Mental Health Disparities Impact Rural Communities

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Access to healthcare has been challenging during COVID-19. But many communities, especially those in rural areas, had pre-existing health needs that are now increasing. More must be done to address the mental and physical health disparities between rural and urban places.

Nicole M. Summers-Gabr is an Assistant Professor in the Department for Population Science and Policy at the Southern Illinois University School of Medicine in Springfield, Illinois. She received her Ph.D. in Experimental Psychology from Saint Louis University. Concurrently, she worked as a data analyst for six years at Pennsylvania State University’s Edna Bennett Pierce Prevention Research Center. Dr. Summers-Gabr joined SIU-SOM in 2018. Her recent focus is on community-based participatory approaches that utilize hospital-community partnerships to improve the health and wellbeing of communities. Her particular areas of interest are in child and adolescent emotion development, parenting, and parental ethnotheories.

JA: How did you first get interested in this topic?

NSG: My concern for rural communities is drawn from the service region of our department. The state of Illinois has 102 counties. Our department serves 66 of those counties, many of which are rural. While rural communities are at greater risk for health disparities, their culture, character, and strength are inspiring. So many of our partners were thriving up until COVID-19, and I became quite concerned about the wellbeing of youth and other residents. While the world focused on becoming virtual, I was concerned that health disparities would only continue to persist for rural communities where residents are already more likely to die from heart disease, cancer, and suicide than urban communities. The solutions for urban communities are not an option for rural communities who may not have the technology, trained doctors, or broadband access to receive basic healthcare. I think expanding broadband access is an investment rural communities need. This investment would not only increase access to physical healthcare, but it will also improve access to mental health care, education, and remote work.

JA: What was the focus of your study?

NSG: The focus of my paper was to highlight how changes due to COVID-19 can exacerbate mental health disparities. Specifically, I examined patient access to mental health providers across eight states: California, Colorado, Illinois, Louisiana, Michigan, Montana, New York, and North Carolina. Within those states, I studied differences between metro and nonmetro counties based on their Rural-Urban Continuum Code designated by the Department of Agriculture. My paper concluded by describing how policies attempted to bridge these differences. Unfortunately, most have not brought equity to mental health access.

JA: What did you discover in your study?

NSG: While more states should be examined than those included in my analysis, entire counties are without access to a psychologist or psychiatrist. Not only that, but nonmetro counties are disproportionately affected. For instance, the state of Illinois has 102 counties. Overall, nearly 60% do not have a psychiatrist. From those counties, 35% are metro but 75% are nonmetro. This pattern where greater proportions of nonmetro counties lack mental health professionals than metro counties is fairly consistent and concerning. In a time where people are isolated, at higher risk for domestic violence, and face greater food insecurity, mental health access is crucial. Telehealth could be a solution, but that will only be successful if the provider has the platform and the patient has internet access, money/insurance, and a safe space to talk.

JA: Is there anything that surprised you in your findings, or that you weren't fully expecting?

NSG: I was pleased to learn that the CARES Act provided $100 million to increase broadband access and $200 million for telehealth. This is a good start, but more investment is necessary. An estimated $80 billion is needed to bring broadband access to all. Increased stimulus funds focused on broadband access are crucial to promoting telecommnity, tele-education, and telehealth. This funding would not only provide immediate relief but invest in building back future healthier, equitable communities.

JA: How might readers apply what you found to their lives?

NSG: Take the time to investigate your place of work, your children’s school, and your healthcare provider. Understand what mechanisms are in place to continue communication and identify where the weaknesses are so that the organization can improve them in the event another pandemic or similar crisis occurs.

JA: How can readers use what you found to help others?

NSG: If your work pushes for telecommuting or your child’s school makes policies around remote learning, think about whether these decisions are equitable. Not only do rural communities suffer from lack of broadband access, but there may be people associated with your institution that are in a dead zone, cannot afford internet access, or are from a different country (e.g., international students) where a stable connection is not readily available.

JA: What are you currently working on?

NSG: I am currently working on two projects which focus on reducing health disparities in rural communities. The first project is COVID-19 related and examines the successes and challenges of K-12 teachers during remote learning. Data revealed that teachers from districts that had fewer policies (e.g., no grading, replacing internet access) were significantly more likely to have moderate or severe anxiety than schools that had clear policies in place. In another study, we are investigating the quality of Community Health Needs Assessments (CHNA) as required by the 2010 Patient Protection and Affordable Care Act. We have found these assessments often lack primary data and there is an over-reliance on consultants to complete the work. We have created a model called Partnership HEALTH (Hospital and Education Alliance for Long-Term Technical Help) to improve the CHNA process by leveraging community partnerships and promoting community ownership. We plan to pilot this process with local hospitals soon.

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