Mental Health Association launches hub dedicated to improving rural mental health access and education

Rural health includes mental health care.
(Mental Health Association photo)

The Mental Health Association launched a new hub with information and free resources to help rural residents access mental health treatment, reports Liz Carey of The Daily Yonder. The site also provides community members with tools for supporting mental health care in their area.

MHA built its hub to help address the drastic need for improved mental health treatment and education in smaller communities. Carey reports, "About 7.7 million rural adults, or about a quarter (23%) of all nonmetropolitan adults in the U.S., reported having mental illness in 2022, according to the Substance Abuse and Mental Health Services Administration. Additionally, about 1.6 million, or nearly 5%, of nonmetropolitan adults reported having serious thoughts of suicide that year."

While the hub contains many options, its conversational style and easy-to-use format make it approachable. The site's landing page features a "Get Help" drop-down list of information with links on managing a mental health crisis. The site features online mental health tests and surveys to help residents determine what kind of help might fit their situation.

America Paredes, MHA’s chief social impact officer, told Carey, "Based on an individual’s screening results, they have access to a self-guided platform that helps them navigate their mental health journey based on their experience and where they are in their journey."

Resources for communities working to help residents or families cope with mental illness are also available. Paredes told Carey, “We hope this hub serves as a first step for individuals who may feel alone in their experience and organizations looking to support these communities by providing them with free resources.”

Through the hub, MHA introduces rural residents to various care options, including telehealth, which can help them access care from mental health professionals they would otherwise have to drive long distances to see. Joy Jay, executive director of MHA-SC, told Carey, "The acceptance of telehealth has helped others in rural areas reach the help they might not have otherwise had access to."

'Recovery-friendly' employers can help both those healing from addiction and the broader community

Cafes and catering businesses can offer flexibility and
support for people in recovery. (Photo by K8, Unsplash)

By providing a job and a supportive structure for people transitioning into drug-free living, employers are helping their broader community, reports Kristi Eaton of The Daily Yonder. "Rural communities ravaged by substance misuse could benefit from people in recovery being active members of the local workforce, say experts in criminal justice, substance misuse, and labor studies." Sometimes called "second-chance workplaces," these businesses offer employment and a place of meaning without drugs.

Kristina Brant, assistant professor of Rural Sociology at Pennsylvania State University, told Eaton, "[These are] employers hoping to adopt specific policies and practices that are going to be supportive of people who are in recovery from substance use disorder. They want to create an environment that's structurally and culturally going to help people in recovery thrive." Eaton adds, "Stable and meaningful employment is a goal for many people in recovery – not everyone, but many people, she said."

Drug misuse recovery can be harder in rural places because of stigma and a culture of "everybody knows everybody's business." Eaton reports, "Being in recovery can still hurt peoples' chances at getting a job, acquiring a place to live and even making friendships, Brant said. . . . Logistics also play a role. Someone in treatment court may be required to attend court several times a week, and a recovery-friendly workplace would be conducive to that."

Black Sheep logo

Some business models are flexible and can adjust to addiction recovery needs. "Brant said there are many examples of recovery-friendly workplaces. Cafes are popular options. One example is Black Sheep Brick Oven Bakery and Catering, located in Jackhorn, Kentucky," Eaton reports. "The restaurant hires. . . folks emerging from incarceration created by the opioid crisis." Brant told Eaton: "You're serving this dual purpose of creating a place that people know will be a supportive work environment, but also bringing something positive to the community. I think that's a really nice model to focus on."

Douglas Swanson, associate extension professional in the Labor & Workforce Development Program at the University of Missouri Extension, said, "Rural communities and employers have greater challenges due to the shallower pools of available workers." Swanson told Eaton: "You can't hire workers who aren't there. This dynamic puts rural employers in the position of needing to look at the potential an employee may have instead of their past."

It's the start of a long weekend; take a breath and a moment to prioritize mental health, especially if you're a farmer

Roger Wenning and grandson Travis, now gone, spent a day planting.

Perhaps some things need to be repeated to resonate, and reminding farmers and farming families that emotional well-being matters may be one of those items that ought to be on replay.

"Farmers prioritize their livestock, plant and soil health, but among those should also be mental health," Allison Lund reports for Farm Progress. "With stressors so different from other professions, it is increasingly important for farmers to keep mental health top of mind."

Lund's object example is farmer Roger Wenning of Greensburg, Ind. "He has struggled with depression since the loss of his grandson Travis a few years ago and is now focused on sharing his mental health journey to help others," Lund writes. Wennign told her that acknowledging a mental health issue can prompt both supportive and unsupportive responses: "I was told by someone that I trusted, 'You just need to suck it up.' . . . When I was in the deepest of my depression, I got into some situations that were very questionable as far as danger. I could have been hurt or a lot worse."

Lund adds, "When friends started to notice that something was off, they volunteered to drive Wenning to appointments and find resources that could help him. That was when he realized he needed to put his mental health first." Part of his experience was moving past what others might "think about your problem" and prioritizing getting help.

"Wenning explains there is a stigma surrounding mental illness in the farming community, and overcoming that stigma to receive help can prove difficult. Farmers are also typically isolated, which can cause mental health conditions to worsen if left unchecked. . . . During this time, Wenning says he struggled with his faith and found himself angry with God. However, he later found it important to speak with clergy and church members to help with his mental health. He told Lund: "I lost my faith, and working my way back has helped in the healing process. . . . I'm not fully there yet, but I have definitely made strides in the right direction."

To help break down stigma and misunderstanding, "Wenning believes it would be best for mental health to be promoted through field days, flyers at ag businesses and more publicity on the topic," Lund reports. "He also believes that simply being there for friends in need could help tremendously. This can be as simple as talking over the phone." Wenning told her: "Chances are there is a problem, and that's why they called you. They might not be ready to talk, but just sit there and listen."

The U.S. Department of Agriculture has a list of Farm Stress Resources.

Views of mental health among younger rural residents are similar to urban counterparts; both are more accepting

Photo by Nathan Dumlao, Unsplashed

Studies have found that rural populations place more stigma on mental health and its care than their urban counterparts, but those attitudes seem to be changing with younger generations, reports Liz Carey of The Daily Yonder: "New research from the Rural Health Equity Research Centers at East Tennessee State University finds that rural residents are less likely to have negative attitudes toward those with mental health illnesses than previously thought. Prior studies had found that there was more of a stigma around mental illness in rural communities. Younger people in rural communities are becoming more open and accepting of mental health diagnosis and treatment," 

According to researchers Kate Beatty and Michel Meit, "Previous studies found that perceived prejudice against rural residents with mental health concerns not only reduced treatment but that rural residents felt that treatment wouldn’t work," Carey writes.

When Betty and Meit interviewed more than 2,000 rural and urban residents, the responses were revealing: "Rural respondents did not differ significantly from urban respondents when it came to negative stereotypes toward mental illness," Carey writes. “Once you control for age and race, there’s no more stigma about mental illness” in rural communities than in urban ones, Meit told Carey. "The study found that rural residents between the ages of 18 and 29 had the lowest scores on negative stereotypes, while respondents 60 and older had the highest," Carey reports.

The study suggests that the national conversation about the importance of mental-health care is reaching rural Americans through outreach and even pop culture, Carey writes: "Recently, celebrities like Megan Thee Stallion, Prince Harry and Meghan Markle, Selena Gomez, and Michael Phelps have spoken out about their struggles with mental health. These cultural touchstones for younger populations – both rural and urban — may be changing the way people view mental illness."

“One powerful destigmatizing strategy is awareness,” Beatty told Carey. “The more people talk about and normalize mental illness the less stigmatized folks will be.”

Analysis: Rural chronic-illness patients face four broad barriers to treatment that go beyond doctor shortages

Rural residents are more likely to have a chronic illness and more likely to die from it than their suburban and urban peers, in large part because of lack of access to health care. The longstanding shortage of doctors and nurses is partly to blame, but so are widespread barriers to access. A new analysis of 62 studies, recently published in the Annals of Family Medicine, identifies four broad barriers to access rural patients with chronic illnesses face:

• Navigating the rural environment. This includes the financial and physical costs of living far from medical care. Some patients found it difficult to stay in the car for long distances, and some said the cost of gas was prohibitive. Some patients said caregivers weren't able to drive them so far, or that they felt too guilty about the time and cost to ask for a ride. But patients and caregivers in nearly half the studies surveyed said they were willing to drive further away for care because locally available services weren't good enough.
• Navigating the health-care system. Some patients and caregivers described delays in obtaining care because there weren't enough local clinicians. Many also said it was difficult to maintain continuity of care with certain doctors or organizations because of high turnover. And many said they were frustrated with clinics' inflexible scheduling and long wait times while in the clinic (on top of the long drive there and back) that made it difficult to fit a visit into the patients' schedules.
• Financing chronic disease management. Half of the studies analyzed cited patient complaints that health-care was too expensive, when factoring in rural price hikes, the already high cost of health care, hotel and transportation costs, childcare, and time spent away from work. Participants in nearly half of studies citied competing financial priorities such as bills, childcare and other household expenses, and some patients simply accepted that they couldn't afford treatment because of the cost. Many patients who said they couldn't afford treatment said they lived in communities marked by "widespread poverty, a lack of employment opportunities, and a general sense of being 'forgotten' by policy makers." Some subgroups, especially Native Americans relying on the Indian Health Service, said lack of health-insurance coverage made treatment too expensive.
  
• Rural life. Many participants cited tight-knit rural communities as a positive aspect, but that can be a "double-edged sword" for those with highly stigmatized chronic illnesses such as HIV or mental-health disorders. Participants in 13 studies said worries about gossip and lack of privacy kept them from accessing care. Participants in about one-third of studies said that rural values of self-sufficiency and stoicism made them reluctant to seek treatment. And some patients said they felt belittled or stereotyped for being rural. Indigenous patients described western clinicians as often "paternalistic, condescending, and openly skeptical of tribal healing practices" and "inadequately versed in tribal health-related beliefs, communication preferences, and social norms"

The researchers undertook the analysis because these barriers to access haven't been well represented in studies. That's partly because it's harder to recruit and retain rural student participants, and partly because studies about rural health-care access sometimes overgeneralize about rural living, ignoring the wide variance in rural settings and lifestyles.

Syringe program restrictions led to severe HIV outbreak in rural W.Va.; state often leaves local health depts. in the dark

Most residents of West Virginia now live more than 75 miles from a
sterile-syringe program. (Graphic by The Guardian; click on it to enlarge)

West Virginia is seeing a severe outbreak of the human immunodeficiency virus (HIV) that causes AIDS, spurred by state restrictions on clean-syringe programs for intravenous drug users, The Guardian reports. The problem may be particularly severe in rural areas, which now have even less access to the programs.

"Kanawha County, where Charleston is the seat, diagnosed 40 people who inject drugs with HIV in 2020, about as many as New York City, a place 47 times more populous," Jessica Glenza reports. "Last year, the head of HIV prevention at the Centers for Disease Control and Prevention warned Kanawha had the nation’s 'most concerning' outbreak of HIV among injection drug users." Cases began rising there in 2018 after the city restricted syringe programs. Soon afterward, nearby Huntington, then the state, followed suit. Since 2018, nearly half of such programs in the state shut down.

"The new law requires programs to offer a range of health services in addition to the exchange, only serve people with a West Virginia ID card, and aim to get one used syringe back for each new one they give out," Quenton King reports for Mountain State Spotlight.

Glenza reports, "The restrictions mean that almost 1 million people in West Virginia, the state with the highest drug overdose rate in the U.S. for nine years running, now live between 20 and 75 miles of the nearest needle exchange. Meanwhile, experts worry HIV is spreading undetected in rural West Virginia, where testing and treatment is limited."

However, it's difficult to assess the impact of HIV in rural areas: To preserve patients' privacy, the state's health department only releases ballpark numbers, King reports. That means even county health departments are in the dark about the local extent of the problem, and they are generally left out of the loop on HIV cases.

Robin Pollini, a substance-abuse and infectious-disease epidemiologist at West Virginia University, "says that it should be considered a significant concern when HIV appears in any county that previously had no cases, but especially in rural counties where access to care is limited," King reports. "There are actions that counties can take — from ramping up testing to creating harm reduction programs — by just knowing the number of HIV cases popping up in the county."

But local agencies might have a difficult time responding even if they knew about new cases. "With the current landscape — stressed by Covid, underfunded, and with new laws restricting the types of harm reduction programs they can offer — county health departments have few opportunities to address potential outbreaks, even if they see them coming," King.

High HIV case rate in Miss. blamed on rural stigma, lack of broadband/telehealth and reticence to discuss sexual health

New HIV diagnoses are declining in the U.S., mostly because the preventive drug PrEP (pre-exposure prophylaxis) is being used more widely. But diagnoses have remained high in Mississippi, especially in rural areas, because of stigma and lack of telehealth or broadband, Sarah Fowler reports for The Washington Post.

Those factors contribute to an overall increase in rural HIV cases, according to a May 2020 report by the National Advisory Committee on Rural Health and Human Services. Black and Latino Americans are also at a higher risk of becoming infected. 

Mississippi, which is largely rural and has the largest Black population percentage of any state, finds itself at the crosshairs of both trends. "Despite a recent push to install broadband across the state, many still don’t have reliable Internet access. Without it, telehealth services aren’t an option," Fowler reports.

Another problem is that health-care providers are often uncomfortable having frank conversations about sexual health with patients. As Thomas Dobbs, Mississippi's chief health officer, told Fowler: "People don't want to talk about sex in the South."

Rural health-care experts suggest five creative ways the Biden administration can improve rural health care

The pandemic has pushed many rural hospitals and clinics to the brink of bankruptcy, or into it. To reverse the trend, say two doctors who study rural policy, the Biden administration must include rural advocates in policymaking and think more deeply about the root causes of rural health-care disparities.

"The solutions rural America needs aren’t just about expanding broadband or insurance coverage, both of which are critical to extend telehealth and health care access. Rural health care will have to transform to survive and then thrive," Lauren Hughes and Sameer Vohra write for The Conversation. Hughes is the state policy director at the Farley Health Policy Center and an associate professor of family medicine at the University of Colorado Anschutz Medical Campus. Vohra is a pediatrician and the chair of the Department of Population Science and Policy at Southern Illinois University.

Hughes and Vohra suggest five creative ways the Biden administration can improve rural health care:

1. Rethink how providers are paid. Normally hospitals bill patients per service, but a la carte billing encourages hospitals to focus on elective procedures and services that bring in more paying patients (and therefore profit). Pennsylvania launched a program in 2019 that pays participating hospitals a fixed annual fee that covers inpatient and outpatient service. "With a predictable budget, enrolled hospitals can focus on the care their communities need, such as treating addiction, increasing cancer screenings and improving the management of patients’ chronic diseases like diabetes to reduce the need for more expensive acute care. The goal is to reduce costs while improving care," Hughes and Vohra write. 

The Biden administration could help transform rural health care by encouraging creative solutions such as Pennsylvania's, they write. Specifically, the administration could create a division within the Center for Medicare and Medicaid Innovation dedicated to designing and testing solutions to rural problems.

2. Expand mental health and addiction services. Rural residents often have difficulty getting mental-health care. "Expanding mental health and addiction services for Medicare and Medicaid recipients and integrating those services with primary care could improve access and reduce stigma. And that could avoid wasteful spending on preventable hospitalizations and medical transfers to larger facilities," they  write. "One way to do that is to change Medicare’s lopsided billing rules for mental health care."

Clinics designated as Federally Qualified Health Centers or Rural Health Clinics already get higher payments for primary care services to Medicare and Medicaid patients, but FQHCs can bill for a wider array of mental-health and substance-use treatment services than RHCs. "Rural clinics could better address higher rates of behavioral illness and substance misuse if they could fully bill for these services," Hughes and Vohra write. "Changing how telemedicine visits are billed by making them equal to in-person visits would also help rural patients access needed services."

3. Build transformational leadership. Rural hospitals already train and recruit physicians through various incentive programs; such pipeline programs should be created or expanded to bring in innovative health-care administrators. Hughes and Vohra suggest employer-supported master's degree programs and expansion of the National Health Service Corps.

4. Bring back pregnancy and childbirth services and improve them. Fewer than half of rural counties in the U.S. have hospitals that deliver babies. Obstetrics, which has high malpractice-insurance costs, is among the first to be cut when hospitals tighten their belts. But the lack of such services has made it more difficult for rural women to access prenatal care or give birth and increased poor outcomes. 

"The new administration could offset costs necessary for critical access hospitals – small, 25-bed hospitals that exist only in rural areas – to deliver babies through special maternity care payments tied to quality outcomes such as increasing breastfeeding rates," Hughes and Vohra write. "These payments would prevent the temptation for small hospitals to grow expensive surgical service lines to cover financial losses commonly associated with offering maternity care. Such payments would also allow rural hospitals to hire dedicated obstetrics nurses." They also write that more grants through the Patient Centered Outcomes Research Institute could encourage university hospitals to partner with rural health-care providers.

5. Invest in health-promoting rural infrastructure. Crumbling rural infrastructure makes it harder for patients to get health care, and health-care workers to get to work. Though the Trump and Obama administrations improved transportation and telecommunication, "these investments were often viewed as solutions rather than tools for innovation. Rural towns would benefit from infrastructure investments that also encourage healthy behaviors," Hughes and Vohra write. They cite examples of communities that have expanded bike paths and built accessible playgrounds.

Americans report lowest mental-health ratings in nearly 20 years; farmers have trouble reaching out due to stigma

"The coronavirus pandemic and its associated lockdowns, prolonged unemployment, social isolation, and general uncertainty appear to have contributed to a decline in Americans’ mental health—to the point where self assessments have hit a nearly 20-year low," Emma Coleman reports for Route Fifty. "Seventy-six percent of adults now rate their mental health as 'excellent' or 'good,' a nine-point decline from 2019, according to a new Gallup poll that surveyed 1,018 people Nov. 5-19. Since 2001, the polling firm has been surveying Americans about their mental and emotional well-being, and in each of those years, between 81% and 89% of respondents had a positive outlook on their health."

The results are not surprising, considering the pandemic and its economic fallout combined with the coming winter, which can trigger seasonal depression, Coleman reports. But not all Americans saw the same rate of mental-health decline, and one demographic even saw an improvement. 

"Republicans, independents, women, those who never attend religious services, and unmarried people were among the groups that all saw double-digit drops in rating their mental health as excellent," Coleman reports. "Democrats had the least change in their ratings, dropping by only one point compared to last year. Those who attend weekly religious services were the only group to report better mental health this year than in 2019."

Rural Americans are more likely than their suburban and urban counterparts to report mental-health conditions, but less able to access or afford mental-health treatment, and stigma surrounding mental health problems sometimes makes them less likely to seek help.

Farming is one of the most stressful jobs in the U.S., and farmers report some of the highest rates of mental-health issues and suicides of any occupation. But farmers value independence, and it can be difficult for them to reach out or talk about stressors in their lives. In Eads, Colo., for example, a poor growing season has stressed many local farmers, but not many are seeking help, Susan Green reports for the Colorado News Collaborative.

Dawn Beck, a physician's assistant in Eads, told Green her patients "bristle" when she mentions anxiety or depression. "They say 'Well, we’ve been through this before,' even though this is by far the worst year anybody can remember. It’s a pride thing. A cowboy thing. And it’s just eating people up."

Tuesday afternoon webinar will discuss the challenges of HIV/AIDS prevention and treatment in rural America

The Rural Health Information Hub will host a free webinar at 3 p.m. ET Tuesday, Oct. 6, to discuss "recent increases in new HIV infections in rural areas, address barriers to HIV prevention and treatment services, and present on the committee's site visit and policy recommendations," according to the website. Click here for more information about speakers or to register for the webinar.

Specifically, the webinar will discuss recent a recent policy brief and recommendations the National Advisory Committee on Rural Health and Human Services wrote for the Department of Health and Human Services.

The NACRHHS paper made three major policy recommendations: 

1. HHS should modernize the Ryan White HIV/AIDS Treatment Extension Act of 2009 to better meet rural needs. That includes increasing funding to grow existing rural programs and encourage pilot programs, earmarking some funding opportunities for rural areas, giving preference to rural applicants in areas with a shortage of health-care professionals, and expanding telehealth to increase access to services and reduce stigma in rural areas.
2. HHS should increase rural access to pre-exposure prophylaxis for rural residents through the Health Resources & Services Administration's Community Health Centers Program and the Rural Health Care Services Outreach Program.
3. HHS should support a streamlined grant application process for cash-strapped rural providers, as well as more virtual grant-writing technical assistance for rural communities so they have a better chance of successfully applying for HHS funding.

Colorado brings medication-assisted therapy for opioid users to rural areas with recreational-vehicle clinics

One of the RVs and two of its staff in Holyoke, Colorado.
(Photo by The Holyoke Enterprise)

Medication-assisted therapy (MAT) is widely acknowledged to be the most effective way to treat opioid addiction, but it can be difficult for rural residents to access it. Colorado is trying to make it a little easier by deploying six RVs to circulate among small towns with no access to MAT.

"Each RV will have a nurse, an addiction counselor and a peer coach who is in recovery from addiction," Jennifer Brown reports for The Colorado Sun. "The rigs — with satellite capacity — will use telehealth to connect a patient with a doctor who can write prescriptions" for the synthetic opioid buprenorphine. The RVs will also have a bathroom to collect urine samples, a nurse's station, and a private room for counseling sessions.

Buprenorphine can be prescribed for a month at a time, unlike methadone, which must be dispensed at clinics daily for those just beginning their recovery. That means the RVs can help more patients and cover more ground, Brown reports.

Three of the six RVs are already on the road, and the other three are still being retrofitted. "The goal is that each of the six vehicles eventually will see at least 50 patients per week, providing medication-assisted treatment for those who are addicted to heroin or prescription opioids," Brown reports. "Visits are by appointment or walk-in, and staff have been spreading the word at medical clinics, hospitals and shelters."

The RV staff say that being out-of-towners is an asset because it helps bring drug users out of the woodwork who wouldn't admit to locals that they needed help, Brown reports. That may help local leaders realize that their communities have an opioid problem and take action, said Robert Werthwein, director of the state Office of Behavioral Health. He had the idea for the RVs after hearing about a similar effort in New York state.

The Office of Behavioral Health in the Colorado Department of Human Services is funding the project with $6.7 million from a federal State Opioid Response grant. The grant has also paid for almost 42,000 overdose kits, provided naloxone to 16 county jails, helped open clinics, and trained doctors to prescribe buprenorphine.

Transportation, fear of stigma and lack of confidentiality biggest barriers to use of rural syringe exchanges: Ky. study

Counties in study are in red; click on the image to enlarge it.

Rural residents who inject drugs say they are less likely to access syringe exchange programs because of transportation problems, inability to get to the service at times it's open, and concerns about stigma, lack of confidentiality, and law enforcement. So says a newly published study examining barriers that can prevent people who inject drugs (PWIDs) from accessing syringe service programs (SSPs) in Appalachian Kentucky.

The researchers surveyed 186 PWIDs who used their local health department SSPs in three rural counties in 2018: Clark, Knox and Owsley (though Clark is in a metropolitan area, much of it is rural). Kentucky leads the nation in the number of SSPs, partly because it has 120 counties. As of July 2019, it had 52 SSPs that aim to reduce the spread of HIV and hepatitis C by giving PWIDs clean needles and disposing of dirty ones, and often offer more information about addiction treatment services when the person is ready.

Among the study's participants, 53.2 percent were male, 92.5% were non-Hispanic whites, and 78.5% had Medicaid coverage. About 39% said they injected more than one drug; methamphetamine was the single most popular drug, with 45.2% reporting it as the primary drug they inject. The next most popular was non-prescribed buprenorphine, which is sold legally as Suboxone for drug treatment (25.8%), followed by heroin (16.1%), other non-prescribed opioids (11.3%), and various other drugs (1.6%).

The biggest barrier to SSP use was the lack of transportation, with 18.3% reporting it as the primary barrier. Other barriers were: inability to access the program during operating hours, which are often limited (12.9%); concerns about stigma, privacy, and/or law enforcement (9.1%), not enough syringes (5.4%); and the location of the program (4.8%).

Participants' concerns varied based on the degree of their county's rurality. In Clark and Knox counties, the least rural, transportation was the most frequently cited barrier. But in Owsley, the most rural county, fear of stigma and lack of confidentiality ranked highest.

Rurality also factored into participants' consistency in accessing the SSPs. Participants in Knox and Owsley were more likely to consistently use the program than participants in Clark. The researchers believe the more consistent uptake in rural areas is because people in rural areas tend to have higher residential stability. However, Clark County participants may be less likely to consistently use SSPs because they're more likely to have an alternate means of accessing clean needles.

The study is part of a larger National Institutes of Health-funded effort to learn about SSP uptake in rural areas. This study's authors recently published another study about PWIDs in the same three counties, focused on what kind of interventions are most effective and which drug users are most likely to seek treatment.

Project aims to capture the wide variety in Appalachian accents in North Carolina and instill pride in its speakers

Map by North Carolina Language and Life Project; click the image to enlarge it.

If you hear someone talk about an Appalachian accent, you might hear the echo of a Kentucky twang in your head. But accents and terminology vary widely even within Appalachia, which nearly 26 million people in 13 states call home. Mountains foster isolation, which has led to communities even a few miles apart having slightly different accents and vocabulary.

Walt Wolfram, a linguistics professor at North Carolina State University, is trying to showcase the variety in Appalachian speech in his state through the North Carolina Language and Life Project, Cass Herrington reports for Blue Ridge Public Radio.

"We celebrate our wonderful Southern writers, we celebrate our artists, we celebrate our songwriters, but we tend to stigmatize language," Wolfram told Herrington. "One of the things we need to understand is that language is part of our history, it’s part of our tradition and we need to start celebrating that." Because of that stigma, many Appalachians have worked hard to lose their native accent to gain an edge in the workplace.

The project also aims to capture the ethnic diversity that informs North Carolina Appalachian accents, contradicting the narrative that Appalachian means white. In fact, 18.2% of Appalachians were racial minorities in 2016, up from 16.4% in 2010, according to the Appalachian Regional Commission. "But there have been communities of color in the region all along," including the Cherokee, Herrington reports.

The project has produced material that teachers can incorporate in lessons. "Wolfram says he hopes instead of feeling shame, people will be encouraged to celebrate their heritage, to include how they sound," Herrington reports.