PINEVILLE, W.Va. -- Every other month, Tanya Nelson travels 32 miles from the heart of Appalachia's coal country for an appointment with the nearest psychiatrist for therapy and to renew prescriptions. But the commute, which should take less than an hour through the winding mountain roads of southern West Virginia, consumes her entire day.
Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she does not drive, so she must use a van service to keep her appointments. It makes numerous stops along the highway, picking up other travelers, and usually doesn't return to her home in New Richmond, W.Va., until day's end.
"I'll call and tell them I'm ready (after my appointment ends), but they tell me they're waiting for someone else," Nelson said as she described a typical trip.
Nelson is among many area residents who do not drive. Patricia Hagerman, 63, of nearby War, W.Va., has relied on her sister for the past 11 years to drive her about an hour each way to the nearest psychiatrist -- in Princeton, W.Va. She makes the trip once every two months for depression and anxiety treatment.
"I don't want to go," Hagerman said, "But I do go. (Seeing the psychiatrist is) worth the trip."
Getting mental health services here is fraught with challenges. But the need is great.
There are no psychiatrists in Wyoming County. A handful of small, general medical practices and a few behavioral health specialists handle services for the 21,763 residents. Patients' issues -- ranging from depression, anxiety, addiction and other mental health concerns -- are aggravated by the local economic downturn.
Dr. Joanna Bailey, who practices family medicine here and treats patients covered by Medicaid, said the lack of mental health care access puts her patients at a disadvantage.
"As a family doctor, I'm doing way more psychiatry than I am comfortable with," Bailey said. She sends patients like Nelson, who need more specialized help, to the closest psychiatrist in Beckley, W.Va. In addition to the transportation hurdle, it can take a month or more to get an appointment.
Bailey practices in both Wyoming and McDowell counties -- Appalachian areas once fueled by a booming coal industry. Today, much of the local economy relies on tourists coming to use the area's ATV trails. Infrastructure has been neglected. Shops have been boarded up and abandoned. Medicaid enrollment is roughly 35 percent in Wyoming County and 48 percent in McDowell County, according to the advocacy group West Virginians for Affordable Health Care.