People with mental illnesses live everywhere, but there are particular challenges to living with a mental illness in a rural area. I’m proud to be a farmer’s daughter, and I live in a county where two-thirds of the land is considered rural. I love being part of rural America. I love living close to nature and I love the peacefulness here. I think most of us who live in or near the country feel the same way. Unfortunately, rural people often experience problems such as few jobs opportunities and high poverty rates. Farmers have the same stressors as anyone running a business, plus they are dependent on good weather (which is totally out of their control) to plant and harvest their crops; country people are also more isolated than city people. Suicide rates are higher in rural areas than in urban areas. Stigma can be an issue, too.
“The stigma of mental illness is definitely exacerbated in rural areas,” noted Paul Paulman, M.D. of the University of Nebraska Medical Center College of Medicine in a Newswise article. “Many patients in small towns have anxiety that someone may see them walk into the counselor’s office on Main Street.” Having grown up just outside a village of 500 people, I can tell you that gossip spreads quickly in such places. (What else is there to do?)
Often, though, there are no counselors on Main Street in rural counties. The federal government designates areas with shortages of mental health professionals, and the vast majority of these are rural. Telemedicine such as tele-psychiatry , where counseling or medication management sessions are conducted online, is helpful in addressing this shortage. My former employer, a non-profit rural mental health agency, sometimes uses tele-psychiatry. But even this isn’t enough to address the shortage of rural mental health services providers. As it stands now, it can take several weeks to get an appointment for an initial evaluation at my former employer except in the most dire emergencies. This is not unusual for a rural mental health clinic.
So, what to do? In addition to increased use of telemedicine and (hopefully) increased funding to build more rural mental health clinics, another option is for primary care physicians to provide more mental health services. A program in New Mexico aims to educate primary care physicians in mental health treatment so that they can provide these services to their rural patients. Many clients that I saw in our mental health clinic had psychiatric medications prescribed by their family physicians. Sometimes these medications were appropriate; sometimes they weren’t. If primary care physicians are going to help alleviate the shortage of mental health services, they must be properly trained to do so, either through formal programs like the one in New Mexico or through their own research.
Country living can be a beautiful thing. But as with so many things in life, there are trade-offs. However, good mental health treatment shouldn’t be one of them.