Rural Health Day 2022: Recognizing Rural America’s Mental Health Needs

Last week BPC staff joined Dartmouth Health for the launch of their new Center for Advancing Rural Health Equity in New England. Clinicians, researchers, population health experts, consumer advocates, and community members gathered to discuss how to achieve health equity in rural communities, including closing the gap in addiction treatment and continuing federal telehealth flexibilities beyond the public health emergency.

The timing of this event was fitting: Since 2010, the National Organization of State Offices of Rural Health has designated the third Thursday of November as National Rural Health Day. This year’s celebration centers around the theme of “Advancing Behavioral Health Equity in Rural Communities.”

Rural America is home to nearly 61 million people. While rural living has its benefits—a slower pace, deep community ties, rich agriculture—it is not without its challenges, especially when it comes to accessing health care.

The number of individuals experiencing mental health and substance use challenges has increased during the pandemic, intensifying the need for access to quality behavioral health services. Approximately 4 in 10 adults reported symptoms of anxiety and depression in January 2021—nearly four times as many as before the pandemic started; more than a quarter of young adults and 22% of essential workers reported suicidal thoughts. Like with mental health conditions, the pandemic also intensified the opioid crisis, with overdose deaths rising 30% between 2019 and 2020. Overdose mortality reached an all-time high, surpassing 100,000 overdose deaths across a 12-month period. The Commission on Combating Synthetic Opioid Trafficking estimates that drug overdoses cost the U.S. approximately $1 trillion annually.

Despite these rising numbers, access to behavioral health services remains a significant challenge in rural America. In 2021, more than one-third of Americans (37%) lived in areas—disproportionately rural and frontier communities—experiencing shortages of mental health professionals. Current capacity does not meet the growing demand for services: As of 2020, fewer than half of adults with mental health conditions (totaling over 24 million Americans) received services, and 86.6% of patients with opioid use disorder were not receiving treatment.

Recent telehealth flexibilities linked to the COVID-19 federal public health emergency benefitted many Americans by minimizing the need to travel for services or take time off for care. There is ample research showing tele-mental health services are of comparable quality to in-person treatment. Interestingly, 40%-50% of all behavioral health visits for traditional Medicare beneficiaries in 2021 were virtual. Access to virtual care allows patients to see providers outside their immediate community and avoid the stigma of receiving this type of care in-person, especially in rural, tight-knit communities.

At BPC, we continue to make rural health issues a priority and support evidence-based policies that extend quality health care services in rural communities. While there is more work to be done, providers like Dartmouth Health and others across rural America continue to tackle head-on the challenges in health care, such as workforce shortages and record-high overdose deaths. We look forward to continuing our work with federal policymakers and industry leaders to promote innovations around rural health care delivery.

New Hampshire—Members of BPC’s Health Program with Karen Borgstrom of Dartmouth Health