The Critical Need for Psychologists in Rural America

The nation continues to face challenges in providing equitable and adequate health care for rural Americans. This is especially true for mental and behavioral health care. Thus, while rural residents often have a greater need for these services, they have less access to care than their urban counterparts.

• State Offices of Rural Health have identified suicide, stress, depression, and anxiety disorders, and lack of access to mental and behavioral health care, as major rural health issues (Texas A&M University’s Southwest Rural Health Research Center, 2005).

• By the late 1990s, rates of suicide were 54% higher in rural areas than in urban areas (Bishop, 2009).  Suicide is the second leading cause of death in states with primarily rural populations (Advancing Suicide Prevention, 2005).

• Rural areas have a higher proportion of people who are at risk for mental and behavioral health problems, especially older adults and the chronically ill (National Advisory Committee on Rural Health and Human Services Report, 2004).

• Data obtained by the National Health Interview Survey found that the prevalence of major depression was significantly higher among rural (6.11%) than among urban (5.16%) populations (South Carolina Rural Health Research Center, 2005).

Rural residents are more likely to report fair to poor health status than urban residents and are more likely to have experienced a limitation of activity caused by chronic conditions than urban residents (Agency for Healthcare Research and Quality, 2006; S.C. Rural Health Research Center, 2008).

• Obesity is more common among rural residents (27%) than urban residents (24%), as is diabetes, heart disease, and high blood pressure (National Center for Health Statistics, 2007; S.C. Rural Health Research Center, 2008).

• Rural areas have higher rates of later-staged cancer, attributed in part to residents being older, less educated, and poorer, and having little to no access to early detection cancer programs and services (Cancer in Rural Areas, 2003).

• The National Institute of Mental Health reports that rural residents have an equal or even greater likelihood of suffering from substance abuse problems as urban residents (Journal of Rural Community Psychology, 2003)

Of the almost 3,300 federally designated mental health professional shortage areas, 66% are in rural areas.  The shortage problem of mental health providers is particularly acute for those specializing in children and older adults (Health Resources Services Administration, 2009).

• There are approximately 39 psychologists per 100,000 residents in urban/suburban areas (Metropolitan Statistical Areas) but only 16 psychologists per 100,000 residents in rural areas (non-Metropolitan Statistical Areas)—less than ½ those in urban/suburban areas according to a survey conducted by The Center for Health Policy, Planning & Research for the American Psychological Association (October 2007).

• Due to the shortage of mental and behavioral health providers, primary care physicians, who do not have the sufficient training and skills to deal with mental and behavioral health issues, provide as much as 60%-70% of mental and behavioral health services in rural areas (Rural Assistance Center, 2005).

• The federal Community Health Centers Program has urged the nation’s underserved communities to weave together primary care, mental health, and substance abuse services in order to adequately serve underserved populations (National Association of Community Health Centers, 2004).

A survey of state and local rural health leaders finds mental disorders to be the fourth most often identified rural health priority (Advancing Suicide Prevention, 2005).  As experts in the assessment, diagnosis and treatment of mental and behavioral health problems, psychologists can really make a difference in the l health care of rural residents.

• Psychologists possess the training and skills for treating adolescents and adults suffering with alcohol and substance abuse problems. Psychologists have also developed highly effective programs to treat other behaviorally based health problems, such as smoking, eating disorders, poor diet and stress (Journal of Consulting and Clinical Psychology, June 2002).

• Psychologists are uniquely qualified to promote healthy behavioral choices that can prevent or ameliorate many chronic illnesses (e.g. heart disease, diabetes and cancer). This is especially significant given that chronic diseases are responsible for 7 out of 10 deaths in the US and affect the quality of life of 90 million people (CDC, 2005).

• Psychologists address a variety of mental and behavioral health disorders throughout the life span, from children who suffer from attention deficit disorder or emotional disturbances to older adults who suffer from anxiety and depression, which can lead to suicide. The President’s New Freedom Commission on Mental Health recommends screening for mental disorders across the life span (American Psychological Association, 2005).

• Availability

• Accessibility

• Acceptability

Advancing Suicide Prevention, 2005