Rural mental health
Today, we’re looking at studies of clients in rural areas. First, Kruis, Sprouse-McClam, Johnson, Guille & Harvey (2024) published “Barriers and Facilitators to Implementing Psychiatric Collaborative Care in Rural United States: A mixed-methods systematic review” in Journal of Rural Mental Health. Here are the edited abstract and impact statements:
Behavioral health (BH) disorders are highly prevalent in the United States and especially concerning in rural areas, which severely lack access to BH services. Psychiatric collaborative care management (CoCM)—a measurement-driven, team-based approach to managing BH in the context of primary care—has a strong evidence base, but implementation in rural settings has proved difficult. We conducted a mixed-methods systematic review focused on identifying barriers and facilitators to CoCM implementation in rural U.S. primary care settings. Using guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses and JBI’s Mixed Methods Review Methodology Group, we reviewed quantitative, qualitative, and mixed-methods articles found in four databases (Pubmed, APA PsycInfo, CINAHL, and SCOPUS) published between 1995 and October 2023. For inclusion, studies had to include implementation of integrated care in a rural U.S. primary care clinic and a multidisciplinary team mirroring that of CoCM. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We integrated qualitative and quantitative data from 13 studies into a mixed-methods, thematic synthesis which surfaced five themes related to barriers and facilitators: (a) the perceived acceptability of the CoCM model among clinic staff; (b) multidisciplinary care team communication; (c) the importance of having a well-defined, well-supported behavioral health care manager role; (d) working in the context of a strained, rural BH workforce; and (e) adaptive and scalable CoCM training. To support implementation of CoCM in rural communities, these key factors driving implementation must be considered and implementation methods adapted to meet the specific needs of rural contexts.
This study highlights important considerations for implementing collaborative care management (CoCM) within rural primary care to address behavioral health needs. By examining existing research, the authors identified key themes—such as workforce shortages and training needs—that impact the success of CoCM in rural areas. These findings offer valuable insights for tailoring CoCM approaches to better serve rural communities with limited access to behavioral health resources.
This is a no-brainer but I thought it was important to document. Next, Nygaard, Ormiston & Husmann (2025) published “Barriers That Interfere with the Delivery of Intensive School Mental Health Services” in Journal of Rural Mental Health. The edited abstract and impact statement follow:
Schools are increasingly being called upon to provide mental health services to youth which is of particular importance in rural areas given the increasing youth mental health needs and reduced access to mental health treatment compared to other locales. Although school mental health providers (SMHPs) are trained to deliver intensive school mental health services to students, many find they are limited in their capacity to do so, despite the growing need for such services. Therefore, the purpose of this study is to use a national participant sample of SMHPs (e.g., school counselors, school psychologists, school social workers) and a mixed methods convergent parallel design to examine SMHPs’ perspectives on barriers that interfere with the delivery of intensive school mental health services. Through a researcher-generated survey and semistructured interviews, participants indicated systems-level barriers and limited resources from the outer context, particularly in rural areas, prevent students from getting services in school due to the increasing youth mental health needs that are “crushing the system.” Barriers to effective collaboration with school-based community mental health providers are also discussed. Overall, we advocate for the shift from focusing on what SMHPs should be doing to what the system should do to support SMHPs and, in turn, students. Limitations and implications for policy are discussed.
Although schools are an ideal point of entry to provide mental health services to youth, school mental health providers from this study report significant limitations to provide intensive services due to persistent systems-level barriers and limited resources. Provider shortages and limited funds, for example, prevent providers from delivering the level of supports students require, particularly in rural areas. We call on the field to shift the focus from what school mental health providers should be doing to what the system at large should be doing to support providers and, in turn, students.
Just as collaborative psychological and psychiatric care is critical, support for school mental health professionals is just as critical. Next, Kirkby & Papps (2025) published “Correlates of Mental Health Help-Seeking Attitudes among Farming and Nonfarming Rural Women” in Journal of Rural Mental Health. Here’s the edited abstract and impact statement:
People living in rural Australia have a significantly greater risk of suicide than those living in major cities. Barriers to mental health help-seeking have been proposed as one reason for this finding. Unique sociocultural factors influence rurality and farmer mental health help-seeking attitudes, yet whether these factors also influence mental health help-seeking in farming and nonfarming rural women is underexplored. This study investigated the relationship between mental health help-seeking attitudes and masculine gender role ideology, stoicism, mental health self-stigma, distrust of health care professionals, and mental health literacy in a farming and nonfarming rural women living in Australia. One hundred ninety farming and nonfarming rural women living in Australia participated. Data were collected through an anonymous online survey using validated measures, and exploratory multivariate analyses were applied to assess differences between farming and nonfarming rural women and the relationships among the variables of interest. Compared with nonfarming rural women, farming women scored higher on masculine gender role ideology, stoicism, and self-stigma, and lower on mental health help-seeking attitudes and mental health literacy. For farming rural women, masculinity, stoicism, and self-stigma were significantly associated with attitudes toward mental health help-seeking. For nonfarming rural women, only self-stigma, distrust, and mental health literacy were significantly associated with attitudes toward mental health help-seeking. Future research could investigate factors related to masculine gender role ideology among farming women to help shape approaches to rural interventions that address the specific needs of the two groups of women.
The present research demonstrated distinct correlates of mental health help-seeking attitudes for farming and nonfarming rural women, with masculinity and stoicism significant correlates only for farming rural women. Differences identified between farming and nonfarming rural women in correlates of mental health help-seeking suggests that different interventions may be required for mental health support in each group of rural women.
Although this study was done in Australia, I suspect the findings are generalizable. I thought it was helpful to explore farming and nonfarming women. Having grown up on a farm, I find the masculinity and stoicism finding very plausible and it’s very important for professionals to know. Next, Conan, Black & Haverstock (2025) published “Evaluating a Class-Based Cognitive Behavior Therapy Intervention in a Rural Setting” in Journal of Rural Mental Health. The edited abstract and impact statement follow:
Additional intervention services are needed to address mental health disorders in rural regions. These interventions must effectively address symptomology while also considering the unique elements of rural mental health care, namely, the availability, accessibility, and acceptability of services. This study provides the results of a retrospective chart review of the outcomes for clients who completed a low-intensity, high-volume cognitive behavioral intervention in a rural region of Canada. The results demonstrate that such an intervention is both effective for, and acceptable to, rural mental health clients and reduces demand on the existing mental health system. The nature of this intervention, as well as suggestions for future research in this domain, is included.
The present study suggests that a class-based cognitive behavioral intervention may improve the availability and accessibility of mental health treatment in rural areas. This study found that the psychoeducational classes reduced symptoms of depression, anxiety, and general psychiatric distress among clients, who found the classes to be an acceptable form of care. This study also found that the program was an efficient method of service delivery for the rural mental health program.
This time, what struck me was the importance of class-based interventions. As urban-trained professionals do more telehealth work, it will be important for them to recognize some of the critical differences between rural and nonrural clients. Finally, Ward & Blosnich (2025) published “Seasonal and Sociodemographic Factors associated with Farmer Suicide: National violent death reporting system 2014–2021” in Journal of Rural Mental Health. The edited abstract and impact statement are as follows:
Farmers are disproportionately affected by suicide, necessitating culturally appropriate interventions. This analysis sought to identify factors related to suicides among U.S. farmers and farm workers from 2014 to 2021 and examine seasonality trends compared with those in the general population. Data from the National Violent Death Resources System Restricted Access Database were used. Bivariate statistics and logistic regression investigated correlates (month, meteorological season, sex, race/ethnicity, marital status, education level, stressors, and age) predicting farmer versus nonfarmer suicides. After filtering occupation codes and death dates, 3,410 farming and 207,501 nonfarming individuals were included. In unadjusted models, farmer decedents were significantly more likely than nonfarmers to be older, male, White, and married or in a domestic partnership or civil union, with lower educational attainment. Spring and summer showed the highest prevalence of suicide among both groups. In unadjusted models, farmers were significantly more likely to have experienced a physical health problem but not more likely than nonfarmers to have experienced a financial stressor. In adjusted models, meteorological season, month of death, and physical or financial problems were not significant predictors for farmer versus nonfarmer suicide, but age, race, marital status, sex, and education level were. The peak of suicides in warmer seasons and sociodemographic differences are consistent with previous findings. Financial stressors were no different than those of the general population, suggesting farmers require coping strategies beyond financial ones. The findings provide implications for future research and public health interventions aimed at reducing farmer suicide, especially the timing.
Farmers are most likely to die by suicide during the spring and summer seasons, so prevention communications and interventions should be targeted at those times. Other recommendations for prevention include introducing coping strategies beyond financial resilience and addressing physical issues farmers face.
Once again, the findings are not surprising in contrasting farmer and nonfarmer suicide, but I felt this provided helpful information for professionals. Taken together, each of these studies may be helpful to those working with rural clients.