Although rural living offers peace and quiet for people who choose to live far from large cities, it can also isolate people seeking help in crisis situations.

Local military combat veterans have reported particularly tough circumstances as they’ve tried to connect with mental health services in communities that lack providers who provide specialized care.

Finding a provider who understands the unique issues caused by the trauma of war can be even more challenging in a small community.

Pierce County Veterans Service Officer Ron Montonye told the Tribune, “We are kind of limited right here in Rugby, because of our population, and not having a lot of mental health services.”

As with other services, mental health care can be more easily accessed in larger cities.

Montonye said the US Department of Veterans Affairs has established Community-Based Outpatient Clinics, or C.B.O. clinics, to assist veterans living in remote communities.

“The (US Department of Veterans Affairs) established these community-based clinics, because of the isolated area we live in, and because of the distance so many veterans would have to go to get to Fargo,” Montonye noted. “In our area, the two nearest ones would be Minot and Devils Lake. So, those are available for veterans.”

However, the closest communities with C.B.O. clinics are still about 60 miles from the Rugby area.

Montonye said the North Dakota Department of Veterans Affairs offers free rides to vets who live in Bottineau, McHenry, and Renville Counties for both VA and non-VA medical appointments. Those wishing to schedule rides may call (701) 228-2115, or the Pierce County Veterans Service Office at (701) 776-6178.

Summer Hanson serves as Post 911 Transition and Care Manager for the U.S. Department of Veterans Affairs in Fargo.

“I spent my first seven and a half years working at the VA in our mental health clinic, and we have very specific treatments for PTSD (post traumatic stress disorder) that we offer cognitive processing therapy and prolonged exposure therapy; there are also very specific, evidence-based treatments for other mental health conditions like insomnia, depression, anxiety. There’s a wide range of therapy modalities, and a number of staff,” Hanson told the Tribune. “Now, the challenge is getting that help to Rugby, North Dakota, right?”

Hanson said North Dakota’s state government website, nd.gov, has links to resources for vets needing help.

“There’s the nd.gov/veterans website, and there are resources and information on there,” Hanson noted.

“At nd.gov, on the main page, there’s a bar at the top that says, ‘benefits and services,’ and you can click on that, and then under there, there’s a bar that says ‘mental health,'” she continued.

“And we have our veterans’ line, and if you ask veterans to use that if they’re needing to talk with someone, and that’s 24 hours a day, 7 days a week,” Hanson said.

The phone number for the service, called First Link is (701) 235-7335.

“And there, The first link has an option that’s a great resource in North Dakota, and that’s to call 211,” Hanson said. “That’s also 24 hours a day. Then below that, there’s the North Dakota Cares Coalition.”

Hanson said ND Cares provides information and resources for referrals, provider trainings, and collaboration with state legislators working on veterans’ issues.

Hanson described one piece of legislation affecting veterans: “We have the New Mission Act ,” she said. The New VA Mission Act expands services available from the US Department of Veterans Affairs.

“Basically the rule is that for care in the community to be provided and paid for by the VA, if the person lives over a 60-minute drive time from the VA location, we offer the service. Also, if they have to wait longer than 20 days (for help), they can use our care in the community option. They would need a consult to be placed, or they would need to call and request it through our Care in the Community program. It has to be pre-approved, but once it’s approved, they can seek mental health care through their local community’s provider if they meet those guidelines.”

Describing another option, Hanson noted, “We have a clinic in Minot, and a clinic in Devils Lake. So, if a person wanted to see someone in person, they would probably go to Minot, because we have a therapist there,” she said.

One site is called “Make the Connection”; another is called “Moving Forward,” and it talks about service dogs and grants available to North Dakotans with post-traumatic stress. There’s tons of resources and information down below, also, with a number of links like the military one source, and a lot of other National Guard and human services links.

Hanson said on nd.gov/veterans’ mental health tab, “There’s a link for local vet centers there are probably some vet center options, and they do travel a lot in the state as well, so they may come closer than Minot. A vet center is available to any veteran who served in a combat zone; any veteran who had a military sexual trauma, and also for family members of those veterans.”

Hanson described other helpful links: “One site is called, “Make the Connection”; another is called, “Moving Forward,” and it talks about service dogs and grants available to North Dakotans with post-traumatic stress.”

Hanson also described telemedicine as an option for vets who travel to clinics in Minot or Devils Lake. “(The service) is called CVT to Home and it’s a great option to people who maybe can’t travel, or it’s too much to work into their daily lives to get to those appointments far away,” she said.

Hanson said telemedicine services are delivered through a secure internet connection similar to Skype.

John Butgereit, Clinical Unit Supervisor at North Central Human Service Center, described some of the mental health services the center offers in rural communities.

“We’re (located in) Hartley’s Mall,” Butgereit said. “That office is staffed once a week on Thursdays.”

“We have counseling, and mental health therapy as well as case management out of that office,” he continued. “We have case management for adults and youth alike, and mental health therapy for adults and youth alike. As we continue to develop our telehealth services, we hope to expand our telehealth medication services in that area as well.”

Butgereit said people seeking help should call North Central Human Services at (701) 857-8500 for a screening appointment with the center’s triage unit.

“Depending on what services they’re looking for, our triage unit would assess their needs and determine whether they need to come in for an evaluation, or come in immediately triage would decide that,” he noted.

Butgereit said the center places a priority on clients based on “severity of risk, and financial needs combined. So, we tend to fill a gap where there’s not services provided by private providers in the community, clients may be very difficult to treat by a private provider, then, we’re able to treat them. So, if you’re having a highly severe symptomology, or a financial need, and you’re unable to get services outside of state-run facilities, that’s what we do.”

North Central Human Services also connects people with local resources in their communities, including Alcoholics Anonymous and other support groups.

“I have a community resource list with me now, and it shows there is an AA meeting in the Heart of America Medical Center on the second floor, and they meet Mondays at 8:00 p.m.,” Butgereit said.

The AA hotline provides more information at (888) 680-0651.