Mental Health and Well-Being Models for Rural Healthy Aging

Mental health and well-being are essential for healthy aging in rural communities, where unique challenges can affect access to mental health resources, social support, and quality of life. Mental health is a key component of overall health and is influenced by social, biological, and environmental factors.

Mental health conditions can affect older adults' relationships and daily activities. Older adults often face significant life changes as they age, such as changes in health, loss of a spouse or partner, and decreased independence, and they may also be at higher risk for mental health conditions. Social isolation, trauma, and elder abuse can also put older adults at higher risk of developing mental health conditions. Rural older adults may face geographic isolation, which can exacerbate mental health conditions and make it more difficult to access in-person mental healthcare. For people living in rural areas, stigma associated with mental health challenges may pose a barrier to seeking help.

Because rural areas tend to have higher percentages of older adults and lower numbers of mental health professionals, it is important for rural mental health programs to tailor their services to older adults living in the community. For more information on evidence-based and promising models and resources to support organizations implementing mental health programs in rural communities across the United States, please visit the Mental Health in Rural Communities Toolkit.

Evidence-based and promising mental health and well-being models relevant to rural older adults are described below with examples.

Community health worker models can reduce the burden of mental illness among older adults by promoting the evidence-based use of community health workers (CHWs) and peer support specialists who can be trained to deliver mental health services. For more information on implementing a rural CHW program and examples of CHW programs, see our Community Health Workers Toolkit.

Faith-based and community organization-led mental health initiatives rely on community members in different settings to implement behavioral health interventions for older adults. Faith-based leaders or organizations are often the first point of contact for mental health support, especially given the shortage of mental healthcare providers in rural areas.

• Faith-based programs in churches can offer mental health and emotional support to older adults in rural communities.
• Mental Health First Aid teaches community members, first responders, and teachers how to identify, understand and respond to signs of mental illnesses and substance use disorders to support older adults' mental health. MHFA offers training specifically for rural communities and older adults.

Telemental health programs can help older adults to access care in areas with limited mental health resources, provide effective treatment for mental health conditions, and improve medication adherence. For more information about telehealth models and implementing them in rural areas, please see Telehealth Models for Increasing Access to Behavioral and Mental Health Treatment.

In-home counseling programs can help aging adults reduce depressive symptoms and improve quality of life.

• Listed as one of the Administration for Community Living's Evidence-based Prevention Programs for Older Adults, Healthy IDEAS (Identifying Depression Empowering Activities for Seniors) is an evidence-based depression management program. This program integrates depression awareness and self-management into existing case management and includes screening for depression, depression education, and linkage to mental health providers. Healthy IDEAS has been implemented at numerous sites across the United States.

Clinic-based depression care management for older adults is an evidence-based model of service delivery that involves a collaborative care approach of screening for depression, regular monitoring of progress by trained depression care managers, education for patients and primary care providers, support for medication management, psychotherapy, and a supervising psychiatrist, if needed.

• The Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) model is an evidence-based collaborative approach between a primary care provider, depression care manager such as a psychologist, nurse, or social worker, and a psychiatrist. Patients receive education on late-life depression, complete an intake assessment and weekly check-ins, and receive a treatment plan.
• Prevention of Suicide in Primary Care Elderly Collaborative Trial (PROSPECT) aims to reduce suicidal ideation, depression, and death among older adults. PROSPECT is an effective way to reduce suicide and depression in older adults in urban, suburban, and rural areas.

Assertive community treatment (ACT) is an evidence-based service delivery model that provides community-based, time-limited services for individuals with serious mental illness who may also be at risk or experience co-occurring substance use, frequent hospitalization, housing insecurity, criminal legal system involvement or may be in psychiatric crises. Maintaining Fidelity to ACT: Current Issues and Innovations in Implementation describes examples of ACT implementation for populations, including older adults living in rural areas.

Considerations for Implementation

Maintaining good mental health is a lifelong journey. Understanding that people experience setbacks as well as periods of growth is an important consideration for implementing and evaluating mental health and well-being programs. Offering flexible, individualized approaches and support and empathy are key to implementing successful mental health and well-being models.

Different mental health and well-being models focus on prevention (addressing risk factors) and treatment (providing care, addressing symptoms) to varying degrees. When selecting or recruiting for mental health and well-being programs, program implementers should consider where older adults are in their mental health journey to ensure people are matched with appropriate services. Further, some programs may require a specific diagnosis or level of severity for an older adult to qualify for participation.

Given the stigma around seeking help for mental health issues, working with trusted individuals, organizations, and institutions can encourage older adults' participation in mental health and well-being models.

Models that require highly specialized staff or complex coordination may be better suited for larger organizations or well-resourced communities. For instance, the ACT model requires staff to have clinical expertise and intensive coordination that may be challenging for a small community organization to implement. Small, rural communities may find success sharing resources with other local communities, though developing these relationships can take time.

Partners that do not serve older adults or people with mental illness can still make valuable contributions to creating age-friendly communities. Partners that address risk factors, such as brain injuries, substance use, and stress, can also play an important role in promoting mental health and well-being in rural communities.

Resources to Learn More

How to Improve Mental Health for Older Adults Living in Rural Areas
Document
Discusses common mental health challenges experienced by older adults in rural areas and how to best support them.
Organization(s): National Council on Aging
Date: 1/2024