Closing the Gap: Increasing Community Mental Health Services in Rural Indiana

Schultz, Kristi; Farmer, Sara A.; Harrell, Sam; Hostetter, Carol

doi:10.1007/s10597-020-00737-x

Cited by 9 publications

(6 citation statements)

References 23 publications

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“…Even when farmers described scenarios in which they would consider going to therapy or a similar intervention, they expressed concerns about their privacy and the negative impact that publicly seeking care for a mental health disorder would have on other community members’ perceptions. These themes are consistent with previous literature illustrating barriers to mental health care in rural areas and underutilization of existing services (Schultz et al, 2021). Many of the farmers were still seeing the same family doctors they had seen their entire lives and worried about disclosing mental health information to someone they see at church or around their hometown.…”

Section: Discussionsupporting

confidence: 91%

“It’s easier to go to the beer store than ask for help”: A qualitative exploration of barriers to health care in rural farming communities.

Hopkins¹,

Proctor²,

Muilenburg³

et al. 2023

Journal of Rural Mental Health

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Farming is a challenging occupation, not only due to its physical and mental demands but also its sensitivity to environmental, sociocultural, and policy changes. Because of external stressors and often an internal drive to succeed, farmers in rural areas have high rates of prescription drug use, excessive alcohol use, depression, and suicide. Past research has not focused extensively on help-seeking behaviors in the farming community. This study explored perceived barriers to seeking and receiving physical and mental health care in rural farmers. In-depth interviews (30 min–1 hr) were conducted with full-time rural Georgia farmers (n = 15) in 10 counties throughout the state. Thematic analysis identified themes and patterns in transcribed interview recordings. Four main themes were identified that related to barriers to accessing care: (a) cultural norms in the farming community; (b) normative beliefs about health care in the farming community; (c) stigma around mental health in the farming community; and (d) formal health care concerns. Future programs that address cultural norms, normative beliefs, and stigma associated with health care should be coupled with policy changes to increase access to health care in rural areas.

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Section: Discussionsupporting

confidence: 91%

“It’s easier to go to the beer store than ask for help”: A qualitative exploration of barriers to health care in rural farming communities.

Hopkins¹,

Proctor²,

Muilenburg³

et al. 2023

Journal of Rural Mental Health

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“…Participants in our study talked extensively about staff recruitment and retention challenges in their counties and how limited workforce capacity results in large caseloads, burnout, and lower quality services delivered to clients. This finding is strongly supported in research studies and reports and is widespread in rural areas across the country (Baum & King, 2020;Buche et al, 2017;Gale et al, 2019;Schultz et al, 2021). These studies and reports recommend incentives to increase the size of the workforce including higher salaries; flexible hours; additional residency slots; and loan repayment, pipeline, and relocation and resettlement programs (Baum & King, 2020;Buche et al, 2017).…”

Section: Limited Workforce Capacity and Burnoutmentioning

confidence: 81%

“…This created stress, undervaluation, burnout, and turnover. Therefore, though burnout and turnover among rural providers are well-studied concepts (e.g., Gale et al, 2019;Schultz et al, 2021), our study identified a restrictive quota system as a contributor which suggests that the way service quotas are determined to be revised to address the unique needs of each county and population.…”

Section: Restrictive State Policies Approaches and Regulationsmentioning

confidence: 89%

“…Residents are also hesitant to seek behavioral health care due to the rural culture of self-determination and the heightened stigma created by the close-knit nature of rural communities (Harris et al, 2023; Schultz et al, 2021). Beyond access to care and help-seeking, rural residents face deep-rooted issues that contribute to poor mental health and suicide risk including high rates of poverty, financial and employment challenges, food insecurity, interpersonal violence, child abuse and neglect, and housing insecurity.…”

mentioning

confidence: 99%

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In their own voice: Behavioral health care delivery barriers in rural New York.

Harris,

Gallant

2023

Journal of Rural Mental Health

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Rural areas are disproportionately impacted by mental health and substance use disorders, drug overdose, and suicide. Several environmental and service access barriers are linked to these disparities, yet little is known about facilitators and barriers to care delivery that may impact client outcomes. Our study sought to explore these facilitators and barriers from the perspective of service providers. We conducted a qualitative focus group study with 206 professionals with a vested interest in behavioral health in 16 rural counties across New York State between March 2020 and September 2021. We started focus groups in person and then transitioned to Zoom during the pandemic. We audio-recorded, transcribed, and analyzed focus groups for themes. Multiple themes related to the delivery of behavioral health services emerged including invested and collaborative provider networks as facilitators and limited workforce capacity, state policy and regulatory issues, and scarce funding as barriers. Specifically, participants described how the way funding is allocated puts rural areas at a disadvantage and does not provide them with the flexibility or resources necessary to address the unique and extensive needs of their communities. They also explained how strict service quotas contribute to stress, burnout, and turnover among service providers. Despite these challenges, they described significant investment, collaboration, and determination that helped them provide high-quality services with limited resources. Together, our findings uncovered new regulatory and policy-related contributors to behavioral health care disparities in rural areas and suggested developing and implementing community-specific, needs-based approaches that leverage community strengths and assets. Public Health Significance StatementThis study uncovered several regulatory and policy-related contributors to behavioral health care disparities in rural areas, but also significant strengths and assets that can and should be leveraged for mental health promotion and suicide prevention. A strengths-based approach positions rural communities to take immediate action to address behavioral health morbidity and mortality.

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“…Authors of a rapid review identified 31 mobile apps and 114 web-based resources (e.g., telemedicine) that could be used to support mental health for Canadians during the pandemic ( Strudwick et al, 2021 ). Many barriers exist to accessing these resources, including awareness, cost and connectivity and these may be responsible for reported high priority but lack of completion of mental health checks in this study ( Schultz et al, 2021 ).…”

Section: Discussionmentioning

confidence: 97%