Living and working in rural America presents a variety of distinct stresses and strains as varied as rural America itself. Regardless of differences, state leaders from across the nation indicate that mental and behavioral health problems are a major, widespread rural concern.

Mental health is one of the top 10 leading health indicators targeted by Healthy People 2010, the nation’s blueprint for improving health. And mental health care is the most expensive care for people, accounting for nine percent of their personal health spending. Unfortunately, the need for mental health care has not been met with widely available and accessible mental health services in rural areas.

Among other factors, the problem of inadequate mental health care is strongly tied to a lack of affordable, meaningful health insurance coverage. Recognizing that this must change, the Center for Rural Affairs has identified mental health services as one of the top health reform issues for rural America. See our new report on mental health.

Addressing mental health issues is a concern across the country, though the situation may be worse in rural America. Here, major depression rates in some areas significantly exceed those in urban areas. Stress is associated with increased mental health disorders, and rural people experience stress with cyclical farm crises, natural disasters and social isolation.

The Farm Crisis Response Council of Interchurch Ministries of Nebraska operates a “Hotline” designed to help any rural person who is negatively affected by a rural crisis. According to the most recent hotline data, between July 2008 and March 2009, nearly 50 percent of their calls were related to mental health issues.

Despite the substantive call for mental health services in rural areas, barriers prevent rural Americans from receiving the care they need. These revolve around issues of availability and accessibility. In a number of rural communities, mental health services are simply not available.

Though nationally progress is being made, many issues remain before we meet the mental health needs of rural residents. Workforce shortages, confidentiality and cost are the most significant barriers. Programs like the Rural Response Hotline in Nebraska, offering vouchers for mental health services, have helped to meet the needs of rural residents. But such programs rely on adequate numbers of trained mental health care providers, who simply do not exist in many parts of rural America.

Appropriate training for primary care providers may be the first step towards ensuring that rural residents have access to mental health services. The next step is reaching true parity in mental health coverage – all individuals should have insurance coverage for mental health services regardless of where they work or live.

One way to achieve this is through health care reform that includes a public health insurance option. With such a choice, small business owners like farmers and ranchers and their employees can have access to the same mental health coverage that currently only larger groups enjoy. For health care reform that benefits rural America along with the rest of the nation, equal access to and coverage for mental health services must be part of the design.

The information in this article is excerpted from the Center for Rural Affairs’ most recent health care report, Mental Health: Overlooked and Disregarded in Rural America. Authors are Dr. Dianne Travers Gustafson, Creighton University and a Center advisory board member, and Kim Preston and Julia Hudson, Center staff. The series of papers examining health care issues in rural America is available on our website, www.cfra.org.

For more information, contact Kim Preston, kimp@cfra.org or 402.687.2103 x 1022.