A recent report reveals that one in four rural hospitals are at risk of closure. That means behavioral health in rural communities is quickly becoming less available to populations that already struggle with higher rates of isolation, addiction and access to affordable care. The Behavioral Health Workforce Research Center found that 60 percent of mental health visits in rural areas are conducted by a primary care provider who may have limited expertise in behavioral health.
Studies have shown that the lack of Medicaid combined with payers’ inability to cover uncompensated care has a devastating effect on the profitability of rural hospitals. The problem is exacerbated in communities with aging patient populations.
Without the federal government's commitment to the expansion of Medicaid, hospital closures will continue, producing a ripple effect that erodes the practice of behavioral health in rural communities and, according to AARP Public Policy Institute, drives up the cost of care for socially-isolated Medicare beneficiaries by an additional $134 a month. The additional cost of treating arthritis is $117 a month, 13 percent lower than the additional cost of treating beneficiaries in socially isolated areas.
In addition, many rural communities are experiencing a decline in population, as young professionals seeking technical skills are moving to cities and more populated areas to start their careers. As a result, technical schools have closed, shrinking the labor pool for medical technicians and negatively impacting staff recruiting and retention in rural hospitals.
Behavioral health professionals are even less available than medical technicians in rural communities. The National Institute for Mental Health reports that “More than 90 percent of all psychologists and psychiatrists and 80 percent of Masters of Social Work work exclusively in metropolitan areas. More than 65 percent of rural Americans get their mental health care from a primary health care provider, and the mental health crisis responder for most rural Americans is a law enforcement officer.” Limited staff leads to increased wait times, placing patients in need of continuous care in high-risk situations in between appointments.
In addition to external challenges, rural residents must also overcome the stigma attached to behavioral health. In a small town where everyone knows everyone, the decision to pursue behavioral health can often be a greater barrier than the bill associated with it. While increasingly recommended and even applauded in cities dotting the coasts, the act of seeking care for mental health in rural communities is often equated to weakness, instability and damaging, divisive labels like “crazy” and “sick.”
This lack of behavioral health care resources will be particularly troublesome as rural communities, along with the rest of the nation, seek to regroup from the physical, economic and emotional toll of the coronavirus crisis.
HOW TO CHAMPION BEHAVIORAL HEALTH IN RURAL AREAS
While large, external factors play into the lack of access to behavioral health in rural communities, health care providers can achieve progress through initiatives and investments in technology to facilitate the delivery of integrated, collaborative care and unite medical professionals in a holistic approach to patient care.
Identify strategic partners in behavioral health delivery. In response to the high suicide rate of rural farmers, Midwestern farming communities have been looking to technological solutions that enable them to easily and affordably access the behavioral health care they need. One group reached out to GROW, a nonprofit organization that offers online video conferencing to address mental health issues.
Just like these farmers, rural health care facilities can take a proactive approach to behavioral health by working with strategic technical partners that supports their staff in the delivery of care. “In an environment with poor access, technology can act to leverage the professional’s manpower,” notes Matthew Wick, who runs a family medicine practice in Abilene, Texas. “As in the military where technology can act as a “force multiplier,” the right tools for rural healthcare providers can multiply the force of their skills to reach more patients in more meaningful ways.”
Empower residents to actively participate in their care. Mental health is a daily practice, so treatment plans are more successful when they encourage patients to invest in their mental health each day through activities they can complete from the comfort of their home. Wick uses NeuroFlow, a behavioral health platform to stay engaged with and proactively care for his patients in between appointments. “I was honestly surprised when approached by several patients that the daily prompts for journaling and educational materials gave them the insight they needed to progress in healing.”
Develop meaningful relationships between patients and providers. Rural hospitals are an integral part of their communities, and as closures continue to plague at-risk populations, it will be up to everyone to generate awareness, advocate for critical funding and contribute to solutions that improve access to care.
Elevated by the voices of those who work in rural hospitals and live in socially isolated communities, the American Hospital Association’s Rural Advocacy Agenda is advocating for Congress to reform information-sharing laws regarding patients’ history and fully fund treatment programs that improve patient outcomes and strengthen rural communities.
These efforts are led by those who can tell the firsthand stories that Congress can’t ignore. As health care providers and residents come together to champion behavioral health in rural communities, the emotional barriers that come between patients and their personal progress will fade, resulting in a stronger, safer and more equitable community for all.