How to provide mental health support in rural communities.


Mental healthcare in rural farming communities is in a state of emergency due to ongoing challenges with accessibility and availability. Rural areas pose significant challenges to timely access to care because of the sheer amount of distance between a rural family farm, for example, and a treatment center. Further, there is a national shortage of clinicians, and it is more acute in rural areas.

However, the horizon is bright with the upsurge of telemedicine. Incorporating timely and early access mental healthcare into the healthcare delivery process through a telepsychiatry platform is an area of innovation we must expand upon. Telepsychiatry has proven to be beneficial for our most underserved populations in both acute situations and preventive care.

Telemedicine solves the problem of accessibility and availability in these three ways:

 First, we know from our experience and research that someone who seeks professional mental healthcare is rarely seen on the same day. Telemedicine has the potential to eradicate the wait time because it connects a professional directly with a patient in a crisis much faster and more efficiently. This is hugely beneficial to someone who is suffering and simply cannot wait weeks for an appointment.

Second, telemedicine is set up so that a psychiatrist and a therapist work together to create a treatment plan for the individual. Research tells us consistently that a combination of psychopharmacology prescribed by a psychiatrist and therapy provided by a therapist offers the best opportunity for positive outcomes in any type of behavioral health illness, including addiction.

Third, telemedicine can fill in the gaps in mental healthcare delivery that have resulted from hospital closures. One in four rural hospitals is at risk of closing—that is a loss of 673 facilities in a setting already experiencing a severe shortage of mental health support. However, with telemedicine, a clinician who lives in Florida can treat someone who lives in Missouri—on the same day.

The Struggle of the Rural Community

While the healthcare system has its share of struggles nationwide, the problem is especially severe in rural areas where there is a shortage of physicians and some hospitals are closing permanently. Additionally, many people who live in rural communities do not carry health insurance to cover the cost of therapy. The systemic complexities, further complicated by the reality that these populations are considered at-risk due to unstable economic factors stemming from the agricultural industry upon which they rely heavily, mean that the most cost-effective method for improving health outcomes for these communities is solving for timely and frictionless access to care.

Timely care is difficult due to the distance to treatment center locales. This sets the stage for less-than-desirable outcomes in an environment where 21.2% of adults in non-urban areas suffer from a mental illness and 4.8% of adults contemplated suicide prior to Covid-19.

Why Farmers Are an at-Risk population

Even though depression and isolation affect everyone, farmers experience additional pressure and stress as a result of the unique challenges of managing a farm. Farmers are highly dependent on factors out of their control, such as weather, crop prices, and political decisions. They could do everything correctly in terms of running and managing a farm but still may not have a fruitful harvest season.

Add to that a lack of access to mental healthcare and the stigma for needing mental healthcare, and we are dealing with potential crisis situations. In recent years, agricultural communities are struggling financially, leading to higher rates of suicide among farmers. In a 2017 study, University of Iowa researchers found that farmers and other agricultural workers had the highest suicide rate among all occupations from 1992 to 2010, on average 3.5 times that of the general population.

Because of the limitations of traditional healthcare models, agricultural workers often do not get their mental healthcare needs met in a timely fashion. Telepsychiatry has proven to be the platform to provide access for individuals efficiently in rural locations and to drive positive health outcomes. As demonstrated in response to Covid-19, telepsychiatry is a viable solution and is becoming a standard of care in all geographies.

The Challenges Surrounding Telemedicine

Currently, there are some regulatory challenges. Licensing of clinicians is time-consuming and expensive, and it is segmented to the states. A physician is required to have a DEA number if they want to prescribe meds, which takes weeks to process. Billing credentialing is an additional requirement that presents timely delays. These delays result in individuals being unable to access timely care even though there is a clinician properly trained and credentialed and ready to go.

An additional challenge in the provision of care is the Ryan Haight Act—created to regulate online internet prescriptions—which requires a practitioner to conduct an in-person medical evaluation to prescribe a Schedule 2 medication. The provisions for the Act were loosened during Covid-19, and we witnessed how effective telepsychiatry has been during this public health crisis. As it pertains to telepsychiatry, our evaluation of the patient via telemedicine is exactly as it would be in the traditional model, if we are sitting in the same room. Continuing to allow practitioners to prescribe without a face-to-face evaluation post-Covid will be critical to ensure successful outcomes for the patients.

Looking Forward to Good Outcomes in Mental Healthcare

Assessment tools that are easy and quick to access that measure depression and anxiety will go a long way in helping us to develop treatment plans for timely care. As treatment occurs, we expect to and often see improvement in outcomes, and if not, then we have the measurements to make modifications to the plan. When patients can access treatments that work when they need them, we have good outcomes.

I am optimistic about the delivery of mental healthcare because right now we are seeing a shift in awareness and acceptance of this health crisis. More people are willing to speak up and ask for help, and more and more people are empathetic and less judgmental toward the factors that negatively contribute to poor mental health. I believe that we are collectively moving in the right direction, and I am looking forward to the positive changes that will take place in the timely access and provision of mental health and addiction care.

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