- Hi, I'm Joanna Kail, executive producer of the program you're about to watch.

A State of Mind is a six part documentary series about the mental health crisis in Wyoming.

Wyoming PBS has partnered with Alpheus Media to bring you compelling stories directly from Wyomingites about their struggles, triumphs, and sometimes losses affecting communities across our state.

We hope this series opens minds and inspires hope in anyone who might hesitate to seek help.

Each episode will touch on different aspects of mental health and from different perspectives.

You will hear from veterans, youth, emergency responders and others.

Wyoming PBS is proud to bring awareness to this important topic, and we hope it will inspire you to take a closer look at Wyoming's mental health issues from a new perspective.

On behalf of Wyoming PBS, I'm proud to introduce the premier of a State of Mind episode one, The Cowboy Code.

- Wyoming has built for itself this idea of the frontiersmen.

- Every day you gotta put your boots on one at a time, pull 'em up and get going.

- It's pretty rough and tough around here.

I think most people they're used to just get up and get on with it.

- That tough it out, that rugged individuality.

- It's known as the cowboy code, that concept of being able to meet any obstacle to overcome any task.

- I think when people hear mental health in Wyoming, there's some varied answers.

You're touching the stigma of society when you ask these questions.

- I think people are reluctant to seek help because they're scared to admit that there's something wrong.

- They think you're a crazy person.

- You're looked at as you can't handle it, and it would be an admission of weakness.

- You were taught to just kind of keep your feelings to yourself.

If you needed to go and talk to someone, you would do it in private.

- We all feel alone, and I just wish more natives were able to reach out to each other.

- Wyoming has this highest suicide rate, so I think that we really need to focus here and help people to understand that it is okay to seek help.

- Tell me what's been happening since I seen you last.

- Gossip's gonna happen.

And when you're in a healthier state of mind, that stuff will just roll right off your back.

- We do need to fight the stigma around mental health in the state of Wyoming.

(soft music) - [Narrator] Funding provided by a private donation from Jack and Carole Nunn.

Blue Cross Blue Shield of Wyoming, a proud partner with Wyoming PBS, and other community organizations to provide funding for education to raise awareness of the mental health crisis in Wyoming, reduce stigma around mental health and connect people to available care that promotes positive mental health and hopefully saves lives.

(soft music) - I was out with some friends in the evening, and we were drinking and I had my pickup, there was several people there that did try and get me to not drive home.

Evidently I told 'em I would stay local in my office and I would just sleep it off, but evidently I didn't do that.

Heading now towards Shell, I passed a vehicle, it happened to be some friends of mine and they knew my truck, it was pretty recognizable.

I passed them and went completely off the road, so they decided to follow me.

My friends that were behind me were flashing their lights because I was in the oncoming lane.

(car hooting) The vehicle that I struck saw those lights and they were able to slow down and get off the highway, but what we figure is I was following the lights and I hit them head on.

The computer in my pickup said that I was doing 55 miles an hour.

I've talked to several of the first responders that showed up, they did not think I was alive when they pulled up.

When I came to it was my friend trying to tell me that I was in a bad crash and to sit still 'cause they were really worried about the amount of blood that there was, and they were surprised I even came to.

And the next morning, being told what I did, there were four other people in the vehicle that I struck.

Two of them were life flighted to Billings, and one of them they didn't expect to live, they gave him less than 30% chance to live.

I wished I would've died in that crash because of what I did.

(soft music) - There's not a whole lot of acknowledgement around mental illness, or mental health issues in the state of Wyoming.

I think people tend to try to manage things independently until they can't before seeking help.

- I think if you start maybe a decade ago, mental health conjure the image of the crazy person running through the street, right that really had no idea what was going on.

It was obviously in desperate need of help.

- The stigma is strong, it's just continuously something that I battle every day.

Leaving the reservation for a certain time period and moving down off the reservation, I've seen it in both places that I've lived in.

- We've really worked to break down some of that stigma.

Stigma is a lack of information, it's a fear of being discriminated against, just negative feelings.

For some reason, you just think, oh, mental health.

I don't need to worry about that, I don't need that stuff, those people aren't gonna help me.

- I didn't think that's what men did, I thought men, you know, were supposed to be strong, the leader and it still would've been weak in my mind to take care of those issues.

- It's an interesting thing to live in a place with more cows than people.

- We're classified as frontier for a significant portion of the state by federal agencies.

- You wake up in the morning, and you open up the windows of your home and you get to see what a beautiful world this really is.

The people here support each other, and they're fiercely loyal to their independence, their freedoms that they enjoy.

By the same token, Wyoming has its challenges also.

- There's not a lot of people in this state, Cheyenne's big, but other than that, there is a lot of emptiness and I think that's kind of how some people's mental health can feel.

They're a little empty, they're a little sad.

- It's hard out here, it's cold, and you have to get up and go do things you don't wanna do.

- There's very hard winters here, lots of dark days, lots of wind, snow.

Those things, after a period of time, can be very hard on somebody who's already struggling, say with depression.

- Wyoming's altitude is quite high.

The most recent research on the relationship between living at high altitude, and mental health is very concrete.

Those people that live at these higher altitudes are much more prone to suffering from mental illness and suicidal ideation.

- Wyoming is filled with coal, oil, natural energies, and some of that's been shut down quite significantly, the coal, the oil fields, lot of unemployment based out of that.

Lot of shut down, layoffs, so that has really hit Wyoming hard.

- There's a phrase in Wyoming that it's a big town with very long streets.

So the whole state knows everything about everyone.

- People that have been here for generations have roots, but we also have people that have moved here for that small town atmosphere, so you can know your neighbors.

- The good things about that is that we have all this networking that we can get a lot of work done in the state of Wyoming.

- You know your friends are there to help you, that people wanna see you succeed.

You always know who's in your corner.

- The downside to that is when there is personal struggles, or you're battling something personal that you really do want personal and that you deserve that privacy, it's not welcomed in that way.

- In some of our more rural communities, there might only be one school counselor, or one mental health professional in the whole community.

And so if you're parked outside of their office, people recognize your vehicle, they know that you're going to see them, and it's again seen as a sign of weakness.

It's this sort of open secret, it's clear that our communities are struggling and no one seems to want to talk about it.

- So if someone on the reservation has a mental health challenge, or has an issue come up, who do they usually reach out to first?

- Nobody, but I think also randomly it's people that you just see.

I feel like I've been at a gas station people come up and start talking to me and they dump all of their issues on you all at once.

And they're like, what was that?

And then you don't tell anybody 'cause you don't want to be spreading their business around, and you're just at a loss.

- It's really important to fight the stigma, and to increase access to behavioral health services in our state.

For one, because we have the largest suicide rate per capita in our country and obviously that's very concerning considering our low population.

- Everybody does get sad sometimes, everybody gets down, everybody struggles with things, things happen in your life that kind of throw you off the tracks.

But it's not normal to stay in that place, or to feel like it's weighing you down to the point where you can't function.

My name is Sherra St. Clair, and I'm a psychiatric nurse practitioner at the University of Wyoming, I'm a clinical assistant professor.

It's important to teach nurses about mental health because nurses are one of the most trusted career fields.

Nurses have the ability to engage with people on a really deep level, they can change people's lives.

(students mumbling) - All right, you guys let's reconvene.

So let's talk about stigma a little bit, a little bit more.

I want you to think about in general in Wyoming, what stigma exists, what words would you give it?

- Any mental illness within Wyoming, I think the stigma is it's not exactly real.

They can just fix it, they just have to have a different mindset and that's not always the case.

- People just being like, oh, you're anxious, stop thinking like that.

And I think a lot of us even have heard it, especially anxiety and stuff.

- My class is on mental health, and it kind of focuses on the nursing aspect of professional health.

So what we're doing is we're learning about different disorders.

- Most of these diseases get easier to manage if people feel supported.

So the power of this assessment right here of really digging into this assessment, the power of that can save a life.

- If you think of a specific disorder, you think of the negative side affects, you don't think of the person who has the disorder, you characterize them as the disorder which really puts a negative stereotype on people.

And then on top of that, with the stigma around help, with getting help, they don't wanna be labeled as someone who has schizophrenia, they don't wanna be the schizophrenic of the town.

They don't wanna be the person who's got depression, they don't want the labels that are attached with those.

- This is a very sort of let's get together, and raise a barn kind of place and that falls apart when it comes to mental health.

- In my situation, I hit the front page of the paper, so I couldn't hide from it.

So to go out and seek help, just go do it.

Your health and wellness is more important than a little embarrassment because a little embarrassment from the community is gonna go away.

All four of the people in the vehicle lived, and they're all doing good.

They're gonna have lifelong injuries just like I will, but I'm the one that caused this.

- My name is Kristi Hann, I'm a clinical director at Wyoming Recovery here in Casper Wyoming.

Monte is a gentleman who came to Wyoming Recovery well over a year and a half ago.

When Monte came to us, it was for substance abuse treatment, but we discovered he had quite a bit of PTSD.

- It started probably with my grandfather's death when I was 16.

He killed himself and he was my best friend, and I'm the one that found him.

I couldn't understand why my grandfather decided to do that.

Why would he want to leave me?

It really rocked my world.

We had a farm and I just had to get back to work, so I stuffed it, I stuffed all those feelings.

You can't live by that alone because those feelings need to be dealt with and if they don't, they continue to fester.

I kept stuffing 'em, and stuffing 'em until it just blew up.

- There's strong research showing that adverse childhood events can contribute to patterns of thinking.

When you grow up in a traumatic or abusive home, your brain learns to survive and that's the main focus in your early years with your brain development is to form a pattern that's gonna serve you for the rest of your life.

Sometimes there are neurochemical imbalances, just like if there was elevated blood sugar with diabetes, it's chemicals.

People don't realize necessarily that it's something that can be helped with a medication, or with therapy even and both of those sorts of treatments can make a huge difference.

- My name is Reinette Curry Tendore, I'm the UW Native American Education, Research and Cultural Center program director.

I grew up on the Wind River Reservation, and I'm enrolled in the Northern Arapaho tribe.

I manage the native center here on campus.

What's important for our native students when they come to a university and they leave home for the first time, they need somewhere they can call home and I'm thankful to be able to manage the center that they can call home.

I do a lot of one-on-ones and direct support with our native students.

When they walk into my office, I provide sweet grass and cedar for them to smudge and to bless themselves.

Getting rid of anything negative, and hoping that they connect to their ways and to our creator, and to our grandfathers and grandmothers.

We have a kitchen here, at least every other week we try to have a dinner, a community dinner here where we all cook a dish from home, and bring it into the center.

A lot of our native culture and a lot of the things that we do is around food, so we cook.

There's many nights that I make fry bread.

We find humor in everything ironically even in our hardest, most difficult times, we find humor and that's something that I know has been passed down from our ancestors to this generation now and we still use it because a laugh like they say, laughter is the best medicine, and to us, we really use it as genuine medicine.

I had someone recently tell me that we didn't talk about our problems because of the historical trauma that we've all been through.

We were taught to stay silent, we were taught to keep everything a secret, and now I'm on the other side of it where I'm teaching my young people, and my own children that we need to talk about it.

We need to talk about our problems, I guarantee you it's gonna make you feel better.

And I wanna destigmatize mental health issues and being able to talk about it.

Because like I said, a lot of people in Wyoming are just taught not to.

- We need to start the conversation about mental health for everyone in our community, and it needs to be different discussions based on how you come to the table.

- I take care of myself by coming down here, and taking care of my horses.

I break way rope, tie goats, and run barrels.

It's okay to feel sad every once in a while, but the only way to stop feeling that way is to do something about it.

You don't wanna ride the lows too long, so whatever you gotta do to make yourself happy, do that.

- There's a lot of open spaces, you can go free your mind a little bit.

Whether you're gonna go throw a line in the water, and go fishing or go up and see some of the national parks, how beautiful they are and kinda get away from the city a little bit.

And they can kinda get lonely, and you kind of think you're the only person going through it.

You gotta have a strong mental focus in saying, I'm not where I wanna be, but I'm gonna get to where I wanna be.

For me roping, if I'm struggling, I go out to a coach and I know the basketball team does.

We've got trainers, they have people to help you out in business.

And guys will fix your tire as simple as that, I mean, why not ask for some help?

Like, hey, I'm depressed man, what do I do, or I'm kind of lost.

- Mental Health is more openly talked about now than it used to be when I was even in school.

It's something that we can talk about right up front.

Let people know that we're here to help them, we're here to give them the resources they need.

We just want to make sure our students are in an environment that makes them successful.

- We don't know what other people's battles they're in at the moment.

They might just need a friendly smile, and a good pat on the back, tell 'em they're doing a good job.

Especially here at practice, you tell somebody, hey man, you had a great day.

And they're like, shoot, I didn't think I did.

But then they're like, well he thought I had a great day, maybe I did have a great day.

- I don't think that people are more depressed, or sad in Wyoming than they are in any other area.

I think that people in Wyoming don't have the same access to care that people in larger communities do.

- Often people don't want to seek help locally because in a small town, maybe you know everybody.

You don't necessarily have to go to the clinic in your own town, there are ways around that stigma, or that outing if you will that makes it so other people are talking about your business.

There are online services, telehealth services that are available across the state, and from out of state sources.

So have you been since I saw you last?

- [Man] Okay, I've sort of been up and down, kind of struggle.

- There's therapy online, it's completely anonymous.

Nobody would know you're online talking to a therapist, you just sign up and go for it.

As far as psychiatric providers, medication providers, such as myself we offer telehealth.

So how have you been feeling since we increased your dose?

- Wyoming is really equipped to offer telehealth services in remote environments.

Because of our rural nature, because we're spread out, somebody could join a therapy session, or a psychiatrist appointment from the comfort of their home and nobody would have to know.

- We saw a huge increase in that in Wyoming, and I think a lot of places in light of the COVID 19 pandemic.

It's helpful because then you aren't just limited to people who are in your immediate community, you can access anybody who's licensed in the state.

(soft music) - Part of being able to battle some of these misconceptions and stereotypes of us as native people in Wyoming, I feel like we just have to continue to keep talking and keep showing people who we really are, rather than have them see them for what they think they know us as.

I don't think I would be this far in my healing with my mental health issues, if it weren't for my native spiritual beliefs, for my culture and my traditions and my heritage.

Just being able to hang onto all of those things is what helped me get this far.

To me, being strong is getting help for your mental health.

Being strong is reaching out and using those resources, and especially as a native woman.

Knowing that I come from the Wind River Reservation in Wyoming, it makes me lift my head up higher and it helps me and I just have to sometimes remind myself that's where I come from to help me get through those tough times.

- I think in Wyoming, we've finally come to the realization that the conversation amount around mental health is that it's necessary and that it is crucial to living here and we need access.

- Part of the cowboy culture is ride for the brand, and I think we need to take that and apply our mental health needs to that theory, that mantra.

It references loyalty, we have loyalty to each other, we have loyalty to our state, loyalty to our family members.

And I think that if we're going to maintain that, that means that we carry that loyalty into all areas of need.

If that means that my community member, or my family member needs behavioral health services, that's okay.

It's a demonstration of loyalty to help, and encourage them get the services that they need.

- We euphemistically call it the Wyoming Way, that ability to find an answer to every challenge.

That cowboy code of ethics is huge, and it runs deeply entrenched into our citizens, but that same code of ethics, that same Wyoming Way is the way by which we team together to overcome this.

- I think that's step one, you have to be willing to say, yeah, I need help and I need to talk to somebody about this.

A lot of times when we talk to somebody about anything that's bothering us, it holds us accountable that it's out there now, we've said it, now what are we gonna do about it?

What's the next step?

- 'Cause every day is...

They call it the present for a reason, some presents the box is empty and sometimes it's a gateway to a whole new life, so you just gotta keep trucking along and going about each day.

Each day's an opportunity, and sometimes we get caught up in the day before or the week before, or even years before, so you might as well keep trucking along, it'll get better.

- Before the accident, I never once thought I needed to take care of any mental health issues.

The next thing that stuck with me, and it stuck with me since that day is I have a strong faith in God, and I knew I was alive for a reason.

I'm hoping I know that reason now, and it's to be able to go around, and talk about my alcoholism and the decisions I made.

My name's Monte Bush, and we're here to talk to you about drinking and driving.

Back then if I would've went to a therapist, I would've thought I was weak.

And honestly, you're not weak, you're brave for going and getting help.

- I think Monte's work should be commended.

And I think anybody who takes the time to walk away from their life for a little while, step into treatment, do whatever it is you have to do to get well should be commended, but then to take it further and share it with other people, that's really impressive.

- The best thing is I get to do it with one of the people I hurt in the accident.

I was nervous of course, but I had faith that God was sending me down this road, and so did she.

So I do call her my friend now, and she calls me a friend.

- We can't undo these things, we can't make 'em unhappen.

It's what we do next that matters.

- I think a lot of times with mental health, people need to know that there's other people just like them struggling with the same thing.

Anytime we get somebody who's able to come back from something like that and share their story and be very successful.

He's employed, he's very successful, anytime people can see that, it changes the nature of what we think mental health and substance use is.

- Behind closed doors you really don't know what people are struggling with.

- Everybody in Wyoming is very welcoming.

A lot of farmers or ranchers might come to town once, or twice a month, but every time you see 'em, they're very happy to see you.

Wyoming's one of the few places you can go, and when you drive down the road, somebody's gonna wave at you and make you feel like this is home.

- Being a proud resident of Wyoming is reaching out, and getting help.

- Kind of bringing down that idea that individual self-reliance type of Wyoming person does not mean you can fix this by yourself, it's actually what we want you to do is couple that individual idea with your community idea and your community is there to help you and support you just like if you broke your arm.

So we have to educate, and we have to do that education on both sides.

Not only do we wanna educate people that it's okay to go get it, but we need to educate and work with employers and businesses in Wyoming, and we've seen some great enthusiasm from leading businesses and employers in Wyoming that wanna make sure their employees know, no we support this, this is absolutely okay for you to be not okay for whatever is going on, and we want you to go get help.

- You can achieve recovery, and you can do this independently.

Nobody's saying that you will forever need behavioral health services, what we're saying is let's help get the process started, let's help put one boot on and then get you moving forward.

(soft music) - Thank you for watching A State of Mind, episode one, The Cowboy Code.

The first episode in a six part series, exploring the mental health crisis we're facing in our state.

In the coming months, you can watch the rest of the episodes here on Wyoming PBS.

Thank you for joining us.