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Extension’s Role in Promoting Mental Well-Being: Where Do We Fit?

By Karen Shirer, Associate Dean — Family Development

Last week, a colleague posed an interesting question to me: What is University of Minnesota Extension’s role in promoting mental well-being in Minnesota? I didn’t have a ready answer for her and began to consider the question. What is and could be our role? I approached it as a puzzle with many pieces.

Puzzle Piece #1: Meeting a National Problem with a Flexible Framework

That evening on the way home from work, I got my first clue as to what our role could be. On July 6, NPR aired an interview with a family physician in rural Wisconsin. Alan Schwartzstein, M.D., talked about how his approach to prescribing pain medications has changed in response to the opioid epidemic. He noted that in his county, like in many other rural areas, opioid addiction increases as the population of unemployed or underserved grows. A recent report from the Centers for Disease Control and Prevention (CDC), Vital Signs, confirms that the counties where opioids are prescribed the most tend to be ones with a larger percentage of non-Hispanic white, unemployed people with lower levels of education.

This interview reminded me of a number of conversations over the past year where opioid abuse has come up with colleagues. What can and should Extension do, if anything, about the opioid crisis? So I looked at the literature and came away with these key points about this growing epidemic.


In the late 1990s, a movement in the medical community began to identify and treat pain more aggressively. With this increase in demand, more prescription opioids — methadone, hydrocodone, and oxycodone, for example — were available and began being used (and abused) for both medical and non-medical reasons. A 2011 CDC study found that during 1999 through 2008, sales of prescription opioids, substance abuse treatment admissions, and overdose death rates rose in parallel.

Rates* of opioid pain reliever (OPR) overdose death, OPR treatment admissions, and kilograms of OPR sold — United States, 1999--2010

This figure shows rates of opioid pain reliever (OPR) overdose death, OPR treatment admissions, and kilograms of OPR sold in the United States during 1999-2010. During 1999-2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially.
* Age-adjusted rates per 100,000 population for OPR deaths, crude rates per 10,000 population for OPR abuse treatment admissions, and crude rates per 10,000 population for kilograms of OPR sold.
Figure from Vital Signs: Overdoses of prescription opioid pain relievers — United States, 1999–2008.

For more information about the increased availability and access of prescription drugs, see Understanding the Rural–Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States.

Rural Health Care Systems

The problem not only occurs in rural areas. It is an urban problem as well. But rural areas have unique conditions that have made the problem worse. Rural areas have fewer health care providers, especially in addiction services, and fewer alternatives for treating pain, like physical therapy. In fact, with the current opioid epidemic, rural health care systems are even more stressed.

Social and Economic Conditions

Lastly, as Dr. Schwartzstein noted, social and economic conditions in rural areas have made it fertile ground for addiction. Out-migration of younger adults to more urban areas, loss of well-paying jobs, a depressed farm economy, and social isolation have all been attributed to the growing crisis. Likely, the opioid epidemic cannot be solved without addressing these issues as well.

In Family Development, we use the CDC’s social-ecological model and the Prevention Institute’s spectrum of prevention to guide our work. We educate individuals to make meaningful behavior change. We also recognize that if the conditions in which one lives do not support that change, the change is difficult to sustain. In that case, we work to change policies, systems, and environments that influence individuals. These models apply to healthy eating and physical activity, as well as preventing substance abuse and promoting mental well-being.

So the first piece of the puzzle for our role in promoting mental well-being is to apply the social-ecological model and spectrum of prevention.

Puzzle Piece #2: Facing a Statewide Stressor

Mental well-being is a concern to all of Extension. On Friday, I received a message from Brent Hales, senior associate dean, that illustrated this concern.

MDA Survey to Inform Regional Workshops

The first part of the message requested that we complete a survey from Minnesota Department of Agriculture. With the continuing depressed prices in the agriculture economy, many producers are experiencing high levels of stress. The survey results will inform the development of regional workshops to teach people who interact with farmers to recognize and respond to mental and emotional stress.

These workshops will be for community agency and Extension staff, as well as those in the private sector like veterinarians, bankers, coop field staff, clergy, and so on. The idea is not to turn these folks into therapists, but rather to help them spot the signs and symptoms of stress, anxiety, and depression; feel more comfortable talking about it; and connect people in distress with appropriate help and support.

You can do your part by completing an anonymous 10-question Stress & Mental Health in the Farming Community survey about what you are seeing and experiencing in your work and what you want to learn more about relative to recognizing and helping farmers in trouble.

Webinar: 'Mental Health Across Minnesota'

The second part of the message was an announcement for a webinar from Extension’s Office of Professional Development on August 15 from 11 a.m. to noon. The webinar is titled, "From Private to Public Health Concern: Mental Health across Minnesota." The goal is to build our common mental health knowledge and identify how it intersects with current and future Extension work across the state. Presenters include:
  • Anna Lynn, MPP, mental health promotion coordinator — Minnesota Department of Health 
  • Cari Michaels, MPH, Extension educator — Children, Youth & Family Consortium
  • Ellie McCann, MS, FLE, Extension educator — Family Resiliency, Center for Family Development 
Please make plans to participate in the webinar and encourage others to do so. Register on the Extension intranet: [link no longer available].

Puzzle Piece #3: Attending to the Personal

I am follower of Sarah Rudell Beach’s blog, Left Brain Buddha. This July 3 post reminded me of four steps that each of us can take to promote our mental well-being: World Pain: Are You Feeling It, Too?

quote from Thich Nhat Hahn

The post also reminded that I had met with the University’s Center for Spirituality and Healing to plan offering their online mindfulness program. Staff Development Coordinator Sharon Mulé will be leading our efforts to offer the online class. Details should be available by late summer.

Other Puzzle Pieces

These three puzzle pieces do not complete Extension’s mental well-being puzzle. They are but the start of the picture of our work. We have many web-based resources on Family Development’s website section:
In addition, we will continue to develop our efforts to address this important issues for all Minnesota individuals, families, and communities.

How about you? What do you do to promote well-being in your work, your office, and your home?

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