The Reality Of Rural America - And Response

Rural America has an ugly reality: addiction, abuse, and untreated mental illness. Most of the adults in these communities are mentally unhealthy, and oftentimes do not have the resources to improve their mental health or are victims of stigma surrounding mental healthcare. Because of this, their children are severely negatively impacted, and the cycle continues. Individuals who leave the community often seek for healing, and find it in larger communities where mental health resources are much more accessible. This reality is unfortunately common. Access to mental health services in rural communities is a present and continual issue within the United States.

Mental health is frequently identified as a rural health priority, however, almost 75 percent of rural communities (with populations from 2,500 to 20,000) lack a psychiatrist, and 95 percent lack a child psychiatrist (Gamm et al., 2010). Because of high unemployment rates, many rural residents lack adequate health care coverage, so accessing health care is unrealistic for several individuals (Hastings & Cohn 2013). Another challenge faced in rural communities is the fishbowl phenomenon. Because of the small population, almost everyone knows everyone, and individuals are not only known for their own work and actions, but by family, social, and historical context as well as family legacy within the community (Campbell & Gordon, 2003).

Therapists and psychologists often shy away from practicing in a small community because of the increased amount of stress as a result of an increased likelihood of having multiple relationships with clients within the community (sheriff’s daughter, realtor, mechanic) (Campbell & Gordon, 2003). Scholars have reported feeling a lack of training when it comes to practicing in rural settings, because graduate programs often steer towards the assumption that the practice will take place in an urban setting with an abundance of resources (Dyck et al., 2008).

There are organizations and individuals that are actively moving to make change and increase access to mental health services for rural Americans. With the goal of better integrating care and improving substance use disorder and behavioral health outcomes, in 2014, the Substance Abuse and Mental Health Services Administration implemented a new pilot program to create Certified Community Behavioral Health Clinics (Sulzer et al., 2024). Individuals advocating for increased access to mental and behavioral healthcare in rural communities include Senator John Barrasso, Senator Michael Bennet, and Senator Catherine Cortez Masto. Senator John Barrasso sponsored legislation such as the Rural Health Clinic Modernization Act and the Mental Health Access Improvement Act. Senator John Barrasso also worked along side Senator Michael Bennet to lead “bipartisan efforts to support reimbursement for advanced psychology trainees in Medicare, which would expand the psychology workforce and increase access to mental and behavioral health services, particularly in rural communities” (Congressional Champions, 2023).

To review, within the issue of lack of mental health services in rural communities, there are a few large factors that should be addressed. The first issue is lack of health care coverage. This is due to a high rate of unemployment, and so many individuals cannot afford to seek out mental health services. The second issue is the fishbowl phenomenon. In a small town, everyone knows everything about everyone. There is much less privacy for individuals than there tends to be in urban communities, so potential clients may not feel comfortable sharing with their counselor/therapist/psychiatrist with concerns for anonymity, among other things. This leads into the third issue. Psychologists have a high likelihood of experiencing multiple relationships with their clients. Because of the small population in the area, running into a client outside of the professional environment is very likely, i.e. fellow school board member, the barista, neighbor, ect. A lack of resources is prevalent in rural communities, and scholars often do not feel they have adequate training to navigate this environment because it is so different from what they have been trained for: an urban community with an abundance of resources, clear boundaries with clients, and plentiful referral options.

What can you do? There are two organizations that I will point you towards supporting - Rural Minds and the National Rural Health Association. Rural Minds serves as the informed voice for mental health in rural America and to provide information and resources regarding mental health. Rural Minds takes initiative to advocate for mental health services in rural communities through multiple pathways: providing a forum for individuals to share their experiences with mental illness, connecting rural Americans with existing mental health resources, identifying gaps in mental health information and services, partnering with community leaders and organizations on mental health initiatives, and developing educational resources and support services to address mental health access in rural America. The NRHA works to improve the health and well-being of rural Americans and communities. The NRHA advocates for policies that support access to mental health care in rural areas including telehealth services, workforce development programs, and funding for rural mental health initiatives. You can donate to either of these reputable organizations to support rural Americans today. Do not let the cycle of abuse, addiction, and untreated mental illness continue.

Emilie Updegrave

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