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
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
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
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
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
Health Service Delivery for Vulnerable Populations
Discusses the behavioral health workforce shortage in rural areas and potential
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
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