Rural America has an ugly reality: addiction, abuse, and untreated mental illness. Most ofthe adults in these communities are mentally unhealthy, and oftentimes do not have the resourcesto 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 wholeave 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 UnitedStates.
Mental health is frequently identified as a rural health priority, however, almost 75 percent ofrural communities (with populations from 2,500 to 20,000) lack a psychiatrist, and 95 percent lack achild psychiatrist (Gamm et al., 2010). Because of high unemployment rates, many ruralresidents lack adequate health care coverage, so accessing health care is unrealistic for severalindividuals (Hastings & Cohn 2013). Another challenge faced in rural communities is thefishbowl phenomenon. Because of the small population, almost everyone knows everyone, andindividuals are not only known for their own work and actions, but by family, social, andhistorical 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 ofthe increased amount of stress as a result of an increased likelihood of having multiplerelationships 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 inrural settings, because graduate programs often steer towards the assumption that the practicewill 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 andincrease access to mental health services for rural Americans. With the goal of better integratingcare and improving substance use disorder and behavioral health outcomes, in 2014, theSubstance Abuse and Mental Health Services Administration implemented a new pilot programto create Certified Community Behavioral Health Clinics (Sulzer et al., 2024). Individualsadvocating for increased access to mental and behavioral healthcare in rural communities includeSenator John Barrasso, Senator Michael Bennet, and Senator Catherine Cortez Masto. SenatorJohn Barrasso sponsored legislation such as the Rural Health Clinic Modernization Act and theMental Health Access Improvement Act. Senator John Barrasso also worked along side SenatorMichael Bennet to lead “bipartisan efforts to support reimbursem*nt for advanced psychologytrainees in Medicare, which would expand the psychology workforce and increase access tomental and behavioral health services, particularly in rural communities” (CongressionalChampions, 2023).
To review, within the issue of lack of mental health services in rural communities, thereare 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 outmental health services. The second issue is the fishbowl phenomenon. In a small town, everyoneknows everything about everyone. There is much less privacy for individuals than there tends tobe in urban communities, so potential clients may not feel comfortable sharing with theircounselor/therapist/psychiatrist with concerns for anonymity, among other things. This leads intothe third issue. Psychologists have a high likelihood of experiencing multiple relationships withtheir clients. Because of the small population in the area, running into a client outside of theprofessional 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 theyhave adequate training to navigate this environment because it is so different from what theyhave been trained for: an urban community with an abundance of resources, clear boundarieswith 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 HealthAssociation. Rural Minds serves as the informed voice for mental health in ruralAmerica and to provide information and resources regarding mental health. Rural Minds takesinitiative 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 ruralAmericans with existing mental health resources, identifying gaps in mental health informationand services, partnering with community leaders and organizations on mental health initiatives,and developing educational resources and support services to address mental health access inrural America. The NRHA works to improve the health and well-being of rural Americans andcommunities. The NRHA advocates for policies that support access to mental health care in ruralareas including telehealth services, workforce development programs, and funding for ruralmental health initiatives. You can donate to either of these reputable organizations to supportrural Americans today. Do not let the cycle of abuse, addiction, and untreated mental illnesscontinue.
Emilie Updegrave
