To find out what works in rural mental health care, listen to the innovators – InsideSources


Everyone in this country is experiencing the impacts of COVID-19 on mental health in one way or another. Even before the pandemic, nearly 14.2 million Americans suffered from severe mental illness every year, such as schizophrenia, bipolar disorder, and major depressive disorder. It might surprise you to know that if you live in a rural area, you are more likely to have serious mental illness than if you live in town or in the suburbs. And, while access to care is a universal problem, you are also more likely to face serious barriers to getting treatment if you live in a rural area.

When you consider rural health care delivery, and indeed all health care, we know that the people of those communities know what works best. In rural communities, the mental health workforce provides evidence-based care tailored to the population, resources and available workforce. So to share their knowledge, as national mental health organizations, we recently summoned and listened to clinicians, administrators and mental health staff in rural and remote communities across the country to find out how they were solving problems and where they could use further help.

The issues they raised were the availability, accessibility and acceptability of care. They told us that in rural areas it can be difficult for individuals to find a mental health clinician, especially one who takes out insurance. We heard about the impact of poverty: People with severe mental illness sometimes had problems finding a vehicle to get to their appointments or someone to look after their children. To boot, high speed internet is not as prevalent as in more populated areas, making video telehealth less than useful for some people.

Finally, mental health stigma, although pervasive across the country, has its own impacts in small communities. In places where news often travels fast, where everyone knows everyone, and where the philosophy is to “pull your own boots”, people fear that getting help or even talking about it might show weakness.

The bottom line is that solutions that work well in urban communities may not translate perfectly into rural communities. That’s why it’s important to listen to the healthcare teams living in these communities, who understand the real issues people face as well as the workarounds that will achieve the best results.

They told us:

  • Communities ensure the availability of care. It works well when local primary care providers have an understanding of mental health or, ideally, have access to a psychiatrist in something like the Collaborative care model. It’s powerful when local paramedics and other frontline responders are involved, so that they and other community members are ready to step in when people are facing mental health crises, such as suicidal thoughts.
  • Rural communities are creative in their approaches to make treatment accessible and meet rural patients where they are. Mobile mental health clinics reach people without readily available transportation who are miles away from the clinics. More powerful broadband can increase the use of telehealth when it is an option. Until then, routine phone access is used to minimize travel and overcome broadband issues.
  • Third and finally, overcoming stigma and increasing acceptability of mental health services won’t just come from a celebrity tweeting their feelings (even if it doesn’t hurt). In rural and remote areas, community leaders, such as religious leaders, are leading the charge by talking to their neighbors about these services. Overcoming stigma also comes in the form of sharing experiences with care via conversations in coffee shops and barber shops.

The focus groups and interviews painted a portrait of the staff, administrators and clinicians who work every day in rural and remote communities to innovate and provide care to one in five Americans. who live in these regions. We can all learn a lesson from this practicality and dedication, and we hope that some of the lessons we learned will inform policy makers and our mental health colleagues about what really works to save lives.

About Stephen Ewing

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