Rural Mental Health

small town main streetThe rural mental health vision for the Mountain Plains MHTTC is to support increased access to providers of mental health services for the more than 60 million Americans living in rural communities. To achieve this, the Center develops and promotes training and technical assistance which supports the rural mental health workforce and reduces barriers to mental health treatment for rural residents. The Center also provides specific resources and training for agricultural communities. These resources are available on the page dedicated to Farm Stress and Mental Health.


Rural Barriers to Mental Health Services

  1. Accessibility

    Rural residents may have limited access to mental health care due to cost of services, insurance coverage, lower behavioral health literacy which allows mental health concerns to go unrecognized and/or untreated, and travel distances to receive services.
  2. Acceptability

    Rural residents are likely to experience self-stigma, fear, or embarrassment related to seeking mental health care. Rural mental health programs, community members, and mental health care providers should consider how stigma may impact access and use of services. 
  3. Availability

    Nearly every county in the Mountain Plains MHTTC Region 8 states are designated as whole county mental health professional shortage areas. Higher levels of unmet need for mental health professionals exist in counties that are more rural and have lower income levels.


Mountain Plains MHTTC Rural Mental Health Products

Farm Stress: Facts, Impact of COVID-19, and Resource and Training Needs of Mental Health Care Providers

Team members at the Mountain Plains and Mid- America Mental Health Technology Transfer Centers (MHTTCs) and the Mountain Plains and Mid-America Addiction Technology Transfer Centers (ATTCs) contacted key stakeholders in May 2020 to assess the impact of the farm crisis and perceptions regarding next steps. Feedback from these providers and key stakeholders is included in this brief along with updated data related to farm stress and mental health implications. These interviews and data will guide future activity for both the Mountain Plains and Mid-America ATTCs and MHTTCs. The brief also provides a long list of resources for assisting providers in addressing the mental health of farmers and their families. 

Depression, Alcohol and Farm Stress: Addressing Co-Occurring Disorders in Rural America

The Mountain Plains Addiction Technology Transfer Center and the Mountain Plains MHTTC have collaborated to release a resource guide to assist rural health care providers with screening and assessment of alcohol use disorder and depression. The guide uses a case scenario to illustrate the most common barriers encountered in identifying co-occurring disorders and underscores the unique needs of rural communities that are home to agricultural producers.

Rural Mental Health in a Pandemic: Q&A with Thomasine Heitkamp and Dennis Mohatt

Mountain Plains Mental Health Technology and Transfer Center Co-Directors Thomasine Heitkamp and David Mohatt were interviewed by the Rural Health Information Hub regarding mental health issues that have come up in this pandemic. The article discusses rural mental health concerns, opportunities, and challenges that have emerged as a result of COVID-19. This conversation includes how mental healthcare has changed in quarantine and the role telehealth is playing in response. 

Promoting Positive Mental Health in Rural Schools: A Resource Guide

This resource guide provides an examination of policy and practice implications and offers tools to assess students’ needs. Included are suggestions for next steps and evidence-based strategies to assist rural school officials in meeting the mental health needs of their student body.

Farm Stress and Mental Health Website

The Mountain Plains MHTTC team recognizes that the agricultural community encounter unique challenges related to the accessibility, availability, and acceptability of mental health services. In response, specific trainings and resources have been developed to address mental health and suicide among agricultural workers and their families. Unless otherwise specified, “farm” and “farmer” refer to ranchers, farmers, farm managers/owners, and agricultural workers.


Mountain Plains MHTTC Rural Mental Health Training 


Improving Mental Health Service Access for Farming and Rural Communities: Three-part Series

June - July 2020

This three-part series is a partnership between the American Psychological Association (APA), the Great Lakes Mental Health Technology Transfer Center in Region 5 and the Mountain Plains Mental Health Technology Transfer Center in Region 8. The purpose is to collaborate and disseminate information to better address the mental health needs surrounding the farming and American frontier communities, through psychological science and research. 

Rural Primary Care Tools and Resources for Managing Suicidal Ideation During COVID-19

June 2, 2020

COVID-19 has created additional stress on our rural and agricultural communities who were experiencing a host of stressors prior to the pandemic. Concerns about a possible increase in deaths by suicide and serving people with suicidal ideation are the source of increased distress among rural health and mental healthcare providers. This webinar provides tools for primary care providers working in rural areas to address these concerns.

Compassion Fatigue: Farm Stress and the Mental Health Provider

January 6, 2020
Robin Landwehr, LPCC, discussed burnout prevention strategies for mental health providers working with farm and ranch populations. This session focused on the unique challenges and stressors faced by the individuals who work to support persons experiencing farm stress. Robin also discussed ways for providers to increase compassion satisfaction, minimize compassion fatigue, and prevent the onset of burnout related to mental health work.

Hands-on Tools and Strategies to Assist Providers Working with Farmers

December 16, 2019
Meg Moynihan, from Eyes on the Horizon Consulting, and Monica McConkey, from the Minnesota Department of Agriculture, provided an overview on the tools and strategies they utilize every day to address the mental health needs of farmers, ranchers, and agricultural producers. This session highlighted specific examples of resources available to support farmers experiencing stress and mental health challenges, as well as a discussion on the best practices for providers working with this population.

The Economics of Farm Stress

December 9, 2019
Dr. David Flynn, Professor of Economics, provided an overview of the economic landscape that affects farmers, ranchers, and agricultural producers in the United States. This session highlighted the challenges faced by producers in adapting to uncertain commodities pricing, the long and short term impacts of tariffs, and the financial pressures caused by uncertain crop yields and changing weather.

Introduction to Farm Stress: Mental Health Needs among Diverse Farm Populations

November 25, 2019
Dr. Shawnda Schroeder and Thomasine Heitkamp, Director of the Mountain Plains Mental Health Technology Transfer Center presented alongside Matt Perdue with North Dakota Farmers Union. In this first of multiple sessions addressing agricultural mental health, presenters described the definition of farm stress, contributing factors, the impact of farm stress on the family, and how farming demographics and associated stress may vary by U.S. region. This session introduced resources that currently exist for farmers addressing stress and suicide risk, as well as presented ongoing gaps and barriers to utilizing mental health services among agricultural communities.

Building Capacity of Rural School Personnel to Address Mental Health Needs of Students through Communities of Practice

November 7, 2019
Sarah Nielsen, Susan Bazyk, Tanja Brown, and Thomasine Heitkamp described a Communities of Practice (CoP) Model pilot project targeting implementation of a multi-tiered approach to address school mental health in six rural schools across three states. Presenters described: a) unique features of rural schools; b) CoP practice approach utilized; c) strengths and weaknesses of the CoP process, and d) identified strengths and barriers to implementing a multi-tiered approach in rural settings.

Housing for All in Rural Communities

June 24, 2019
Jennifer Lopez discussed housing for all in rural communities with a focus on housing solutions for persons with mental health concerns in rural settings.

Together with Veterans: A Rural Veteran Suicide Prevention Program

June 20, 2019
Gina Brimner spoke to the Together With Veterans Program. Together With Veterans targets rural populations and empowers Veterans to lead community-based and evidence-informed planning efforts to address Veteran suicide locally and discuss implementation strategies.

Farm Crisis and Behavioral Health

June 19, 2019
Charles Griffin provided a backdrop to the recurrence of the farm crisis, new legislation to address the crisis, as well as strategies for addressing the needs of farming communities.

Rural Mental Health Disparities and Workforce Implications

April 25, 2019
This webinar was part one in a series addressing rural mental health. As the first in the series, this webinar provided a basic introduction to rural mental health. Presenters discusses the definition of rural, rural demographics, and data on rural mental health and mental health disparities. Speakers also presented rural issues of access, acceptability, and availability of rural mental healthcare services. Several resources will be shared for participants to find additional data, policy briefs, funding opportunities, best practices, and toolkits specifically addressing rural mental health.


Goals to Address Rural Mental Health

The Mountain Plains MHTTC is addressing the barriers of rural mental healthcare accessibility, availability, and acceptability by developing and providing training and technical assistance that:

  • Reaches students, entry level professionals, and established providers in rural communities.
  • Highlights the appropriate use of technologies for the existing rural mental health workforce including teleahealth. 
  • Covers effective practice in rural communities. Many established models for delivery of mental health care do not account for the unique challenges presented by rural communities. Providing focused training on the realities of practice for rural mental health providers can help increase the satisfaction of the patients being served by these providers.


Rural Mental Health Resources

There are several resources available that provide summaries of rural mental health concerns, up-to-date data visualization, and toolkits for addressing rural barriers to mental health services. Some of these resources include:

Addressing Rural Behavioral Health Workforce Shortages: Lessons Learned from a Rural Psychology Internship Initiative
This brief describes an initiative focused on developing rural psychology internship opportunities in an effort to grow the rural workforce. These internships have proven effective for behavioral health workforce development and may apply to other health disciplines as well.

Behavioral Health in Rural America: Challenges and Opportunities
This 2019 report describes the prevalence of behavioral health disorders among rural populations as well as the barriers associated with the provision of prevention, treatment, and recovery services. Following discussion of the need, the report presents rural models as well as policy options.

Behavioral Health Provider Geographic Distribution and Reimbursement Inequities
This cross-sectional study examines the relationship between reimbursement and behavioral health provider geographic distribution and seeks to understand how Medicare and Medicaid reimbursement for behavioral health providers may limit service delivery.

Behavioral Health Service Provision by Primary Care Physicians
This project seeks to understand which behavioral health services primary care physicians currently provide for their clients and how often they do so.

COVID-19 Crisis Puts Pressure On Farmers' Mental Health 
Side Effects Public Media address the mental health impact of the COVID-19 pandemic on America's farmers as they face additional stress and financial instability. Mental health advocates worry about the effects the pandemic will have on farmers and their families, including the potential for increased suicides and post-traumatic stress disorder. 

Critical Crossroads: Pediatric Mental Health Care in the Emergency Department
The number of children seeking care for a mental health crisis in an emergency department is on the rise. With often limited mental health services, hospitals in rural areas bear an excessive burden. This toolkit can better prepare hospital emergency departments to manage and coordinate care for children and adolescents in mental health crisis. You can tailor the resources to your specific needs, patient population, and community. This is a product of the Health Resources and Services Administration.

Cultivating Resilience in Rural Communities Toolkit 
This toolkit, developed by the Upper Midwest Agriculture Safety and Health Center was developed to support conversations on stress and mental health in the agricultural community.

National Association for Rural Mental Health (NARMH)  
NARMH is a professional organization that serves the field of rural behavioral health. NARMH's membership includes the entire spectrum of the rural mental health community, including consumers, family members, practitioners, administrators, educators, researchers, and policy makers. A unifying force for NARMH has been a focus on rural concerns, which includes a commitment to rural people and those that serve them. This belief that rural comes first has allowed NARMH to concentrate its efforts to improve access, availability, acceptability of behavioral health and substance abuse services and research in rural and frontier areas.

Pain in the Nation Update: Alcohol, Drug, and Suicide Deaths in 2018 
This report, provided by the Trust for America's Health details updated rates of deaths related to drugs, alcohol, and suicide for 2018. The report breaks down data by race, age, and regionally, including rural versus metropolitan areas.

Promoting Positive Mental Health in Rural Schools
This guide provides resources specific to addressing the unique mental health training and technical assistance needs of schools serving rural and remote communities. Underscoring the purpose of the document was a recognition that schools, communities, and families often lack comprehensive treatment and services for children and youth. That is particularly true in rural communities.

Rural Health Information Hub (RHIhub) Mental Health in Rural Communities Toolkit
This toolkit provides an overview of mental health as well as an introduction to some of the unique challenges facing isolated communities. Additionally, this module will provide insight into important background information needed to implement programming and improve mental health in rural communities.

Rural Health Information Hub (RHIhub) Rural Mental Health Topics Page
Here you can access resources, current data, news, events, models and innovations, and funding opportunities specific to rural mental health.

Rural Health Research Gateway Mental and Behavioral Health Topic Page
The Rural Health Research Gateway is funded by the Health Resources and Services Administration Federal Office of Rural Health Policy. Gateway provides access to all of the research products of the federally-funded Rural Health Research Centers. Access all of their recent research on rural mental and behavioral health.

Rural, Remote, and Resilient: How to Build Better Outcomes Outside of America’s Cities
Developed by the Master of Public Health (MPH) online program from Baylor University's Robbins College of Health and Human Sciences, this product discusses health disparities between metro and non-metro counties and offers strategies on how to collaborate to foster better health results in rural areas.

Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population 
Developed by the Rural and Underserved Health Research Center, this brief compares the utilization of Health and Behavioral Assessments and Interventions (HBAI) services by Medicare recipients in rural and urban areas. The brief includes data on HBAI providers, service units, beneficiaries, and average utilization rate in rural and urban counties.

State Incentive Programs that Encourage Allied Health Professionals to Provide Care for Rural and Underserved Populations
This study describes allied health incentive programs at the state level as described during 30 semi-structured phone interviews with key informants from 27 states and information found online.

Substance Abuse and Mental Health Services Administration (SAMHSA)
Leads public health efforts to advance the behavioral health of the nation. Works to reduce the impact of substance abuse and mental illness on America's communities. Part of the U.S. Department of Health & Human Services.

The Hidden Crisis in Rural America
This short documentary discusses rural mental health access issues and how rural residents with a serious mental illness are both more likely to encounter police and to live without treatment.

Understanding Rural Communities: Perspectives on Rural Mental Health
In 2017, the Hogg Foundation for Mental Health began to take a hard look at ways to work and learn alongside rural communities to promote conditions that support mental health. In this 20 minute podcast, you will hear from Dennis Mohatt, a national expert in the field of rural mental health, as he discusses how the unique characteristics of rural communities affect mental health and the implementation of mental health programs.