Rural Mental Health Access: A Crisis in Public Mental Health?

Although rural environments are often stereotyped as being stress-free, protective, and generally idyllic, many researchers have reported the reality to be quite different. Although rural areas do indeed have positive qualities, they often tend to be characterized by geographical and social isolation, depressed local economies, and inadequacy of key health services. It has been reported that rural residents seem to be particularly underserved in terms of mental health care. The vast majority of U.S. counties classified by the federal government as “Mental Health Professional Shortage Areas” are rural and frontier (i.e., extremely rural) counties, and although nearly 25% of Americans live in rural counties, only 10% of the nation's mental health care providers work in these areas.

The purpose of this presentation is to call attention to some of the key barriers to mental health care in rural America and to question whether the prevalence and magnitude of access barriers constitute a public health crisis. Drawing from surveys of rural mental health professionals conducted in two states (one in the Intermountain West and the other in the Mid-Atlantic region), the presentation will show that these key barriers include cost/lack of insurance, lack of trained staff (particularly psychiatrists and other specialists), travel distance and time, and stigma associated with seeking mental health services. Strategies for addressing these barriers will be discussed in the context of workforce and training issues, national mental health policy, and public health outreach to rural residents with mental health problems.