Through RISE Counseling, Minor expands mental health services in Elkader

By Willis Patenaude 

According to a variety of metrics, rural America has been and continues to be in the midst of a mental health crisis. This is evidenced by statistics collected by the nonprofit organization Mental Health America (MHA), which noted some of the factors responsible for the problem, such as the fact rural areas have 20 percent fewer primary care providers compared to urban areas, and an alarming 81 percent of rural counties do not have a psychiatric nurse practitioner. 

Additionally, in the Journal of Clinical and Translational Science, a study published in 2020 found an estimated 65 percent of rural counties do not have psychiatrists and over 60 percent of rural Americans live in designated mental health provider shortage areas. The study ultimately concluded rural residents disproportionately suffer the negative effects of living with un-met or under-met mental health needs. 

Moreover, the National Alliance on Mental Illness (NAMI) found fewer than 50 percent of rural adult residents with a mental illness received treatment, just 62 percent with a serious mental illness received treatment and over 25 million rural Americans live in areas where there are not enough providers to meet the demand. 

Stepping into this situation is Micah Minor, who grew up in Elkader and graduated from Central. She has chosen to remain in the community, where friends have become family, where her kids have a “network of houses they feel safe and welcome in,” where she and her husband Joe volunteer. It’s a city that lets her son have his own birthday float in the St. Patrick’s Day Parade.  

“I love that a trip to the grocery store means a conversation with an acquaintance in the checkout line. I don’t have to be lonely for long in this town. The music scene is amazing; the activities like Sweet Corn Days and Art in the Park make Elkader so unique and such a fun place to be,” Micah said. 

But Elkader is also rural and prone to the many negative data points illustrated above. From the moment Micah earned a master’s degree in social work from the University of Northern Iowa, specifically trained in processing trauma, including PTSD, depression and chronic stress, she has wanted to help. 

She initially started working at Keystone AEA in a shared position as a school social worker, helping students through counseling and crisis intervention. Through that, Micah realized that’s what she wanted to do, and she knew she wanted to do it in rural Elkader, where she still saw a need.

“It was extremely important to me to be a therapist in rural Elkader, as well as in surrounding schools. Access to mental health support is few and far between and telehealth isn’t a great option for every age or personal preference. I hope to ease the need for services in this area and I hope that I’m one of more to come,” she said. 

One reason for the need, as cited in aforementioned studies, is the notion that “therapy is taboo,” said Micah. This “fear of negativity,” according to MHA, is a substantial challenge in combating mental health problems in rural areas which already have challenges preventing treatment, like access to care (and affordable care), limited availability of specialists, lack of trained providers, inadequate insurance, financial instability and social and geographic isolation. 

These factors exacerbate already worrying trends among rural residents, including the fact rural states have a postpartum depression rate higher than the national average, according to NAMI, who also found rural youth are at an increased risk for suicide. This correlates with findings of the study above, which found “rural children from small communities are more likely to have mental, behavioral and developmental disorders” than counterparts residing in cities and suburbs. 

Making matters more serious is something else the study discovered: the overall suicide gap that has steadily widened since 1999, with “rural suicide rates almost double those of metropolitan areas for both males and females.” Within that data, the most affected groups are early adolescents aged 10 to 14 and adults aged 25 to 43. 

According to the U.S. Department of Health and Human Services, Iowa experienced the fourth largest rise in mental health issues in 2022, and suicide has become the second leading cause of death among adults ages 15 to 39. On top of that, 89 of 99 Iowa counties reported a shortage of mental health care professionals. 

It’s because of these statistics that Micah stresses the importance of mental health. “I see no difference in going to the doctor for blood work versus going to a therapist to work on the way you think or process something traumatic that happened to you. Our brain is what runs our entire body, and if our brains are full of stress, anxiety and sadness, it has a ripple effect on our entire body,” she stated.

Recognizing the need, while also reaffirming the fact the majority of mental health providers are simply “too far away” for people living in rural areas, Micah knew from the beginning that, when she became a therapist, the question of where she wanted to do it was never open for debate. It was always going to be Elkader. Instead, the question and challenge was finding a company that would support that mission.

In April, after a conversation with a friend, Micah looked into RISE Counseling and Consulting, a group private practice founded in December 2021 in Anamosa by Melissa Paulsen, which provides mental health services with an emphasis on rural areas. Micah contacted Melissa, and according to Micah, RISE “agreed with and supported” her goal to operate out of schools surrounding Elkader, as well as in Elkader. This was made possible with help from Jamie Wingert, also a therapist in Elkader, who helped Micah locate an office space in the upstairs of the Midwest Livestock building next to Alpine Communications.

“RISE is a group private practice setting, which means there is a lot of freedom and flexibility, but instead of being in solo practice, I have a lot of support from coworkers, tons of treatment resources and trainings available to me and the advantage of not dealing with the business aspect of billing insurance, bookkeeping and taxes,” Micah explained. 

Micah has extensive experience working with school-aged children, including kids with behavioral concerns and complex family dynamics. She is also being trained in trauma-informed care, with experience working with inattention, hyperactivity, oppositional defiant disorder, anxiety, depressed mood and adjustment-related stressors. 

Micah will provide office-based, school-based and virtual therapy out of the Elkader office, working with ages 3 and up between 8:30 a.m. and 4:30 p.m. during the week. For those worried about affordability, Micah indicated RISE accepts most insurances, including Medicaid, and also has a contract with MHDS (Mental Health Disability Services), which provides funding for those who are uninsured or can’t afford their cost-share as a secondary coverage option. 

Along with providing mental health services in Elkader, Micah wants to spend time in schools seeing students, hoping to ease scheduling conflicts that often prevent them from getting care. She also wants to offer support groups that will be free to the community “down the road,” while also growing as a professional and spreading awareness about the importance of mental health. 

“Emotional weight tears your body up, affects how you feel day to day and affects the health of your relationships. Therapy isn’t a fix all; it takes work and follow through after the fact. But if someone is up for that challenge, I truly believe it will be worth their while. Every person deserves to feel good—and therapy is a great way to get there,” Micah said.