The Tragedy of The Lack of Mental Health Care in Rural America
By: Shirley J. Davis
Tags: Rural America, Healthcare, Mental Health, Psychiatrists, Psychologists

Photo by John Westrock on Unsplash

If you are depressed or suicidal in rural America, you are in deep trouble. There are only a few mental health providers in your area and those few are less qualified and may not be helpful to you at all.

With suicide on the rise among farmers and people living in rural communities, something must happen to not only hire therapists and psychiatrists but to keep them once they settle into their new positions.

We are going to take a look at the tragedy of the lack of mental health providers in rural America.

Suicides are on the Rise in Rural America

There were 44,193 deaths in the United States from suicide in 2015, which is approximately one person dying every twelve minutes. While suicide is preventable, many people living in areas where mental health care is lacking or non-existent die far more often than those living in urban areas.1 (1)

The gap in death rates by suicide between urban and rural areas of the country is widening every year and became noticeable in 2007–2008. Experts put the blame on social isolation, the opioid epidemic, and, of course, the lack of mental health care.

The hardest-hit community appears to be farmers. According to a paper published in The Journal of Rural Health2 (2), white, male, 45–54 years old have 3.5 times as many deaths by suicide than in urban America (General population of the United States = 0.19%; Farmers in rural America = 0.59%).

Predictions well into 2019 and beyond show the number of people dying by suicide in rural will increase not decrease unless something is done.

The Lack of Mental Health Workers in the Urban Regions of the United States

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A paper published in 2018 in the American Journal of Preventive Medicine, found that in 2015 one in five (one fifth) of the population of the United States lived with a behavioral health problem. Approximately 4% had a serious mental health condition that caused interference in their daily lives. The reported study also found that serious mental health disparities exist in the rural parts of the United States with 65% of counties close to a city, 81% of counties lacking a major city,

have a lack of a psychiatrist.3 (3)

There are numerous therapists hold a master’s degree in counseling, however, these councilors lack the knowledge and experience necessary to treat severe mental health conditions and are still hard to find in rural areas of the United States.

It is obvious that rural Americans, especially farming communities, simply do not have access to the mental health care they need. It is no wonder that suicide is so much higher there.

The Human and Financial Loss

We can quote statistics about suicide in rural America and look at this tragedy as something that is happening “over there” to “others”, but in doing so we dehumanize and normalize death. All suicide can be prevented, but we desperately need to find solutions to approach this human calamity.

Not only are people dying, but they are leaving behind them in their wake hurting and grieving families, friends, and communities. Suicide is not something that happens to only certain demography of people either as people from all levels of society are losing hope and dying to escape their pain.

The result of someone dying by suicide passes down through the generations of those it claims as the stress, shock, and grief threaten the body and souls of everyone it touches.

An article was written in 2012 titled Suicide Bereavement and Complicated Grief,4

the survivors of those who die by suicide experience “feelings of loss, sadness, and loneliness experienced after any death of a loved one are often magnified in suicide survivors by feelings of guilt, confusion, rejection, shame, anger, and the effects of stigma and trauma. Furthermore, survivors of suicide loss are at higher risk of developing major depression, post-traumatic stress disorder, and suicidal behaviors, as well as a prolonged form of grief, called complicated grief”.

Added to the above emotional turmoil experienced by survivors of suicide is the disturbing fact that many will choose to also die by suicide.

Lack of Mental Health Care Fuels the Fire of Suicide and Other Problems

When someone is feeling suicidal, too often in rural areas around the United States, there are no professionals to turn to. Also, even if there are some professionals available, they are so booked that it may take weeks to months to attend an appointment with one. The cost of the few professionals that might be available in rural areas is prohibitive too as many do not have adequate or existing insurance to cover the fees.

Some mental health conditions are so severe that not having available mental health support can mean the difference between healing or not healing. For instance, schizophrenia is a serious disorder and it is proven that if one is treated immediately upon the first psychotic break, healing is much easier and almost assured. Without treatment, those who experience their first psychotic break will get worse and find themselves facing a lifetime of trouble from homelessness to institutionalization far from home.5

There Are No Easy Solutions

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Because psychiatrists, psychologists, and other mental health workers have taken any years of college courses and internships, they feel they must charge large fees. The fact is that people living in rural areas do not have the funds to pay large fees so although mental health professionals may initially work there, they do not remain but go to the cities and areas with a more urban population.

There are two possible solutions to this dilemma. One, the federal or state governments could offer large incentives for mental health professionals to locate and serve rural areas. Two, the formation of a national healthcare system would ensure everyone who needs mental health care receives it free of charge.

A third solution is the state and local governments do more to utilize peer support to ease the burden on mental health professional services. Peer support is proven to lower the need for hospitalization and effective in helping those who are feeling overwhelmed to cool down and feel heard.6

The bottom line is that until the United States wakes up and treats the lack of mental health professionals for those living in rural areas, the death toll from suicide and the number of people becoming disabled will continue to rise.

“Any fact facing us is not as important as our attitude toward it, for that determines our success or failure. The way you think about a fact may defeat you before you ever do anything about it. You are overcome by the fact because you think you are.” ~ Norman Vincent Peale

References

1. Centers for Disease Control and Prevention. Suicide in Rural America, (2018). Retrieved from:

https://www.cdc.gov/ruralhealth/Suicide.html

2. Ringgenberg, W., Peek‐Asa, C., Donham, K., & Ramirez, M. (2018). Trends and characteristics of occupational suicide and homicide in farmers and agriculture workers, 1992–2010. The Journal of Rural Health, 34(3), 246–253.

3. Andrilla, C. H. A., Patterson, D. G., Garberson, L. A., Coulthard, C., & Larson, E. H. (2018). Geographic variation in the supply of selected behavioral health providers. American journal of preventive medicine, 54(6), S199-S207.

Retrieved from: https://www.ajpmonline.org/article/S0749-3797(18)30005-9/fulltext

4. Tal Young, I., Iglewicz, A., Glorioso, D., Lanouette, N., Seay, K., Ilapakurti, M., & Zisook, S. (2012). Suicide bereavement and complicated grief. Dialogues in clinical neuroscience, 14(2), 177–186. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384446/

5. Kulhara, P., Banerjee, A., & Dutt, A. (2008). Early intervention in schizophrenia. Indian journal of psychiatry, 50(2), 128–134. DOI:10.4103/0019–5545.42402

6. Davidson, L., Bellamy, C., Guy, K., Miller, R., (2012). Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 2012; 11:123–128.