The bus was vacant, except for the man. His wife stood on the curb, unable to board and go to their couple’s counseling session because while he had Medicaid, she did not and the bus refused to transport her.

“The bus is empty except for him,” said Jody Fiorini, counseling professor, president and director of CreekSide Counseling Services. “I’m on the phone begging, ‘Just bring her, just bring her. I’ll pay you whatever it is.’ It was hard enough to get them to come in. What are you going to do? Leave her on the curb? That’s what they did.”

Transportation to mental health counseling is one of the insurmountable challenges facing areas like Oswego and the North Country, where residents do not have the same access to public transit that urban residents do.

There are local agencies that will bring patients to the counseling center, if their insurance covers it.

“With gas prices and a lot of people in my area, in the North Country, they have serious transportation issues,” said Brenda McAuslan, a child protective services investigator and graduate student. “Even if they have a car or access to a car, now gas is so expensive if they don’t have a job to try and go to counseling on a regular basis is really difficult.”

This will often result in many patients having to miss appointments.

“They cancel appointments all the time, but the caseworkers go and get the medication and drop it off at the house,” said counseling graduate student Lisa Augustus.

Many counselors try and give the benefit of the doubt to the patients in these situations, but that is hard at the same time as well because there are often long waitlists.

Among the adult population, one in four adults have a mental illness, according to statistics from the Center for Disease Control. At the Lifestyles Center at Oswego State, Health Promotions Coordinator Shelly Sloan works with many students, many of whom she does not know their medical background.

“There are so many mental illness with such a range from mild to severe, you kinda have to assume that everyone has one,” Sloan said.

In Oswego and the North Country, depression, anxiety and Post-Traumatic Stress Disorder are common, Fiorini said.

Socio-economic issues like unemployment and domestic violence cause many of these mental illnesses. The depression and anxiety that arise can often perpetuate the problem.

“It’s a chicken and egg thing,” Fiorini said. “Whenever you have areas of high unemployment, when people don’t have jobs, they have a lot of time on their hands. They get on each other’s nerves.”

Often, people feel depressed because they are not providing or do not have the necessary resources for their family. This is a common issue in Oswego County, which has the second highest unemployment rate in New York state at 12.2 percent in February. The only area with higher unemployment is Bronx County at 14.1 percent.

The tension that arises from not being employed and being unable to support family members has a tendency to create friction in households. Domestic violence rates have been rising steadily.

“It’s tough,” Sloan said. “Because when someone falls in love with someone else, it’s about who they are. But control issues, abuse, it evolves as their relationship evolves.”

From 2009 to 2010, there was an increase in domestic violence incidents by about 100 incident in the county, according to a report released by Sen. Chuck Schumer’s office. Domestic violence arrests continue to appear on the Oswego County Sheriff’s daily police blotter, many of the charged individuals are women.

“I’ve seen an increase in trend last year, it got to the point that where I had more male victims than female victims,” McAuslan said.

“If you have been socialized as a man not to hit a woman, they will hit you and hit you and hit you, and they won’t hit back,” Fiorini said. .” I applaud that, but I see that. They’re just as victimized.”

Victims of domestic violence often struggle with PTSD, which triggers the patient to feel afraid even when there is no present danger, according to the National Institute of Mental Health. There are a lot of survivors of sexual abuse and domestic abuse, Fiorini said.

In the North Country, PTSD is still a major issue, but for different reasons. Near Watertown, Fort Drum has many of its soldiers returning from the Middle East. Many of the soldiers have undergone extensive trauma and have difficulty readapting to civilian life.

“The problem is when the soldiers come home, they have to reintegrate after a year or more away into a family structure that has been set,” Fiorini said. “They also have issues from their experiences there so you get a lot of violence, domestic violence, alcohol and drugs.”

Fiorini said that Fort Drum has been actively seeking counselors to come talk to a few of their soldiers. But, because of the government support, it is easier for soldiers to get counseling.

“The veterans are getting primary support when they get back, but [for] the average Joe like you and me, it’s even harder,” Fiorini said.

It is also harder because of a shortage of mental health counselors in the region. There were 150 mental health counselor positions in 2008 in Central New York, which includes five counties. By 2008, the New York State Department of Labor estimates that it will grow to 180, an increase of about 20 percent.

“It’s a small job title, I mean, 150 to a 180. But it’s a growing job title,” said Karen Knapik-Scaizo, a labor analyst Karen from the New York State Department of Labor. “It’s small in that sense, the Central New York includes five counties,”

Knapik-Scaizo said that a 20 percent increase sounds like a lot, but it isn’t when you look at how small the title is.

As a result, sometimes patients are only able to see a general practitioner, or the family doctor. The doctor cannot really do anything but prescribe medication and refer the patient to a mental health counselor, if they know of one to refer to.

“It doesn’t get to the root of what was making you down in the first place, it doesn’t give you a job, it doesn’t help your relationship with your significant other,” Fiorini said.

The job of the mental health counselor is to get to the root of the problem, to talk about the issues causing the mental health illness, rather than having a patient feel better merely physically.

Some of these issues have been evolving since the patients were children, however, the lack of mental health counselors available to speak with children is low as well.

“The North Country is tough,” McAuslan said. “There’s no providers, there is no one there.”

Fiorini said that she believes her practice and one other in the area are able to see children.

“I think if we could have intervened with some of my adult clients when they were younger, and really they are working through a lot of a pain when they were children and I feel bad for every child I have to put on a waiting list because we don’t know what the impact of that will be later down the road,” Fiorini said.

The situation has reached such a critical stage that the government is intervening by providing incentives for graduates to come to the area and counsel. Fiorini recently became part of a Loan Forgiveness Program.

“Because it is such a high needs area, the Federal Government has loan forgiveness,” Fiorini said. “So anybody who works for me can have up to $80,000 paid off of students loan, that’s how bad it is, when the government is stepping up like that.”