SdoH: Behavioral Health is a Major Issue in Rural America

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Original story posted on: February 26, 2020

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Poor access to mental healthcare prompts increased behavioral health emergencies and greater costs of care.

Rural communities face enough challenges with access to basic medical care. Accessing behavioral health has become increasingly difficult for every population, yet those in rural areas face obstacles of grand proportions.

Data doesn’t lie, and there’s new information to validate the scope of behavioral health treatment gaps across rural America. Mental Health America released its 2020 rankings, using 15 measures that encompassed treatment quality for children, youth, and adults with:

  • Any Mental Illness
  • Substance Use Disorder
  • Serious Thoughts of Suicide
  • Reporting of Unmet Needs
  • Uninsured Status
  • Cognitive Disability who Could Not See a Doctor Due to Costs
  • Lack of access to Mental Health Services
  • Inconsistent Treatment
  • Private Insurance that didn’t Cover Mental or Emotional Problems

Also explored were students identified with emotional disturbance for an individualized education program, and mental health workforce availability (true provider deserts).

States with high percentages of rural populations ranked in the bottom 10 of the rankings:

  • Alabama: 40
  • Oklahoma: 41
  • Kansas: 42
  • Montana: 43
  • Carolina: 44
  • Washington State: 45
  • Alaska: 46
  • Wyoming: 47
  • Utah: 48
  • Idaho: 49
  • Oregon: 50
  • Nevada: 51


Poor access to mental healthcare prompts increased behavioral health emergencies, hospitalizations, and greater costs of care for any organization.

On another front, a second new report, Growing Stress on the Farm: The Expanding Economic Mental Health Disparities in Rural Missouri, was published by entities around the state, including the Missouri Coalition of Behavioral Health, Department of Mental Health, Farm Bureau, Hospital Association, and University of Missouri extension. Dismal realities were highlighted, including:

  • Rapidly decreasing numbers of farms, and escalating numbers of foreclosures and bankruptcies
  • Pervasive stigma and geographic barriers to accessing mental health
  • Each of Missouri’s 99 rural counties now a designated Mental Health Professional Shortage Area
  • With only 3.7 percent of the recommended supply, Missouri faces the largest shortage of behavioral healthcare providers in the U.S.
  • From 2003 to 2017, the suicide rate among rural Missourians grew 78 percent
  • Over last decade, hospital ED visits for suicide attempt or ideation have increased 177 percent
  • Rural men between ages of 35-44 have triple the statewide suicide mortality rate.

The report provides information on the signs and symptoms of depression and suicide, and what to do, with key resources. The stigma associated with behavioral health is evident through the data, with a mandate for action necessary.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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