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

Abstract

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.

What Do Farmers Need for Suicide Prevention: Considerations for a Hard-to-Reach Population

“…These findings of disproportionality are global, with similar observations made in countries in Africa, Australia, and North America. [21][22][23] In a study surveying farmers from Ontario, Canada, farmers indicated both geography and culture were significant barriers and felt that even when mental health practitioners were utilized, there was often a disconnect between providers and their understanding of the culture of farming, leading to a lack of "farm credibility." 24 Interventions to address farmer suicide risk and mental health are limited.…”