The National Alliance on Mental Illness estimates that six percent of Americans suffer from serious mental illness. Bipolar disorder accounts for more “years lost due to disability” than heart disease or cancer, according to the World Health Organization, which rates the disorder as the sixth leading cause of disability worldwide. Research supported by the National Institute on Mental Health found that in a given year’s time, 60 percent of individuals with mental illness will go untreated.

This is especially likely to happen in rural areas like Madison County, Ga., where Bass now lives. The federal government has officially designated the county as a place with a shortage of mental health professionals. Hospitals and doctors are available in nearby counties, but these are far away and a ride is not always easy to find. As a result, people with mental illnesses often get the wrong care or no care at all.

In a state that ranked 45th in overall state agency mental health spending in 1999, budget cuts continue to be made to the Georgia Division of Mental Health, Developmental Disabilities and Addictive Diseases, including for this 2009 fiscal year. “We are in a crisis,” said Advantage CEO Cindy Darden.

Madison County is one of 66 rural Georgia counties underserved in the area of mental health. “There are a lot of communities where they have no mental health professionals at all, in any capacity,” said Katherine Cummings, executive director of the Georgia Rural Health Association.

For Bass, who grew up in Millen, Ga., the closest child psychiatrist was an hour’s drive away in Augusta. Such specialists are still in short supply – no matter where in Georgia a family lives – but in rural areas, “the shortage is exacerbated,” Cummings said.

Georgia Department of Human Resources outsources Madison and 9 other counties’ mental health care to Advantage Behavioral Health Services, a private company. But in Madison, the only facility it operates is for developmental disabilities. People who have mental illnesses must travel –sometimes more than 25 miles.

For most of Amanda Bass’s life, being physically distant from medical treatment has been a fact of life. For years, her parents drove from their home in rural Jenkins County to Augusta so she could be seen by a specialist. Twenty years later, not much has changed. “If you’re able to see somebody,” said Cummings, of the rural health group, “most likely you are making a commitment to travel out of town for all of your treatment.”

Bass was a teenager when she and her family found a doctor closer to home. A psychiatrist who mostly treated adults accepted Amanda as a patient, and she discovered that having a doctor nearby made all the difference. Through a great deal of trial-and-error experimentation, they eventually found a combination of medications that effectively stabilized her mood. “If it didn’t do right,” Bass said of the drugs, “I would go see him and we would try something new.”

“In 2004, I found the cocktail of all cocktails,” said Bass. Although she still struggles with maintaining a job and is currently without one, Bass said she functions much better than she used to, especially in terms of managing her own finances. “It made me feel like I was being an adult finally,” she said. Bass also finds that she tends to her hygiene better and pays more attention to her physical appearance. But not everyone with bipolar disorder has attained the level of stability that Bass has.

NIMH reports that as many as one in five bipolar patients with bipolar disorder commits suicide. “If you look at rural communities,” Cummings said, “most of them are not equipped to deal with severe mental health emergencies” – such as the threat of suicide or actual suicide attempts. For individuals with mental health emergencies where there is a significant distance between their home and the closest mental health provider, unfortunately, emergency rooms must often serve as a holding-station.

EMS has only one option of where to transport patients who have not been medically cleared due to injury or mental state, said Jody LaDuke, a paramedic at the Madison County EMS in Danielsville. “We can’t take anybody, no matter what the problem is, anywhere except for an emergency department,” he said.

“The ER is not where people need to go for mental health services,” Cummings emphasized, but there are often no other options in rural areas. “People end up where they are not supposed to be,” Cummings said.

Jails are another one of these places. The Georgia Sheriff’s Association estimates that at least 20 percent of those incarcerated in county jails have a serious mental illness such as bipolar disorder. “We do have some that definitely have mental illness,” said Capt. Danny Bennett, who supervises the Madison County Jail.

Bass has been to jail more than once, though never for more than 24 hours. In 2002, when she was living in Tennessee, her roommate called the police. “I became extremely violent when I was off my medication, and I ended up assaulting my roommate at the time,” Bass said. Because she did not have an extensive record, Bass was not charged and released the same day.

In Madison County, Bennett said, the jail can petition to have a judge issue a court order to transport inmates who are a danger to themselves or others to the Augusta State Medical Prison, two hours away, where psychiatric services are available.

A new state bill was recently passed on May 4. HB-228 calls for the creation of a Department of Public and Behavioral Health from the Division of Mental Health, Developmental Disabilities and Addictive Diseases and the Division of Public Health. Set to become effective on July 1, the bill would bring higher visibility, more leverage, and better advocacy to mental health issues, Darden said. With more attention focused on mental health issues, for residents like Amanda Bass, effective mental health treatment could become the standard of care.