Rural Residents Face Mental Healthcare Gaps

Limited access, workforce shortages, and insurance hurdles create challenges for those seeking treatment.

For many Americans living in rural areas, accessing specialized mental healthcare is a significant hurdle. One Indiana resident’s experience highlights the difficulties in finding appropriate and affordable treatment in such communities.

Seeking Help in a Small Town

Hiley Ward, who grew up in Wabash, Indiana, a small, rural town surrounded by cornfields, didn’t initially consider the impact of her hometown’s size on her life. However, about five years ago, she realized the limited options for specialty healthcare when she sought mental health support.

After finding that local counseling services weren’t meeting her needs, Ward began traveling to Huntington, Indiana, for care. Eventually, she found a suitable counselor in Fort Wayne, an hour away. This was after navigating insurance issues and having to recount her story multiple times. “It was really hard for me to tell my story, and then get up and do it all over again,” Ward said.

National and State Picture

About 20% of the U.S. population, or over 66 million people, reside in rural areas, according to the USDA. In Indiana, this figure is around 900,000, or 14% of the state’s population. For many, accessing specialized mental healthcare poses a significant challenge.

A 2022 report by the WWAMI Rural Health Research Center indicated that rural areas have fewer behavioral health counselors, psychologists, and social workers than urban areas, even as their overall numbers increase.

Joyce Fillenwarth, Indiana’s state office of rural health manager, confirmed this. Her work involves building relationships with rural communities and healthcare providers to help “find solutions” to their daily challenges. The office provides grants to rural hospitals and offers training programs for staff who might otherwise lack such support.

According to Fillenwarth, transportation and service availability are major obstacles for rural residents seeking healthcare. “Those specialty services do not exist within [the most] rural communities. Extensive travel time to urban settings is necessary to receive these services,” she noted, adding that behavioral health care can be “non-existent” or take up to “six months to receive” in some areas.

A study by the Bowen Center for Health Workforce Research and Policy supports Fillenwarth’s observations, highlighting the “significant challenges” facing rural healthcare in Indiana and noting that “Workforce shortages are acute, particularly in mental health, where rural areas have two-thirds fewer behavioral health professionals than urban areas.”

Telehealth and Internet Access

Telehealth has emerged as a potential solution to bridge the mental health care gap in rural areas, according to Mental Health America. It allows individuals to connect with therapists online, eliminating the need for travel. However, its effectiveness is limited by internet access. According to the FCC, 22.3% of Americans in rural areas lack adequate broadband coverage, compared to 1.5% in urban areas.

Costs and Insurance Barriers

Rural residents are more likely to be uninsured than their urban counterparts, according to the National Alliance on Mental Illness (NAMI). Additionally, many insurance companies do not adequately cover mental health services.

Ward, despite finding effective counseling, is concerned about her insurance requiring “proof or notes that show improvement” from her therapist. “If I’m going to therapy for myself, I don’t understand why I have to show progress to help pay for it with my insurance,” she said.

Hospital Closures and Financial Strain

According to the American Hospital Association, 649 rural hospitals are considered to be in danger of closing, which is more than one-third of rural hospitals nationwide (AHA, May 2024). Cost factors are impacting both patients and healthcare providers, according to Dr. Randolph Hubach, professor of public health and director of the Center for Rural and Migrant Health at Purdue.

Dr. Hubach noted that “Nearly half of rural hospitals operate in the red [financial area] today, and over 170 rural hospitals have closed since 2010,” adding that “The low population density of rural areas can make it difficult for hospitals to cover operating costs when their patient volume is low.”

Looking Ahead

Organizations like the Center for Rural and Migrant Health at Purdue and Indiana’s state office of rural health are working to address these critical issues. However, challenges remain, with more than half of rural America living in mental health professional shortage areas, according to NAMI.

Resources such as ruralminds.org offer support for managing rural isolation, loneliness, and suicide prevention in rural America.