There is something about working on the family farm that creates values like developing a strong work ethic, teamwork, and a desire to choose a career path that serves the greater good. Marcia Kent, MD, picked up these attributes and much more, working on her family’s centennial fruit and grain farm in Saranac, Michigan, a small town outside of Grand Rapids. The farming community there, which includes apple orchards, is reminiscent of the Lexington, Missouri area, a place where she’d later practice and put her stamp on behavioral health care.
Kent’s grandparents lived next door to her childhood home. They were hard workers who cared for others around them, helping where they could. Her parents made it a priority to share the produce they harvested with others in need and with their church community. These examples created a foundation for service and goodwill that became tenets that Kent would live by.
Her uncle, a general practitioner, volunteered to treat patients in a small, rural, mountaintop community in an African village. He happened to be the only doctor there and recruited other people to come and serve. Kent decided to go. “I spent two months with him,” she said. “I just hung around the hospital and learned a lot. That experience had a big impact on me.”
Kent attended medical school at Michigan State University College of Human Medicine and soon realized that primary care wasn’t for her. But she loved talking to patients. “In psychiatry, you have enough time to really get to know the patient and really listen to them, without being rushed,” Kent said. “You get to hear their stories and honor their stories. That’s what I love about psychiatry.” Kent called it a natural fit.
This fit translated to the ER with suicidal patients. She said in those instances, she was the go-to. As she worked her psychiatry rotation in an inpatient unit, she saw, for the first time, how many mental health conditions played out in patients. Kent completed her residency at the University of Washington School of Medicine. After finishing an adult psychiatry fellowship, a family tragedy influenced what came next. Her young niece succumbed to cancer at age 20. The devasting toll it took on her niece’s young sisters influenced Kent’s decision to practice child psychiatry.
She ended up in Seattle, living on a boat for a year, where she opened her own practice. After 12 years, she was ready for a change. Kent completed her studies in forensic psychiatry in a year and then provided forensic evaluations for the courts. At the same time, she worked in private practice at a neuroatypical clinic that served autistic patients.
Kent eventually returned to Michigan. But she wasn’t alone. She had three-year-old twins and a five-year-old, confronted with the arduous task of trying to balance motherhood and work. After working in residential treatment at a boarding school for a while, Kent stumbled across the Health Care Collaborative (HCC) of Rural Missouri, based in Lexington, and its Live Well Community Health Centers. She met with HCC CEO Toniann Richard, and things just clicked.
“I liked her, and I liked the group of women I met,” she said. “It was a really good fit and good timing.” Kent flew every other week from Michigan to Missouri to practice at the Live Well Centers.
HCC’s CEO Toniann Richard agrees. “We knew immediately that Dr. Kent was just what we needed,” Richard said. “She brings such a rich, dynamic mix of expertise that’s extremely hard to find. Her dedication to her patients and understanding of rural health is invaluable.”
Because of COVID-19, Kent drives from Michigan to Missouri and works one week out of the month so she can be home with her children. “I get to be at home three weeks out of the month, and work from home, while my kids are remote learning,” she said. “I get to see my patients about once every month or every other month in person.”
Kent credits COVID-19 for making telehealth more widely used and accepted. “I have done some amazing therapy sessions with some of my patients during COVID, and I’m just really excited that this is another venue we are using and hopefully able to continue to use,” she said. However, Kent would also like to see better internet service in rural areas to ensure any patient needing tele-psychiatry services, and who prefer to avoid the clinic due to the pandemic, can be seen.
Kent also notes the emotional toll the pandemic is taking on children. According to JAMA Pediatrics, most mental health disorders begin in childhood, making it essential that mental health needs are identified early and treated during this development period. COVID-19 continues to impact the mental health of some children and adolescents because of multiple factors like social isolation and economic hardships. “For some kids school is a real break from difficult situations. It’s also really difficult for them not to be in contact with their friends, to be isolated, it’s hard,” she said.
As schools in rural Lafayette County and surrounding areas reopen, Live Well’s school-based clinics will play an even more integral role during this pandemic. JAMA Pediatrics notes the school’s role as a “de facto mental health system” for many children and adolescent students. Live Well’s school-based clinics in Carrollton and Orrick offer students, parents, and staff, site-based mental health care.
“What is nice, we are right on site.” Kent said. “Parents snag their kids from class, or a teacher sends them to the clinic.” Kids are seen in an area separated from classroom and student activity. Most appointments are kept because the students are already on site. Kent’s proximity to educators and other administrators is another plus. “I think it’s also a benefit because the counselors are right there,” she said. Kent can collaborate with school counseling staff and administrators, with parental permission, to meet the educational, social [and] behavioral health needs of students.
Kent stresses the importance of being mindful of a child’s emotional state. She recommends listening to what children say, being aware if they are not functioning well in school, with friends, or having outbursts that don’t align with their age. “Five-year-olds have tantrums, sometimes seven-year-olds, but 12-year-olds, not so much. “They’ll get upset and angry, but they don’t usually blow big and long. If people are having blowouts, if they’re crying a lot, if they’re just not engaged in activities, pay attention. There’s something going on,” she said.
She said to also look for signs for nervousness, anxiety, fidgeting, inability to focus, or signs of trauma. Substance Abuse and Mental Health Services Administration (SAMHSA) says indicators for trauma differentiate by child and by age. However, the SAMHSA website says look out for these signs:
- Fearing separation from parents or caregivers
- Crying and/or screaming a lot
- Eating poorly and losing weight
- Having nightmares
Elementary School Children
- Becoming anxious or fearful
- Feeling guilt or shame
- Having a hard time concentrating
- Having difficulty sleeping
Middle and High School Children
- Feeling depressed or alone
- Developing eating disorders and self-harming behaviors
- Beginning to abuse alcohol or drugs
- Becoming sexually active
“I see a lot of trauma. There are kids who have had things happen to them that they don’t talk about until years later, like abuse of some kind that has happened behind closed doors,” Kent said. “So, if there is a sudden change in the child’s behavior, ask questions, pay attention, and listen to what they say.”
Also, never count children out, Kent says, because they are resilient, hopeful, and want to see the good in things. She said this is also true for the toughest kids, once you get past the tough exterior and reach their hearts. There, she said, you’ll find a gentle soul who is caring and kind.
“I really think kids are our hope for the future,” Kent said. “I have faith, both a religious faith and faith in the community. Despite all the horribleness that’s going on in the world, no matter what anybody says, I have to continue to hope. And I have determined that no matter what anybody says, I will work to make the world a better place, and I am teaching my children to do the same. That’s the attitude I bring to my work with children and adults at HCC.”
Kent is triple board-certified in Child/Adolescent, Adult, and Forensic psychiatry. She is one of only a few individuals in the United States with these concurrent credentials.