say that maybe that leads to someone saying, well, you know, we don't even have, you know, a place where I can get help around here so maybe that's telling me that it's not necessary in this community. We don't have issues like that here.

Tracy Schlegel: 06:29

Yeah. Well, and it makes you think that we tell people, you just have to ask for help, but who do they ask? When there is no one, I know I'm familiar with at least one county in Northern Wisconsin that doesn't have a psychiatrist at all. Then a lot of times you are hoping that the doctor you're seeing, maybe a primary care provider that you're seeing is able to or comfortable with dispensing medications to help you. A lot of times that's not the case because you know, they just don't have the experience to to confidently dispense with medications to people.

Tracy Schlegel: 07:15

So there's there's a lot.

Andy Meddaugh: 07:17

Would you say people in rural communities are they're reaching out to people that maybe aren't equipped to deal with what they're dealing with.

Tracy Schlegel: 07:26

Really interesting, after nineeleven there was research done, and granted there has been some time that has passed since then, but at that time, pastors, religious leaders were the number one person or people that someone who was maybe having some issues would reach out to. And I think in smaller communities, that's probably still pretty accurate. Although we have seen a lot of reduction in religious organization membership. The working, I know NAMI works with faith leaders. I know a lot of organizations do and a lot of organized religions have really started focusing more on mental health and mental illness so they can be more helpful and be better research points for the people that care for.

Andy Meddaugh: 08:26

So I guess that kind of leads into, would you say that attitudes are changing about mental health?

Tracy Schlegel: 08:35

I think that they are. I think it's a very slow go and I put a lot of faith in our youth.

Andy Meddaugh: 08:43

Okay, yeah.

Tracy Schlegel: 08:44

It's not that I've given up on adults completely, but I really enjoy spending time with youth because they're very open and they want to talk about things. And when I first started this job just over three years ago, I never had any intention of focusing on youth mental health. I was an adult, you know, I'm an adult. This is what I do. But in the last couple of years, we also support Raise Your Voice clubs in high schools and middle schools.

Tracy Schlegel: 09:16

And I've seen how these kids develop these significant relationships with their peers where they do feel safe talking about these big emotions that they have that sometimes they just don't know how to process. I mean, we're adults and we have days where we don't know how to process emotions. I want to go back to being 14, 15, 16 years old, especially now. There's a lot out there to deal with and a lot of these kids are doing it really, really well. And they're also advocating for resources in their schools with legislators and they're just just the leadership level of these kids is amazing to me.

Andy Meddaugh: 09:58

And you kind of mentioned how they talk about their own mental health. How does the language we use when we talk about mental health, how does that change perceptions?

Tracy Schlegel: 10:09

One of the things that you and I can focus on today because there's so much language out there that, you know, contributes and also helps reduce stigma, but one of the big ones is probably how we talk about suicide. And when we talk you know, we have a hard time talking about suicide as it is. And I think one of the the things I always like to mention and because so many people when they talk to me, talk about how so and so committed suicide. And when we talk about suicide, we need to eliminate the word committed because it's not a crime. Some religions do view it as a sin, but overall, it's not something that a person intentionally does.

Tracy Schlegel: 10:56

What people don't realize is that when it comes to mental illness, when it comes to substance use, there's a pain from the symptoms. And those symptoms are the symptoms of depression, the symptoms of anxiety, the the symptoms of bipolar or schizoaffective disorder. They're not behaviors. They're symptoms. And when those symptoms get to be too overwhelming, that's when suicidality starts to, come into into their thoughts.

Tracy Schlegel: 11:31

When we talk about suicide, we should be framing it a little more gently. They completed suicide. Because, again, committed sounds so purposeful and so wrong and really it's a time for a person who has just had enough. When it

Andy Meddaugh: 11:58

comes to suicide in rural communities, are there any strategies that you're using to help in that area?

Tracy Schlegel: 12:07

The number one, I guess you could say, method of completion of suicide in our area and surrounding Northern Wisconsin communities is firearms followed by overdose. When it comes to suicide, we'll say specifically Marathon County, more than fifty percent of completed suicides are men aged 50 and over and they're completing using firearms. And I think that one of the things that we really need to take into consideration is how are we working with men to help them with their mental health? Aging is hard for everyone, but in rural areas, you are told to be helpful but when you have a certain level of resilience and self reliance and maybe as we get older, well, you know, there's a lot of aches and pains and a lot of health concerns and we are maybe just not conveying to men that it's okay to get help and we need to do a better job of that. And we need to really focus on people that have access to lethal means of like firearms, medications, things like that.

Tracy Schlegel: 13:42

Making sure that they have an awareness themselves that, hey, now might not be a good time for me to have all of these medications at my disposal at any time or these firearms near me. For our loved ones to kind of recognize maybe when they need to suggest some measures just to separate from those lethal means until till things kind of quiet down a little.

Andy Meddaugh: 14:12

And we will be right back. We don't talk enough about mental health later in life. Big changes like retirement, health issues, grief, or caregiving can really take a toll. And a lot of people feel like they're supposed to just push through it. LifeWell at Rogers Behavioral Health is an inpatient mental health program created specifically for adults 55 and older.

Andy Meddaugh: 14:34

The care is age specific, compassionate, and focused on helping people feel stable again, surrounded by peers who are in a similar stage of life. If you or someone you care about needs support right now, help is available. You can learn more or request a free screening at rogersbh.org/lifewell or call [phone]. And now back to the interview. How large of a problem would you say substance use is in rural communities?

Tracy Schlegel: 15:08

You know, it's just as large as is in any other community, if not Because when you're you know, in Wisconsin, it's so socially acceptable to binge drink, and it's also socially acceptable to be that person sitting in a bar at 04:30 after work until, you know, six, 07:00 having a few drinks and then head home. But when that's a seven day a week routine, that's kind of a it's kind of a an issue. But, you know, I think that we've also seen, you know, in the last, what, decade or so, homegrown substances, you know, methamphetamine can be made, things like that. And I think in rural areas, sometimes that might be a little bit easier to conceal when you live out in the middle of nowhere. Sure.

Tracy Schlegel: 16:01

You know, it has to come from somewhere, and there's always someone. But another unfortunate truth there is not only stigma to get help or not realizing it's a problem because it's what everybody does, specifically to drinking, but where do you go for help? That's another one where there really aren't any treatment programs available to people. Even here in Wausau, there is no medical detox facility and I was just in a meeting a couple of weeks ago where without that medical detox facility, by the time someone has detoxed themselves enough to be able to get into any kind of programming, a lot of times you've missed the window and they're not interested or they've used again or drank again to not go through withdrawal on their own. We have a lot of missed opportunity when it comes to giving people help for substance use in rural Wisconsin.

Tracy Schlegel: 17:08

And it's as big a problem here as it is anywhere else.

Andy Meddaugh: 17:12

I imagine one of the big factors is you mentioned earlier that in a small community, everyone knows each other, but it can also be really isolating.

Tracy Schlegel: 17:20

Yes, it absolutely can. We talked about resilience, we talked about self reliance, and a lot of times those are really great characteristics to have, but when they turn into isolating, that's when it's a big problem. The thing about it is that what people need to realize is that you can be strong, you can be functioning, you can be doing the things you have to do and still need support and that's okay. Those things are opposite. They work in tandem and that's all part of beating the stigma and quite honestly, meeting people where they are because if someone has to drive an hour and a half to see a therapist or a doctor, Yeah, if someone has to wait six months to see someone for help.

Tracy Schlegel: 18:23

If they don't have very good internet, we're not doing our job meeting them where they are.

Andy Meddaugh: 18:29

So we've talked about lack of access to care, the heavy stigma. Are there any barriers we're not talking about yet?

Tracy Schlegel: 18:38

Well, just in general, there's provider shortages, Serious provider shortages.

Andy Meddaugh: 18:45

So with the heavy stigma in rural communities, how can someone in your position or somebody else that's talking about mental health come in without feeling like an outsider?

Tracy Schlegel: 18:56

The first thing I do is I bring donuts. That's instant.

Andy Meddaugh: 19:02

Okay. Donuts. Donuts are the key.

Tracy Schlegel: 19:04

You know, we've got some really good bakeries around here, and so, you know, I rely heavily on on that. Snacks are always good, but honestly, one of the things I don't know if you I don't it's not really a secret weapon because if you stand next to me for more than thirty seconds, I'll probably bore you with the story of living with mental illness myself. But when I because, you know, I do this quite frequently. I'll go out and groups will ask me to speak about NAMI, and I will tie in my own personal story of living with mental illness for more than forty years. And it's easy for me because it's my story, and it gives me credibility because I've lived through this.

Tracy Schlegel: 19:48

And one of the things that NAMI does is we empower people to share their stories because, you know, our one of our big catchphrases is you are not alone because you're not. You know, there are so many people like me out there that deal with these chronic diseases that have no cure, but still live fulfilling and quite honestly, I'm pretty passionate about my work and have great support, but not everybody has that. And, you know, what I wanna do is find that for other people. And so that's what I try to convey to communities, you know, sharing the struggles that I've had, but also sharing my wins. And every time I do, there's one at least one person in the room, whether they tell me or not, that feels empowered to get help for themselves.

Tracy Schlegel: 20:44

And, you know, if it's one person out of a 100, it's worth it.

Andy Meddaugh: 20:49

And we will be right back. If you're a veteran or first responder, you're used to being the ones others rely on. But carrying the weight of trauma, stress, or burnout on your own can take a real toll. Firewatch at Rogers Behavioral Health is a mental health program designed specifically for veterans and first responders. It offers structured, evidence based care for things like trauma, PTSD, depression, and anxiety.

Andy Meddaugh: 21:19

The program is built around understanding the culture, the experiences, and the stigma that can make reaching out feel hard. If you're ready to talk to someone who gets it, help is available. Learn more or request a free screening rogersbh.org backslash fire watch. And now back to the interview. So someone listening right now who says, wow, that sounds like me.

Andy Meddaugh: 21:45

I live in a small town, and I really should seek help. Where do they start? How do they you know, where do they go from here?

Tracy Schlegel: 21:53

You know, in places that I'm not familiar with, the best resource anywhere in the state of Wisconsin is nine eighty eight. The great thing about nine eighty eight is that it's not just for suicide or substance use or mental illness crisis. They, just as much as I, want to keep people from the ledge, And we wanna do everything that we can to keep people, to get them the help that they need when they need it. And, the counselors, for nine eighty eight are here in Wisconsin, and they are able to connect you to resources. They are able to listen to you talk about relationship struggles you're having, the financial struggles you're having, and they can help you work through some things.

Tracy Schlegel: 22:39

So it really is a valuable resource.

Andy Meddaugh: 22:41

And now what if someone's listening and they themselves feel okay, but they think they know someone who might need help. What does being a good ally look like in a rural community?

Tracy Schlegel: 22:52

There are One of the things that I was hoping you would talk about is what elements do we have in rural communities that very can helpful. And we've recently, right outside of Wausau, we had a tornado in Ringgold, Wisconsin. And our community came together crazy to help these people. And that's what we do. We take care of our own.

Tracy Schlegel: 23:20

And what I would you know, we already have those things in rural Wisconsin in small communities. We know everyone. Know, we we help We our do good things. And this is one of those things that we can help our neighbors through also. Like to think of it as going back to being better nosy neighbors.

Tracy Schlegel: 23:47

I am a very nosy neighbor covertly, but I still keep tabs on what's going on in the neighborhood. I like to think that if I lived in a small town and I knew of everyone, if I saw that someone was maybe acting, things were just out of character that I would reach out. And and I think that we have to ourselves that we are one of our best assets when it comes to helping people that might be having a hard time.

Andy Meddaugh: 24:15

I feel like you just answered my next two questions right there because I was going ask what gives you hope about the future of mental health in rural communities. You saw it in action, you saw a community come together, right?

Tracy Schlegel: 24:28

And that happens so often. One of the classes that we have is called Family to Family Class and it's facilitated by family members who have gone through the class. They have a loved one who lives with mental illness. And one of the examples they use is or one of the things they talk about is when you share that your loved one has mental illness, what are the reactions you get? As opposed to when you share that your loved one has cancer, what are the reactions you get?

Tracy Schlegel: 24:59

And the one that always sticks in my head is, you know, with the cancer diagnosis or the the broken leg or anything along those lines, inevitably someone will bring a casserole because this is the Midwest. But when it comes to mental illness, people don't know what to do. But I can tell you people that live with mental illness eat. So a casserole would be a really nice gesture. But those people just seem like they still don't really know how to react.

Tracy Schlegel: 25:27

And I think we do know how to react. We've just been not reacting for so long.

Andy Meddaugh: 25:35

So what message would you want someone who's struggling in silence right now to hear?

Tracy Schlegel: 25:43

You don't have to struggle alone and you don't have to wait until things get worse to deserve any kind of support. No matter how alone you feel, there are people that care and there are resources that exist, and you matter. And if you reach out, we will get you help.

Andy Meddaugh: 26:09

Tracy Schlegel, thank you so much for joining me today. This has been a great talk, and I appreciate you stopping by.

Tracy Schlegel: 26:16

Thanks for having me.

Andy Meddaugh: 26:19

Well, listener, if there's one thing that I took away from this conversation today, it's that reducing stigma doesn't require grand gestures. It starts with listening, with language, with creating spaces where people feel safe. And according to Tracy, sometimes it starts with snacks, donuts, or a casserole. But that all makes sense. The support you give someone when it comes to mental health can be the same type of support you give someone when they're dealing with all sorts of different issues.

Andy Meddaugh: 26:50

If you'd like to learn more about NAMI Northwoods, access mental health resources, or find ways to get involved, I'll include links in the show notes. And if this episode resonated with you, consider sharing it with someone who might need to hear it. Because conversations like these are how change begins. And for everyone, if you're still here with me, thanks for listening to another episode of Rise Above, a podcast from Rogers Behavioral Health. Be sure to like and subscribe to be notified of new episodes.

Andy Meddaugh: 27:17

As always, if you or someone you care about is struggling with a mental health or substance use disorder, visit rogersbh.org for a free mental health screening. Until next time, thank you so much for listening.