Rural Health Just One of Many Topics to Be Discussed at Rural Futures Conference

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By Mary Kay Quinlan and Kim Peterson

Murlene Nollmeyer Osburn likes to tell people there’s dirt in her veins, from the sugar beet farm in eastern Montana where she grew up to the Sandhills ranch she now calls home near the Cherry County village of Wood Lake, population 64.

“We are so isolated, but I love it that way,” Osburn says.

But much as she loves her rural home, with its wide-open vistas of newly mown hay meadows and fall-born calves, so also is she passionate about her newly earned opportunity to bring mental health services to a desperately underserved area.

In addition to being a rancher, Osburn, 53, is a registered nurse who earned a master’s degree last year from a federal grant-funded University of Nebraska Medical Center program to train psychiatric nurse practitioners as a way to bring mental health services to rural Nebraska counties, the overwhelming majority of which have no practicing psychiatrists.

Psychiatric nurse practitioners can diagnose mental disorders, from schizophrenia to common depression, work with children who have ADHD, provide counseling and help patients manage what Osburn calls “head meds.”

Osburn was working in a Mullen, Neb. nursing home when she saw an ad in the Hooker County Tribune offering psychiatric nurse practitioner training while staying at home. She thought it was a scam. But when she called the number, which turned out to be at the University of Nebraska Medical Center, she was assured it was most definitely not a scam. So she applied and had a three-hour interview in Omaha in April 2010 while a neighbor waited outside in the pickup truck.

Osburn started the program that fall. She attended classes via computer and accumulated more than 500 required clinical hours by spending three days a week in Hastings with psychiatric nurse practitioner Cathy Phillips at the Mary Lanning Center for Behavioral Services. She accompanied Phillips on her visits to small area communities, providing mental health outreach and access.

Neighbors helped with the day-to-day realities of running a ranch and getting her school-aged children off to school on the days she was in Hastings.

To Osburn, the need for mental health services in rural areas is deeply personal. Two incidents in the fall of 2009 motivated her interest in the UNMC program. That October, Osburn recalled, her best friend in Wyoming committed suicide. The woman was in an abusive relationship and talked to Osburn for two hours before killing herself. “It was her goodbye phone call,” Osburn said.

The following month, a neighbor’s wife, who had suffered from schizophrenia for years, died, despite her husband’s efforts to get help.

And Osburn herself knows what it’s like to deal with mental health issues. One of her sons was killed in a 1997 accident on the Montana sugar beet farm where she lived with her first husband. She also knows firsthand what it was like to live with an abusive second husband, whom she subsequently divorced.

Osburn finished her master’s degree in December 2012, passed the required state test and is waiting for her new psychiatric nurse practitioner credentials to arrive in the mail. When they do, she’ll be in uncharted territory. She envisions essentially starting her own business, perhaps spending a day in Bassett, another in Ainsworth and another in Valentine, seeing patients and visiting area nursing homes.

If you live in the Sandhills, the nearest psychiatrists are in Kearney and Hastings, and patients might have to wait two years for an appointment, Osburn said, adding: “No psychiatrist is ever going to practice here. You need people like us … to fill the need.”

Psychiatric nurse practitioners, like all advanced practice nurses, are required under Nebraska law to have what amounts to a contract with a collaborating physician, which can cost up to $2,000 a month, Osburn said, a challenge she and a colleague in O’Neill are exploring.

Another barrier to mental health care in rural places is the nature of rural people themselves, whose sense of independence and pride in their strength of character often makes them reluctant to acknowledge mental health issues.

One way to overcome that reluctance, Osburn said, “is by talking about it, being frank about my own struggles.”

Things happen to people that are hard to cope with, moms struggle with postpartum depression, people suffer from domestic abuse and families try to deal with children who have behavioral problems—in rural areas just like in cities.

“Everyone struggles and everyone needs support when they struggle,” Osburn said.

With her new degree as a psychiatric nurse practitioner, Osburn will be in a position to help people with such struggles. And she’s adamant that she never would relocate to an urban area—or even a bigger town.

“At the end of the day, I need my feet on the ground,” she said. “Agriculture keeps you grounded. It keeps you real. It keeps you connected to real people. This is my life.”

Rural health is just one of the topics that will be discussed during breakout sessions at the Rural Futures Conference that will be held Nov. 3–5, 2013 in Lincoln, Neb., at The Corn husker, A Marriott Hotel. Other breakout topics will include youth retention and recruitment, entrepreneurship, service learning and civic engagement, rural land use, as well as an open space session for participants to discuss topics and complexities not specifically addressed elsewhere in the conference agenda.

Registrations are coming in fast, so individuals are encouraged to register soon before the conference venue reaches capacity. View the conference agenda at ruralfutures.nebraska.edu/conference to learn more about opportunities to engage at the conference.

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