How virtual care can help ease the rural mental health crisis

By Bill Siwicki

The Southwest Rural Health Research Center has identified mental health concerns and addiction as the first and second most important priorities for rural health stakeholders, according to a May 2023 policy brief.

With a chronic shortage of mental healthcare providers in rural areas, there is a significant lack of access to this much-needed care for those who reside there. An estimated 122 million Americans, or 37% of the population, lived in 5,833 mental health professional shortage areas as of March 31, 2021.

The nation needs an additional 6,398 mental health providers to fill in these shortage gaps, noted Dr. Bob Booth, chief care officer at TimelyCare, a telehealth provider for college students. Two-thirds of shortage areas are in rural or partially rural parts of the country.

In addition, research shows rural Americans are less likely to receive mental healthcare because of the stigma, Booth added.

Healthcare IT News interviewed Booth to discuss the problem with rural and partially rural areas and so few mental healthcare providers, rural patients’ concerns with mental health matters and addiction and the role of telemedicine, and the stigma with mental healthcare and how telehealth can help overcome this challenge.

Q: What is the problem with rural and partially rural areas and so few mental healthcare providers? How did this problem develop?

A: Living in rural America comes with unique challenges, not the least of which includes access to healthcare services. These challenges can be attributed to a number of factors, including but not limited to: geographical isolation, limited infrastructure, workforce shortages, stigma, lack of incentives, regulatory barriers, educational limitations and unequal resource allocation.

In the last two decades, rural U.S. communities have seen a 50% surge in suicide rates. Even as this rate grows exponentially, the number of supporting healthcare providers and practitioners has failed to keep pace. According to Mental Health America, rural areas have 20% fewer primary care providers than urban areas and 65% of rural counties do not have a psychiatrist.

Colleges and universities are not immune to healthcare access issues, especially those based in rural areas. According to the Alliance for Research on Regional Colleges, there are 1,087 rural-serving institutions in the United States.

Between nationwide provider shortages and long wait times that put both students and schools at risk, colleges and universities can no longer meet all of a student’s health and well-being needs on campus. Despite the perception of greater access to resources, many schools are forced to rely on their already overburdened local community’s mental health and crisis resources to support their students.

Q: Two of the biggest problems for rural patients are mental health matters and addiction. How exactly does telemedicine step in here and help solve the problem?

A: Unlike traditional one-on-one therapy with an in-person counselor, telemedicine can significantly scale the reach of patients that healthcare providers can help. Rural patients suffering from mental illness and addiction often face limited access to specialized healthcare services due to geographical remoteness and inadequate healthcare infrastructure.

Telemedicine eliminates these barriers to care, ensuring that patients can receive timely and effective support regardless of their location.

By leveraging telemedicine, patients in need of specialized care for challenges they are facing can access much-needed therapy, counseling, support groups, medication-assisted treatment, etc., reducing the need for in-person visits that might otherwise discourage those seeking help.

The level of privacy that telemedicine offers is another pivotal benefit for those who are struggling with the stigma often associated with mental health and/or addiction. By giving patients an avenue to seek support in a virtual confidential setting from the comfort of their home, it fosters a more comfortable environment for discussing sensitive, personal matters.

This privacy can also encourage more people to seek help early, potentially preventing the escalation of mental health and addiction crises.

Not unlike rural communities, college and university campuses face many similar challenges when it comes to providing greater access to care. This can be especially true for schools that are also rurally located. More than half (53%) of students who sought help through our higher ed-specific virtual care said they would have done nothing if the service were not available to them.

Q: One interesting aspect of all of this is that research shows rural Americans attach more of a stigma to mental healthcare than other groups. How can telehealth help overcome this challenge?

A: Stigma is a major barrier to care that extends across various cultural, socioeconomic and demographic backgrounds, intensifying the challenges people face in acknowledging their need for additional support. The fear of being labeled, judged or treated differently can deter people from openly discussing their mental health struggles or reaching out for help.

Rural communities tend to be tight-knit, making concerns about privacy and confidentiality more pronounced. Virtual care gives patients the anonymity they desire, minimizing the fear of judgment and disclosure that prevents people from seeking care.

College campuses are, in many ways, very similar to rural communities when it comes to stigma and the desire for anonymity. By eliminating the need for physical travel, telehealth reduces the visibility of seeking mental health support. This can help break down barriers related to shame and social judgment, ultimately encouraging more people to take proactive steps to manage their mental health.

Additionally, comprehensive efforts to reshape societal attitudes, raise awareness and promote a culture of caring will empower individuals to prioritize their mental well-being without fear of judgment.

Q: You have real-world experience with rural mental health patients and telemedicine. Please tell the stories of two patients that show how the technology stepped in and filled some of these gaps.

A: Whether rurally based or secluded on a college or university campus, virtual health care has saved and changed lives.

Our 24/7, on-demand emotional support service line helped a high-acuity community college student who was experiencing suicidal ideation after-hours. The student was a commuter and lived a county over from the college in a very rural area with a lack of access to finances, transportation, care, support and internet.

Living in a negative and destructive home environment, this student was experiencing verbal and physical abuse by a family member. Unfortunately, contacting their local emergency response agency was unhelpful due to where the student lived, as the agency was unable to respond in a timely manner.

This student was able to stay connected with one of our providers over the phone instead of relying on an internet connection that was unavailable. The provider was able to not only help the student work through their own emotions, but also helped coordinate another family member to get the student to safety, as well as connect the student with the community college’s counseling center to make sure this student continues to have ongoing support.

The student has since transitioned to our scheduled counseling services for maintenance care.

Our platform solved for a number of issues in this situation, including a lack of access to basic needs and resources, all available at no cost to this student and without the hassle of traditional insurance.

Another rural student who is enrolled with an online college called after hours looking for support to manage their depression. This student had experienced suicidal ideation in the past. Many times, while providers may be licensed in the state in which they are providing care, they don’t necessarily live there.

In this case, our provider made a major difference because they had lived near the student’s rural hometown and were familiar with the local resources to help coordinate care, including connecting the student with a mobile crisis unit that was located about 40 minutes away. The provider was able to remain on the line with the student for the entire drive to ensure they reached physical help safely.

From an institutional perspective, telehealth has been a game-changer for college campuses seeking additional robust resources for students. The vice president of student affairs at a public university said that being based in a rural community made off-campus referral resources limited.

Their school also had difficulty filling traditional mental health practitioner positions and the counseling operation was mostly a traditional 8 a.m. to 4:30 p.m., Monday through Friday operation. By having access to a virtual care partner, this university was able to provide students with on-demand support anytime, anywhere.

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