As policymakers, mental health advocates and practitioners mobilize once again to elevate the gravity of mental illness during Mental Illness Awareness Week, they need to shed light on a troubling reality: individuals in our rural communities face the most glaring gaps in availability, and access to, high-quality behavioral healthcare.
Consider that 4 in 5 Americans with a substance use disorder are left with little access to life-saving treatment, citing lack of public transportation options and considerable distances to care. In 65% of nonmetropolitan counties, where the effects of the opioid epidemic are most significantly felt, residents cannot access a psychiatrist—and that proportion dips just slightly to half when accounting for access to psychologists. As a result, emergency rooms in rural hospital systems are largely left with the burden of care, even while they may lack the proper systems to support patients with mental health issues.
These factors all have propelled the rural suicide rate in the U.S. on an alarming upward trend over the past 14 years, increasing at a rate nearly double that of urban areas. Rates of drug overdoses continue to surpass those in metro areas. And research continues to document the additional barriers that unaddressed mental illness places on rural youths' academic and postsecondary prospects.
As is, they already face a steep, uphill climb to success with limited access to high quality academic and extracurricular opportunities, largely due to matters of geography and circumstance.
But there are proven strategies that can help offset these negative outcomes. A growing number of schools have adopted preventive approaches to improving mental health like positive behavior intervention supports (PBIS) and social-emotional learning (SEL), both of which can support students' mental health, improve a school's atmosphere and safety, and bolster academic outcomes. However, rural schools have less access to these and other research-based models, much less the capacity to identify students who could benefit from these types of supports. This lack of access has significant, negative consequences for their academic success, professional opportunities, and overall well-being.
So we must ask: What can we do to help rural youth overcome these and other such barriers to care? As a promising approach, we can use telehealth practices that already connect doctors and their patients in rural and remote areas—and extend these remote consultations to include educators, families and mental health specialists. These technologies can also empower school support staff and educators to access evidence-based programs like PBIS and SEL that enhance students' mental health and their social and behavioral well-being. Yet, more needs to be done than simply establishing a connection with a psychiatrist or psychologist—or providing a one-off training.
We must also ensure rural health professionals can identify the students in need of these types of supports. That can only happen if we equip practitioners with the tools to identify early signs and symptoms of mental health issues—and ensure they can offer treatment plans that reflect the cultural and contextual realities of rural communities and schools. Ultimately, adapting proven models to the unique needs of rural schools can represent a significant step toward bridging the mental health gap.
Given only a handful of educators in rural areas have access to these types of cutting-edge and research-based approaches, state legislatures must ensure that these professionals possess the training and expertise to support the positive development of our young people, leveraging the latest in prevention science. Schools and states must reinforce their commitment to rural students' well-being by dedicating time and attention to this pressing issue. They can follow the example of the U.S. Education Department's Institute of Education Sciences, which recently funded the National Center for Rural School Mental Health, a five-year, $10 million center designed to support research that tests, adapts and scales existing evidence-based practices to meet the specific needs of students in rural settings. As a result, mental health researchers in Missouri, Montana and Virginia are partnering with rural schools to address these practice gaps.
Bringing research-based services and programs to rural schools is just one step—albeit a significant one—in helping to address the enduring stigmas and barriers to care that children and families across rural communities experience.
Fortunately, there is a growing recognition that rural youth are particularly vulnerable to mental health issues, which, if untreated, can have life-altering consequences. By expanding access to dedicated training, support, and research-based programs, we have an opportunity to reverse the tide starting this school year—and for years to come. If we are successful, we can bridge the mental healthcare gap—but also begin to chip away at an enduring achievement and opportunity gap that hinders 9 million students' prospects for success.
