Cities simply house more people. It’s easier to address social barriers when neighbors are, simply, closer. And, while cities tend to be home to traditionally disadvantaged groups, and have the benefit of sharing large, fixed-cost investments spread over larger populations.
Rural citizens face problems that their urban counterparts rarely encounter. These two spheres of American life will see completely different forms of trauma and structural barriers; rural communities might, for instance, face extreme social isolation, agrarian crises, and natural disasters.
NPR has reported that “More people in rural areas are living in poverty than in urban areas.” While we believe that urban barriers to mental health are significant, it is important to discuss the disparities that those living in isolated parts of the country face.
In response to a particularly graphic episode of Orange Is the New Black, which followed the life of Pennsatucky and her experience with sexual assault, Salon published an introspective essay about rape culture, sexual violence, and rural culture.
The author, Emma Eisenberg, highlights the structural barriers to pursuing healthcare for rural Americans. But many of the cultural stigmas she discusses may also diffuse to issues such as mental illness.
She writes, “Others point to less tangible factors like a culture that prizes independence from government institutions and family reputation over safety and transparency.”
The resulting stoicism is one reason some choose to forego treatment. Research suggests that in rural communities, people usually perceive mental illnesses as serious bouts of psychosis. “Mental illness” rarely includes diagnoses like depression, substance use and anxiety disorders.
But while individuals may not identify with having a particular mental illness, and may rarely be part of conversations about mental health, these problems can still pervade.
At least 24% of rural residents in the United States suffer from mental illnesses and substance abuse. Over half of suicides are committed by firearm, and suicide rates for rural young adults are double those of the urban youth. Yet despite the need, help is hard to find.
More than 50% of U.S. counties have no psychiatrists, psychologists, or social workers. Every single one of these counties is classified as rural.
Even if treatment is available, access is still a problem for rural Americans, as mental healthcare is less likely to be covered by insurance.
Furthermore, the interconnected communities of rural counties may leave many believing they are without anonymity when pursuing mental healthcare.
Numbers could support generalized concerns about confidentiality. A study in Kansas showed that in small towns, 46% of family and general practice physicians treated a notable number of patients who had close relationships with either the physicians or their staff.
Changing the mental health models of rural citizens must be a priority. Even if the system is able to generate enough mental health practitioners to reduce the shortage and provide proper care, it would be futile if patients themselves are unwilling to seek treatment. Proper education and awareness about mental health can play a large role in breaking down the barriers.
In the meantime, integrating mental healthcare into traditional primary care will also improve the situation, as primary care is significantly less stigmatized, as explained by The Atlantic. Insurance parity and telehealth are also options to increase the availability of mental health care services in rural areas.
As we look towards future policy changes, we must accept that mental health care reform cannot be unilateral. Communities of various densities and populations need distinct programs, catered towards their unique challenges.
Daphne Fong is the deputy editor for Beautiful Minds Magazine. Photography by Reece Sisto.