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Rural Health Information Hub

Barriers to Mental Health Treatment in Rural Areas

Rural individuals face unique challenges when attempting to receive effective treatment for serious mental illness and mental health conditions. There may be multiple barriers to care faced by individuals in rural areas. We discuss six common barriers below.

Desire to Receive Care

Desire to (or acceptability of) receiving care for a mental health problem can be challenging because of issues of stigma. Stigma is a societal problem that could lead to shame or embarrassment for the individual experiencing mental health conditions.

Lack of Anonymity When Seeking Treatment

Anonymity and privacy are particularly challenging in rural communities. Because of societal stigma, community members may be embarrassed if friends or family members find out they are seeking mental health treatment. A provider may be a friend or associate, which also may make an individual reluctant to reach out for help because of the lack of anonymity. Individuals may fear being seen walking into a mental health clinic and this fear may deter them from seeking help.

Shortages of Mental Health Workforce Professionals

The United States' workforce shortages in mental healthcare are greatest in rural and low-income areas. These provider shortages may lead to rural patients being put on long waitlists in order to receive necessary care.

One of the main issues resulting from the shortages of mental health providers is that 60% of mental healthcare visits are through a primary care provider versus specialty care. Without appropriate integration of mental health services, primary care alone may not provide the specific treatment necessary for individuals with a mental health condition.

Behavioral health providers may choose not to work in rural areas due to billing restrictions for certain provider types under Medicaid, Medicare, and private insurance. Behavioral health staff may not always be reimbursed for the services they provide to patients, because not all types of clinicians are reimbursable under all insurance plans. Further, reimbursement rates for mental health services, especially under Medicaid and private insurance, are often low, making it difficult to recruit and retain providers in rural areas, where Medicaid enrollment is higher.

Lack of Culturally-Competent Care

As Health Research & Educational Trust explains, culturally-competent care is important because it increases:

“patient engagement and education and …help[s] eliminate racial and ethnic disparities in care.”

Rural areas in the United States are racially and ethnically diverse: more than 20% of rural residents identify as American Indians or people of color. This amounts to over 10 million individuals. Part of the increase in diversity in rural America is due to the influx of immigrants. This group of individuals often faces difficulty when accessing healthcare because of language barriers and cultural differences.

With fewer mental health provider options, it may be more difficult for ethnic and racial minority patients living in rural America to find providers who share or understand their culture. As a result, it is particularly important for rural mental health providers to work toward being culturally competent.

Affordability of Care

In rural areas, one of the main barriers to treatment is the cost of mental healthcare. Some insurance companies do not cover certain mental health services making these services too expensive for a patient to pay out of pocket. Other times, individuals in rural communities may not have health insurance, which can also make healthcare costly.

Transportation to Care

In rural settings, not all individuals have access to reliable transportation to healthcare and this problem specifically impacts the most vulnerable, including low-income communities and disabled individuals. Rural community members are more likely than urban residents to rely on automobiles as a means of transportation, meaning rural residents without automobiles are more isolated from proper treatment. There are fewer mental health providers than primary care providers in network plans, meaning community members have to travel farther for mental healthcare. Mental healthcare services may be farther distances for rural residents, and without access to transportation, care may be inaccessible.

Resources to Learn More

Barriers to Mental Health Treatment in Rural Older Adults
Provides an overview of the perceived barriers to mental health treatment for older adults in rural communities.
Author(s): Brenes, G.A., Danhauer, S.C., Lyles, M.F., Hogan, P.E., & Miller, M.E.
Citation: American Journal of Geriatric Psychiatry, 23(11), 1172-1178
Date: 11/2015

Behavioral Health Service Delivery for Vulnerable Populations
Discusses the behavioral health workforce shortage in rural areas and potential solutions.
Author(s): Buche, J., Beck, A., Page, C., Singer, P., Casemore, B., et al.
Organization(s): University of Michigan School of Public Health Behavioral Health Workforce Research Center
Date: 11/2016

Growing Older: Providing Integrated Care for an Aging Population
Offers strategies for providers to provide integrated care to older adults with mental health and substance use disorders.
Organization(s): Center for Integrated Health Solutions
Date: 10/2016