This document discusses mental health issues in rural areas. It notes that roughly 15 million rural US residents struggle with mental illness. Rural residents face greater barriers to mental healthcare including lack of availability of professionals, accessibility issues due to travel distances and lack of insurance, and social acceptability stigma. Common barriers to rural mental healthcare include overlapping relationships between providers and patients, lack of confidentiality, limited consultation options, and lack of transportation and insurance access. The document suggests implications for improving rural mental healthcare include telehealth services, training community consultants, psychoeducation, and strengthening social supports.

1. By: Nakieta Lankster, PsyD
Mental Health & Rural America

2.  Mental health issues in rural areas
◦ Statistics
◦ The research
 Barriers to mental health care in rural areas
 Implications for care
Mental Health & Rural America: Overview

3.  Roughly 15 million of the 62 million
rural US residents struggle with mental
illness (1)
 Rural community members are at
similar or greater risk for high risk
behaviors (e.g., carrying weapons) and
suicide, and rural schools have higher
rates of students with disabilities and
higher poverty rates (3)
 In one study, of 224 participants 13.5%
reported peer victimization (3)
Rural Mental Health

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Social Physical Cognitive A Major Activity
Rural Urban
Proportion of Adults with Limitations in
Rural and Urban Areas
From: georgetown.edu

5. Availability
• Mental health professionals are scarce
in rural areas due to chronic shortage.
Accessibility
• Residents in rural areas are less likely
to have insurance & have to travel
further distances for services
Acceptability
• There remains a stigma related to
mental health and rural areas leave little
anonymity for those seeking services
Cultural idioms are the DSM of the black
community. The labeling for disorders
amongst African Americans includes
“mental breakdown”, “nervous”, “not in
[her or his] right mind” (Anthony Patrick,
personal communication, 2016), “on the
other side (of sanity)”, someone being
“off”, “slow” (Lakisha Sewell, personal
communication, 2016) and many, many
more. In addition, the community
theoretical underpinnings of the causes of
mental illness reflect a limited, but rich
wisdom about the human psyche. “What’s
in the blood the skin can’t hold” or a
particular event “broke [her or him]
down”. Sayings such as this, in their
intuitive wisdom, alluded to the genetic
and environmental precursors to mental
illness.
Barriers to Rural Mental Healthcare

6.  Ethical dilemmas
◦ Overlapping (dual) relationships
◦ Conflicting Roles
◦ Altered Therapeutic Boundaries
between caregivers and patients
◦ Confidentiality
◦ Heightened Cultural Issues
◦ Limited consultation options
◦ Greater Stress (provider and
caregiver)
 Transportation
 Insurance
◦ Out of pocket expenses
◦ Meeting insurance premiums
 85% of the 1,669 federally
designated mental health
professional shortage areas
are rural (7)
 Lack of personal
boundaries
Barriers to Rural Mental Healthcare

7.  Your supervisor requests
that you start seeing their
nephew (who is also on
your sons sports team) for
therapy
 You are the only therapist
in your area and find out
you are dating the close
family member of one of
your clients
 Your church member is
seeking therapy for their
child (who you teach in
Sunday School).
 A parent of a client (who
also views you as a friend)
asks regularly asks about
their child’s progress in
therapy
Vignettes

8.  Telehealth care
 Training community consultants
 Psychoeducation
 Strengthening social supports
Implications for care

9. 1. Roberts, L., Battaglia, J., & Epstein, R.S. (1999). Frontier ethics: Mental health care needs and ethical dilemmas in rural communities. Psychiatric Services,
50(4), 497-503.
2. Smalley, K., Yancey, C., Warren, J.C., Naufel, K., Ryan, R., & Pugh, J. (2010, May). Rural mental health and psychological treatment: A review for
practitioners. Journal of Clinical Psychology: In Session, 479-489.
3. Crosby, J.W., Oehler, J., & Capaccioli, K. (2010). The relationship between peer victimization and post-traumatic stress symptomology in a rural sample.
Psychology in the Schools, 47(3), 297-310.
4. Hunter, M.E. (2006). Mental health care in rural and isolated areas: Lessons from northern British Columbia. BC Medical Journal, 48(4), 174-177.
5. Clay, R. (2014, April). Reducing rural suicide. American Psychological Association, 45(4), 36-38.
6. Handley, T.E., Kelly, B. J., Lewin, T.J., Coleman, C., Stain, H.J., Weaver, N., & Inder, K.J. (2015). Long-tern effects of lifetime trauma exposure in a rural
community sample. BMC Public Health, 15(1176), Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660633/pdf/12889_2015_Article_2490.pdf
7. Gustafon, D., Preston, K., & Hudson, J. (2009, May). Mental health: Overlooked and disregarded in rural America. Center for Rural Affairs, 4.
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