When one thinks of healthcare, an image of a doctor helping a child with a broken bone or an oncologist helping an elderly patient with their cancer may come to mind. Health encompasses things past physical condition, however. Mental health issues have been a growing concern worldwide, and it has become increasingly clear that rural areas are particularly vulnerable to these issues. Rural healthcare refers to the provision of medical services to individuals living in rural areas, where there are often unique challenges to accessing and receiving quality healthcare. Mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) are common among individuals in rural areas. This essay argues that mental health issues plaguing both patients and providers create significant barriers for healthcare in rural environments to be fully implemented. This issue affects not only patients but also healthcare providers in rural areas, ultimately leading to inadequate healthcare provision.
Rural healthcare refers to the provision of healthcare services in areas that are sparsely populated and often have limited access to medical facilities. Rural areas are generally defined using either a population density model or a population definition. Under the population density model, rural areas are defined as regions with less than 50,000 inhabitants per square mile (Hart). However, this definition can vary from country to country. In contrast, the population definition approach defines rural areas based on their distance from urban centers or the size of the population served by medical facilities. Rural areas often face unique challenges when it comes to mental healthcare provision. Mental health disorders are more prevalent in rural areas due to factors such as social isolation, poverty, and lack of access to services. According to a paper published in the Journal of Rural Mental Health, mental health disorders such as depression, anxiety, and substance abuse are more prevalent in rural areas compared to urban areas (Smalley). The paper also highlights the challenges faced by rural residents in accessing mental healthcare services, including long distances to healthcare facilities, lack of transportation, and shortage of mental health professionals. Efforts to improve rural healthcare provision, particularly in the area of mental health, are critical in addressing the disparities in healthcare outcomes between rural and urban populations. This can include expanding telehealth services, providing incentives for mental health professionals to practice in rural areas, and investing in community-based mental health programs.
The lack of mental healthcare resources is a significant barrier to accessing healthcare services in rural areas. A paper published in the Journal of Rural and Remote Health found that rural residents experience a shortage of mental health professionals and limited access to mental healthcare services (MacDowell). This lack of resources makes it difficult for individuals living in rural areas to receive the care they need to manage mental health disorders.
“So my mom actually suffered from depression growing up, and she was always sad and I never really knew why. Sometimes I felt like I was making her sad, because I didn’t understand. And so my sister suffers with some mental health issues; she’s bipolar. So that really started coming about when she was a teenager…We didn’t know much about any of these disorders,” says Tracy Salisbury, a clinic founder from Alamance County.
The limited availability of mental healthcare services contributes to the propagation of mental health issues in rural areas. Moreover, the overall lack of resources in rural areas compounds the problem of accessing mental healthcare services. Rural communities often have fewer healthcare facilities, less healthcare infrastructure, and fewer healthcare providers than urban areas. This lack of resources leads to longer wait times for appointments, inadequate treatment, and limited access to specialists. Accessibility is another critical issue in rural areas. Distance to healthcare facilities, lack of transportation, and limited financial resources make it difficult for rural residents to access mental healthcare services. A paper published in the Journal of Behavioral Health Services & Research found that rural residents are less likely to receive appropriate care for mental health disorders due to the limited accessibility of services (Joseph). Addressing these barriers to mental healthcare provision is essential to improving healthcare outcomes in rural communities.
The general mindset and stigma surrounding mental health is another significant barrier to accessing healthcare services in rural areas. Rural communities often have a strong sense of self-reliance and may be reluctant to seek help for mental health issues. Additionally, a paper published in the Journal of American Psychologist found that rural areas have a higher proportion of elderly adults who may be more reluctant to accept mental healthcare resources (Human). This reluctance to seek help, combined with the negative stigma associated with mental health issues, creates a significant barrier to accessing mental healthcare services in rural areas.
“They have never been outside of the county, and actually going into town to see a provider, to have the resources to do that is a pretty big issue. The stigma to actually say you need help is quite profound. Also I think a lot of folks with really strong roots in their church, in their religious community, sort of believe that it’s inappropriate to have both a therapist and a preacher, so they feel like they’re going against their family, their church,” [0:07:11.6], says Amy, a physician based in Western, rural North Carolina.
Even with excellent mental healthcare resources, individuals who need help may not be willing to seek it due to the stigma surrounding mental health issues. Rural communities may be particularly resistant to seeking help for mental health issues, as they may see it as a sign of weakness or a personal failing. Addressing the negative attitudes and stigmas associated with mental health issues in rural communities is critical to improving access to mental healthcare services. Education and community outreach programs can help to reduce the stigma and encourage rural residents to seek the help they need to manage their mental health.
The shortage of mental healthcare providers in rural areas can lead to significant barriers to accessing healthcare services. A paper published in the Journal of Pyschology in Health and Medicine found that providers in rural areas experience higher rates of burnout compared to their urban counterparts (Terry). Rural healthcare providers often have to work long hours with limited resources, which can lead to increased stress and burnout. The increased workload and lack of resources can result in rural healthcare providers providing less effective care to their patients. This can set a cycle of negative care, where patients have less positive experiences with healthcare providers, leading to reduced utilization of resources and a further reduction in the quality of care. Addressing the shortage of mental healthcare providers in rural areas is essential to improving healthcare outcomes. Recruiting and retaining mental health professionals in rural areas can help to improve access to mental healthcare services and reduce the burden on individual providers. Additionally, addressing the causes of burnout, such as excessive workload and limited resources, can help to improve the quality of care provided by rural healthcare providers.
Efird, Caroline. Interview with Amy (Pseudonym), 19 July 2019, Y-0095, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Hart, L. Gary, Eric H. Larson, and Denise M. Lishner. “Rural definitions for health policy and research.” American journal of public health 95.7 (2005): 1149-1155.
Human, Jeffrey, and Cathy Wasem. “Rural mental health in America.” American Psychologist 46.3 (1991): 232.
Joseph, Alun E., and Peter R. Bantock. “Measuring potential physical accessibility to general practitioners in rural areas: a method and case study.” Social science & medicine 16.1 (1982): 85-90.
MacDowell, Martin, et al. “A national view of rural health workforce issues in the USA.” Rural and remote health 10.3 (2010): 1531.
Moore, Isabell. Interview with Tracy Salisbury, 05 August 2019, Y-0124, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Smalley, K. Bryant, et al. “Rural mental health and psychological treatment: A review for practitioners.” Journal of clinical psychology 66.5 (2010): 479-489.
Terry, Danielle L., and Min Je Woo. “Burnout, job satisfaction, and work-family conflict among rural medical providers.” Psychology, Health & Medicine 26.2 (2021): 196-203.