Learn / Rural Recovery: Challenges and Hope

Rural Recovery: Challenges and Hope

Grace Ogren
 June 21st, 2024|   Clinically Reviewed by 
Dr. Malasri Chaudhery-Malgeri, Ph.D.

Key Points

  • Rural residents struggle to access mental health care.
  • Long wait times, travel distances, and lack of awareness contribute.
  • Solutions include incentives for doctors, virtual care, and more.

Rural areas offer great benefits, like a slower pace of life, open fields, and close-knit communities. But what happens when they can’t provide the resources someone vitally needs, like addiction and mental health treatment? Lacking what many urban dwellers take for granted—access to resources—can endanger the billions of people living in rural communities worldwide. 

Thankfully, technology has opened new doors for rural areas. With just a phone or laptop and internet access, people can attend therapy online and even virtual rehab. Increased mental health awareness in small communities may also create new and improved resources for areas in desperate need.

To learn more about the healthcare challenges in rural areas and how providers navigate them, listen to our recent podcast episode featuring Dr. Jonathan Rosenthal!

Behavioral Health Challenges in Rural Areas

About 1/5th of rural Americans have a diagnosed mental health condition1. Urbanites make up close to the same. However, those in rural areas have more trouble accessing care and finding clinicians, as opposed to urban cities with multiple clinics and practices to choose from. 

Over 60% of rural Americans live in ‘mental health provider shortage’ areas1, with 65% of rural counties without psychiatrists. Waiting lists for therapy or more intensive care can extend for months. Limited mental health knowledge and stigma often prevent rural residents from seeking treatment at all. If they do, low availability often means they must choose the first provider they can get, whether they’re a knowledgeable fit or not. Personalized care can become more of a luxury than a necessity.

Primary care physicians (PCPs) often become the first and only line of defense for mental health conditions and substance use. While PCPs can prescribe medications and recommend next steps, they often don’t have the specialized training in mental health or addiction to educate and support patients properly.

A Top Challenge: Growing Suicide Rates in Rural Communities

Rural residents are twice as likely to die by suicide than urban residents1. Isolation, stigma, poverty, and an inability to access care contribute to the steadily growing rate of rural suicides. Timely access to care, crisis services, and increased awareness of mental health could lower the risk of suicide among rural residents, particularly veterans and young adults. 

Boundaries to Effective Care in Rural Communities

People in rural areas face several prevalent barriers to care, including limited availability of resources, long travel times to get to treatment, and stigma. 

Lack of Access

Here’s a story highlighting a common treatment scenario in rural communities, where the necessary treatment simply isn’t available:

  • Rosie has been struggling with severe depression and loneliness. After months of waiting, she finally got into therapy. Rosie thinks group therapy would help her feel less alone and stigmatized. Her therapist agrees, but tells Rosie they don’t have any groups in town. Rosie keeps going to individual therapy but misses out on an aspect of treatment she feels is crucial.

Not having access to is the biggest bar to effective care1. Often, those in rural communities simply don’t have clear or easy access to treatment (or any access at all) and thus don’t receive it. And when they do seek treatment, overwhelmed medical providers can only refer to whatever resources they have and hope availability opens up.

Rosie’s story is a poignant illustration of the challenges faced by those seeking mental health care in rural areas. After enduring a prolonged wait to receive therapy, she encounters another hurdle: the absence of group therapy options in her area, which she and her therapist agree could be vital for her recovery. This scenario highlights the disparity in mental health resources available in less populated regions and the significant impact it can have on those in need of comprehensive care.

Long Wait Times

Waiting time poses another barrier to care. Here’s a second scenario highlighting this:

  • Darren has a paralyzing fear of socializing and talking in groups. He feels something isn’t right and seeks out therapy, but hears he’ll have to wait at least five months to get in. To manage his symptoms in the meantime, Darren starts bringing alcohol with him to work and getting tipsy to deal with his social anxiety. 

With these long wait times, symptoms can worsen; patients could lose motivation and back out. Being unable to access care could lead to substance use as a way to cope with conditions like depression, trauma, or anxiety. 

Darren’s situation underscores the pressing challenges that arise from the lack of timely access to mental health services. Suffering from a paralyzing fear of socializing and speaking in groups, Darren recognizes the need for professional help and reaches out for therapy. However, he bumps into a discouraging five-month wait. In a desperate attempt to manage his escalating anxiety, Darren resorts to bringing alcohol to work, using it to lessen his discomfort in social situations. This scenario highlights the detrimental effects that can occur when immediate mental health support is unavailable.

Behavioral Health Illiteracy

People in rural communities may not know how to identify behavioral health issues1 or how to get treatment. Bigger cities and communities often have more programs and initiatives highlighting behavioral health treatment and broadening awareness.


Without adequate knowledge of behavioral health conditions, stigma can make mental health challenges and addiction seem unimportant or weak, discouraging rural residents from seeking help. Living where everybody knows everybody, they may worry they’ll be judged if they try to get help or admit to a problem. 

Travel Times

Rural residents often have long drives to get to a treatment facility or clinic that meets their needs. Juggling the time spent on the road, work, and other personal obligations can delay care2 or keep them from seeking it altogether. Here’s a predicament a farmer may face when trying to get treatment:

  • Bill seeks out treatment for his alcohol use disorder and needs a psychiatrist to go to once a week. The closest psychiatrist to him practices an hour and a half away, which means he’ll be gone for almost four hours each time. But Bill runs his own cattle farm, and he needs to milk his cows every morning and ensure they’re fed. Leaving for 4 hours feels out of the question; he cancels his appointments and decides to deal with his symptoms alone. 

Solutions for Better Access and Support

Rural areas need more general physicians, therapists, and specialists to meet the rising demand for behavioral health services. Incentive programs in some states encourage new physicians to practice in rural areas1, which could steadily grow their workforce and improve access to care. Other solutions, many already in play, include:

Virtual Care

Virtual care uses the internet3 to connect patients and care providers virtually. Since COVID-19, virtual care has become more commonplace and can serve as a vital connection for rural residents and treatment providers. You only need a phone or laptop and an internet connection to access virtual care. You’ll use a secure online platform to conveniently meet with a doctor, therapist, psychiatrist, or other healthcare provider.

With virtual care, you don’t have to live in a certain city or near a therapist’s office. You can even attend residential rehab online and outpatient levels of care. And with a larger pool of providers and specialists to choose from, you can get into treatment faster and find care specialized to your needs. 

Incentives for Rural Providers

Some state governments have incentivized more healthcare providers1 to practice in rural communities. If they practice for a set number of years, they receive additional financial compensation. If every state had the funding for this initiative, it could repopulate the rural workforce with eager health and mental health providers.

Increased Behavioral Health Training

Additional training would benefit current rural providers1 and help them make better-informed decisions on patient care. Primary care physicians would understand all the available options, including virtual care and local crisis services for mental health and addiction. Some programs have started training non-professionals to provide peer support, which has had success in the rural Native Alaskan community.

Known and Accessible Suicide Prevention Strategies

Death by suicide occurs more commonly in rural populations1, especially in kids, young adults, and older adults. Social isolation and not knowing what support they have can lead to untreated crises. Many programs and crisis services do exist and specifically serve rural populations, like local crisis teams, but residents don’t often know they’re there.

Educating community members on their available crisis services and support programs could save lives. Community leaders could make their crisis services more prominent and accessible by posting them in daily newspapers and highlighting crisis hotlines like 988 (National Suicide Prevention Hotline). Schools, churches, and businesses could also spread the word to destigmatize mental health and inform residents of their resources.

Better Support for Physicians

Physicians and mental health professionals face burnout in all settings, but rural providers can end up shouldering high caseloads and pressure to treat more people than they reasonably can. Compassion fatigue and discouragement can drive providers to areas with better support, so providing support in rural settings could help them stay. Financial incentives could bring more practitioners to rural areas, also lightening the load for current practitioners. 

Psychological care, peer support, and financial benefits can help providers retain their well-being and compassion, essentially helping them help others.  

Future Goals and Ideas

In an ideal world, rural populations would have the same access to and knowledge of mental health and addiction care as urbanites. Virtual health would fill in the gaps, with more better-trained and better-supported providers meeting the high need and demand for behavioral healthcare. Awareness and education on behavioral health would reduce stigma and help people feel more comfortable asking for help. 

Low-Cost Clinics

Low-cost clinics, funded by grants or donations, could offer the affordable care many rural residents in poverty need. Staff at these clinics could educate patients on good mental and physical health, with free resources for improving their diet and creating healthier habits.

Funding Local Resources

Funding for local programs could strengthen community services, too, helping them offer more robust non-clinical services. For example, funds to a local crisis support unit could go towards hiring full-time staff with specific crisis training.

In rural areas and beyond, everyone who needs treatment should have a clear path to it and support along the way, whether from their doctor, family, other community members, or all three. 

Learn more about future goals and ideas in improving rural healthcare by listening to our recent podcast episode here!

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