Mental Health in Rural America 

By Kendall Mosher

Residents of rural communities in the United States face challenges in accessing health services for all aspects of healthcare, whether that be due to provider shortages or large distances to healthcare centers. Mental health care is no exception. Availability, accessibility, and affordability all make it more difficult for those living in rural areas to access mental health care. These factors influencing access to healthcare impact Washtenaw county directly – 16% of the Washtenaw County population resides in a rural community. 

Rural areas tend to have certain characteristics which can act as risk factors for mental illness. These characteristics can include geographic isolation which can contribute to loneliness, and lack of mental health resources available to residents. Rural areas generally have a lower availability of mental health resources available to its residents than urban areas; “it is estimated that as many as  65% of nonmetropolitan counties do not have psychiatrists.” NAMI states that more than 25 million Americans living in rural areas live in a designated Mental Health Professional Shortage Area. This means that rural Americans may have to drive long distances in order to receive mental health support, and transportation or busy schedules then potentially become an additional barrier to care. Inadequate access to transportation, balancing limited appointment availability into work or caretaking schedules, and long waitlists to receive care (due to provider shortages and high demand) can pose major challenges to mental health care. 

Affordability is another barrier to receiving mental health care in rural communities. Mental health services nationally have limited coverage by private insurance companies, causing patients to pay out-of-pocket costs. This is also the case for Medicare and Medicaid. According to the Centers for Medicare and Medicaid Services, “people living in rural communities may be less likely to have health insurance”, and mental health services are less likely to be covered by government-funded health insurance. Therefore, with residents facing out-of-pocket costs for therapy or psychiatric services, this can deter the patient from receiving the care that they need. Stigma is also interwoven with insurance status when it comes to the case of children or young adults under the age of twenty-six who may be utilizing their parent’s health insurance. The cost of mental health care being reflected in health insurance statements may discourage a younger person from receiving treatment, and out-of-pocket costs can be unaffordable – especially for someone who may not be making their own income. 

There are many aspects of mental health care that need to be addressed when it comes to serving rural populations. In my opinion, change in this area comes from a population health perspective – mental health workforce incentives, policy reform, and systematic changes to the healthcare landscape are all necessary avenues of change. Improving mental healthcare in rural America is a crucial step in reducing health disparities that impact our country today. 

Kendall Mosher is a fourth-year undergraduate public health student at the University of Michigan School of Public Health. In her free time, Kendall enjoys spending time with friends and family, baking sourdough bread, and playing with her cat Bitty.

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