Alarming rates of substance abuse, suicide, and gun violence fuel concerns about mental health in American life. While the occurrence of mental health problems may not be more significant in rural areas, the capacity to deal with those problems may be less than elsewhere.
A recent U.S. Institute of Mental Health study found:
- Approximately one-fifth of the U.S. population lives in a rural area;
- About one-fifth of these rural residents, i.e., 6.5 million, struggle with mental illness.
Though the prevalence of severe mental illness and most psychiatric disorders is similar between U.S. adults living in rural and urban areas [3,4], adults residing in rural geographic locations receive mental health treatment less frequently, often with providers with less specialized training than those living in metropolitan locations. The reasons underlying this mental health treatment disparity include reduced access to providers and limited availability of specialty mental health care in rural areas, lack of trained mental health providers and care coordination in rural medical care, and under-utilization of available services. (Journal of Clinical and Translational Science 2017, Oct; 4(5): 463–467)
It is estimated that 65% of non-metropolitan counties do not have psychiatrists, and over 60% of rural Americans live in designated mental health provider shortage areas.
According to the National Rural Health Association, the following factors are particular challenges to the provision of mental health services in rural communities:
- Accessibility – Rural residents often travel long distances to receive services, are less likely to be insured for mental health services, and providers are less likely to recognize a mental illness.
- Availability – Chronic shortages of mental health professionals exist, and mental health providers are more likely to practice in urban centers. There is a significant lack of access to specialty mental health care in rural areas in the USA. It is estimated that 65% of non-metropolitan counties do not have psychiatrists, and over 60% of rural Americans live in designated mental health provider shortage areas. The most disadvantaged and under-resourced communities often have the greatest need for mental healthcare providers. As of September 30, 2021, the U.S. Health Resources and Services Administration had designated 3,426 Mental Health Professional Shortage Areas in rural areas.
- More than 90% of all psychologists and psychiatrists and 80% of Masters of Social Work, work exclusively in metropolitan areas. Salary and lifestyle considerations also play a significant role in determining where doctors practice. Residents of rural counties are generally older, lower-income, and in worse health than people who live in urban areas.
- Affordability – Some rural residents may not be able to afford the cost of health insurance or the cost of out-of-pocket care if they lack health insurance.
- Acceptability – Rural residents may be more susceptible to the stigma of needing or receiving mental healthcare in small communities where everyone knows each other and fewer choices of trained professionals can lead to a lack of faith in confidentiality, as well as a reliance on the informal care of family members, close friends, and religious leaders. Of suicide, substance abuse, and gun violence.
Higher Risk of Death in Rural Regions
According to the Centers for Disease Control and Prevention, in 2017, suicide was the 10th leading cause of death in the USA. However, there is a markedly higher risk of suicide among rural populations. This underscores the need to address mental health care disparities in rural areas. Each rural area has unique needs, so a tailored approach is necessary. Engaging local stakeholders, involving the community, and adapting interventions to the local context can significantly improve mental health care in rural areas.
Solutions to Consider
Several approaches may be used to increase the availability of mental health services for rural populations. Financial incentives, including loan forgiveness and scholarships, can be provided to attract more qualified mental health professionals to rural areas. Training and support can be provided to local healthcare providers, such as primary care physicians, nurses, and community health workers, to enhance their capacity to identify and manage mental health issues. Telehealth and telepsychiatry have the potential to allow non-rural providers to serve rural populations and to overcome the sometimes daunting geographic isolation of some rural communities from available services. Mobile mental health units or clinics could visit rural areas regularly and provide services like mental health screenings, counseling, and medication management.
Author Sherry Lane is an Iowa native and a graduate of the University of Iowa. She loves returning to Iowa each year to visit her brother and Iowa friends. Sherry lives in Washington, DC now, and enjoys assisting voters better understand the issues and the voting records of candidates who run for Congress.