Rural Behavioral and Mental Health Still Overlooked
A recent article by Jon Baily of Northeast Nebraska Behavioral Health Network, finds that despite great advances in healthcare delivery rural America remains in desperate need of mental and behavioral health services. According to Bailey, "Rural residents have a higher percentage of all categories of mental illnesses, from a serious mental illness to psychological distress to major depression. Nearly one-in-five rural residents experience some mental illness."
Bailey goes on to state:
The issue has taken on a new urgency as attention is paid to data showing a dramatic increase in premature death rates for rural white women ages 35 to 54 since 1990. Mortality rates for this population increased most prominently around small cities and in rural areas. In the middle of the country – rural Nebraska, Kansas, and Oklahoma – the increases were the greatest. Meanwhile life expectancy rates are increasing and premature mortality rates are decreasing for the rest of the nation’s population.
Reasons for the mortality increase seem to focus on risky behaviors and mental health issues. While rural white women aged 35 to 54 seem to be susceptible to risky behaviors, rural people as a whole engage in greater rates of risky health behaviors. For example, a larger percentage of rural youth abuse alcohol, and a larger percentage of rural adults use tobacco.
Mental health is integral to overall health and well-being. Mental/behavioral health outcomes can influence the onset, progression, and outcomes of other physical health diseases and conditions. The risky behaviors that may lead to the increase in premature mortality among rural people also eventually lead to physical health issues. For example, people with behavioral/mental health issues smoke two to three times that of the general population. That, of course, leads to a host of physical health issues.
Rural areas are being hit hard by new behavioral health challenges. While urban residents had a slightly higher rate of opioid (generally prescription pain killers) users, rural opioid users are more likely to have greater vulnerabilities. Rural users are younger, have greater rates of fair or poor health, have less educational attainment, lower income, and are more likely uninsured. All of those combined for a nearly eight-fold increase in opioid overdose deaths in rural areas from 1999 to 2014.
In 2014, rural people accounted for over half of the population in 19 states where opioid overdose mortality rates were high. Only six states with a high opioid overdose mortality rate had a state population less than 50% rural. Data also show that rural middle aged women (ages 45 to 54) are dying at the highest rate from prescription opiate overdoses.
Lack of mental/behavioral health providers is also a general rural healthcare rule. Data show that as counties are more rural (based on the Rural Urban Commuting Codes), mental health providers are less likely to be available. So much so, that for the most rural counties in the nation mental health providers barely exist.
All of these factors contribute to less than optimal mental health. Nationally, the number of reported poor/fair mental health status days per month increase with rurality.
Rural areas, of course, are wonderful places to live and raise a family. But a lot of rural people are hurting, both nationally and in northeast Nebraska, from not having access to services to relieve that hurt. Rural mental and behavioral health care services are still tied to a lack of affordable, meaningful health insurance coverage.
So what are some things we can do to address these challenges? I'd love to hear your thoughts! Comment below.
For more on rural mental health visit Jon Bailey's full article at the link