There are many benefits to living in a small town — the sense of closeness, the sense of community. But when you are facing a mental health concern, the very same attributes that make rural life so special can also make it dangerous.
The reality is that, while mental illnesses are no more prevalent in small towns than in large cities, the risk of negative outcomes, including suicide, certainly is. In fact, studies show that suicide rates are an alarming 55% percent higher for people who live in rural areas than for their urban counterparts.
Indeed, geographic inequities in mental healthcare are little understood and perhaps even less widely publicized. And yet they are not only taking lives, they are robbing individuals, families, and entire communities of their quality of life.
But what are these barriers to rural mental health care, exactly, and what can be done?
Access to Care
One of the most significant barriers to consistent, high-quality mental health care in America’s small towns and countryside is a simple lack of access. More than 60% of rural areas suffer from significant mental healthcare shortages, with the vast majority of mental healthcare providers opting to practice in cities and suburban areas.
Along with the dearth of mental health professionals, there is also a significant lack of advanced care facilities, including those offering in-patient care for patients facing severe crises. Additionally, mental illness and substance use disorders (SUD) frequently go hand-in-hand. Yet the lack of addiction treatment centers in rural areas often results not only in the perpetuation and worsening of the addiction, but also in the failure to recognize or effectively treat the underlying mental health condition.
These care shortages mean that patients may be forced to wait weeks or even months to schedule an appointment with a care provider many hours away by car. And, because many rural Americans face significant transportation challenges, the simple inability to travel to an appointment can prevent them from seeking help altogether.
Issues of Affordability
In addition to the overall shortage of care providers, many rural Americans are uninsured or under-insured. Rural areas are often associated with low employment and low income, meaning that residents are likely to live with significant financial stress. This incites a vicious cycle in which financial distress leads to an increased need for mental healthcare and yet money concerns and lack of insurance coverage prohibits sufferers from receiving that care.
Fear of Stigmatization
Anyone who has ever lived in a small town knows there’s really no such thing as privacy. Your business, sooner or later, becomes everyone’s business. But when you’re facing a mental health concern, the fear of becoming the talk of the town can be a significant deterrent to getting care.
The simple fact is that despite all the talk today about diversity, inclusion, and “wokeness,” stigmas surrounding mental illness persist and are deadly. All too often, those who suffer from mental health challenges feel embarrassed, ashamed, or somehow guilty. This is particularly true for men and persons of color. In Black and Brown communities, for example, seeking psychiatric care or addiction treatment, especially by men, is often stigmatized as abnormal, a sign that something is “wrong,” “defective,” or “weak” about you.
This fear of stigmatization is especially dangerous for those suffering from mental illnesses because many of these disorders can themselves lead individuals to self-isolate, to feel paranoid, stigmatized, and even hated. Bipolar depression, for example, can make it nearly impossible for sufferers even to leave their homes, let alone face the risk of becoming the target of town gossip and judgment.
What Is to Be Done
As intractable as these barriers to mental healthcare in rural areas may seem, they are far from insurmountable. Telehealth services can be a tremendous asset. Although it’s unlikely that many living in low-income rural areas will have reliable access to the internet or internet-connected devices, it’s still probable that these would be more accessible than a physical doctor’s office might be. Telepsychiatry can even be limited to counseling sessions conducted by telephone alone.
More incentives should also be provided for mental healthcare providers to practice in rural areas. Offering student loan forgiveness or other financial incentives, for example, can be a significant draw for young professionals.
Increasing insurance coverage for mental and behavioral health services is also essential. Medicare and Medicaid can help defray expenses for low-income persons, though the fight for single-payer options may ultimately be the best solution for resolving these disparities.
Finally, public education and awareness are imperative if the stigmatization is to end. Introducing mental health education in schools, workplaces, and the broader community can help eliminate the stereotyping, isolation, and ridicule that persons with mental illness may face. And this can ensure that those who need help know where and how to get it — and are willing and able to do so.
Rural living is a special kind of lifestyle. But barriers to mental healthcare in rural areas can all too often deprive you of the opportunity to enjoy small-town living to its fullest. Though these obstacles are significant, they can be overcome and you can live the healthy, happy life you deserve.