In 2016, almost one in every five people living in the rural United States reported some type of mental illness. The reported percent was 18.7%, likely an underestimate given the stigma associated with mental health. Despite the prevalent problems, though, mental health services are neither sufficiently available nor tailored to the distinct needs of rural communities. Mental health struggles in rural America contribute to the nation’s opioid crisis and exacerbate inequalities between rural and urban economies.
Rural communities need cost-effective solutions to this public health problem that can overcome barriers such as accessibility, affordability, and stigma. “Telemental health” – that is, the delivery of mental health care through telecommunication and internet-based technologies – is a policy solution that can address these concerns and improve the public health in rural areas and the nation overall. But for this solution to work, policymakers need to understand the unique needs of rural communities and the capabilities of telemental health options, which are sure to require increase public funding infrastructure and training to succeed.
Explaining Telemental Health
Telecommunication tools have been used for decades to provide health care, particularly since the 1960s when grants from the federal government encouraged the use of teleconferencing to meet mental health service needs. But early forms of telemental health, as this form of delivery is called, achieved mixed results because they failed to create financially sustainable care options. With the improvements in internet speed and access of the last several decades, telemental health now holds the potential to significantly improve outcomes for patients living in rural areas. Cost-effective videoconferencing and mobile applications are widely available, and recent research has provided evidence that these delivery methods can be effective in delivering care. In a recent study of telemental health in rural Mississippi, my colleagues and I found that the benefits greatly outweigh the costs.
Mental Health Challenges in Rural Areas
Over the past few decades, many rural communities have suffered as their citizens have struggled to adjust to economic changes, particularly in the decline in manufacturing that sustained many small towns. New jobs have primarily become available in the low-paying service sector. Such economic shifts have greatly exacerbated mental health problems in rural communities, which are doubly challenged because mental health services tend to be inaccessible and unaffordable as well as stigmatized.
Accessibility: Both qualified medical practitioners and health care facilities are sparse in rural areas. Although demand has increased for mental health care, numerous hospitals have closed, putting greater strain on the very few remaining independent mental health professionals.
Affordability: Even when rural residents do have access to mental health professionals, the cost is often prohibitive and many lack adequate health insurance coverage.
Stigma: A code of “rugged individualism” often prevails in rural areas, even though relatively high numbers residents require public assistance. The professed individualism of rural people may conflict with their need for social support. Believing that mental health conditions are signs of weak character rather than illnesses in need of treatment, many rural residents avoid seeking treatment they need.
Telemental Health as a Solution
Telemental health options have the potential to overcome barriers of accessibility, affordability, and stigma.
Because all patients need is access to the Internet, many can receive telemental care in their own homes or by making short trips to community centers that are more accessible than hospitals. There are many reasons for improving Internet infrastructure and access in the rural United States, and policymakers and health advocates should realize that improving mental health outcomes is one of them.
Delivering mental health care in homes is economical, saving patients from having to travel back and forth to brick-and-mortar facilities. Although some providers express concern about costs for telemental health, whose overall affordability remains to be fully assessed, startup expenses are likely to be the greatest costs. Once the necessary broadband access and training has been provided, available studies suggest that savings can run into the millions. Furthermore, this form of care ensures a level of privacy that allows patients to seek care despite worries about stigma.
In our research, we found that providers in rural Mississippi view telemental health as an important tool for increasing patients’ accessibility to mental health care. Providers reported that their patients tended to be satisfied with telemental care, especially because of the privacy it provides. And the promise of privacy makes patients more likely to seek care.
With its ability to overcome critical barriers, telemental health is a viable policy solution for the mental health crisis in the rural United States. Growing demand is apparent from the proliferation of counseling apps and services available through iPhone and Android platforms. Available options have proliferated so quickly that the Anxiety and Depression Association of America now provides ratings based on ease of use, effectiveness, personalization, interactivity, and research. But for this kind of care to become accessible to those who need it most, health advocates and policymakers must work for increased public funding to train rural mental health providers and to ensure full rural access to broadband Internet in homes or nearby facilities and telemental health training for health providers. Otherwise, rural needs will again be shortchanged, even as a technology that could address them spreads across the country.
Read more in William Hatcher and W.L. Meares, “Understanding the Implementation of Telemental Health in Rural Mississippi: An Exploratory Study of Using Technology to Improve Health Outcomes in Improverished Communities” Journal of Health and Human Services 41, no. 1 (2018): 52-86.