Infrastructure Limitations Make Rural Communities More Vulnerable To The Mental Health Crisis
There’s been massive adoption of virtual care for mental health that has granted more accessibility to mental health support. Forrester predicts that 60% of virtual visits this year will be for mental health treatment. In addition, the availability of virtual care for mental health is more widely available than ever before through a combination of employers, health insurers, healthcare providers, and direct-to-consumer (DTC) touchpoints.
Here’s the half-empty: Even with what is perceived to be easier access to mental health support, about 50% of those who identified that they need counseling or therapy from a mental health professional over the past four weeks did not get it, based on the US Census Bureau’s Household Pulse Survey. That’s alarming.
Forrester’s Predictions 2022: Healthcare report predicts that health disparities harming rural Americans will be twice the rate of those in urban environments. When it comes to mental health, the rural communities also face major obstacles. We interviewed Dr. DeLisa West, a clinical psychologist in Birmingham, Alabama, and Dr. Leide Porcu, a licensed psychoanalyst in Manhattan, New York City.
Major Obstacles Exist For Rural Communities When It Comes To Mental Health
The challenges with geographical proximity to mental health support in many rural communities has a profound effect on receiving mental health care. This not only impacts individuals but also their mental health providers, as they are challenged with:
- The digital divide. With less access to connected devices, high-speed internet, and strong cellular networks, remote options are limited. Dr. West told us, “I was surprised that many of my patients owned cellphones that didn’t work at their homes but only worked once they were closer to metro Birmingham.” Fear of stigma from the community or an employer may increase, as individuals need to commit more time and resources to overcome the digital divide in getting mental health support.
- Physically distant providers in rural areas and underserved neighborhoods force individuals to commit more time and resources to complete a visit. Many of the areas without providers are also impacted by the digital divide, emphasizing the greater cost and risk of stigma from committing more time and resources to get support. West’s neuropsychological testing services were in an underserved neighborhood of metro Birmingham. When Dr. West asked patients what they did before she arrived in the area, many responded that they went without those crucial neuropsychological care conversations.
- Less providers per capita limits individuals’ options to find a provider that matches their criteria. Providers in rural areas are often fully booked, since they are responsible for a greater portion of the population. This makes increasing the cadence of visits a limited option reserved to those with the greatest needs. Dr. West shared that “in Alabama, we cannot change the cadence [of visits] easily — only for major mental health crises such as suicidal ideation.” Massachusetts has nearly 6x more providers per capita than Alabama.
Infrastructure Is Not A Problem In Urban Communities, But Cost Is
The shift to digital in healthcare overall has improved access to care for patients. Options to plan around one’s work and personal life through virtual visits are here to stay. Dr. Porcu shared with us that virtual care for mental health has been largely successful with her patients in New York City and that it will continue to be a major post-pandemic delivery channel.
Despite more provider choices in urban areas, individuals are still limited due to in-network constraints and affordability. Dr. Porcu said, “There are many people that cannot find good therapists. It’s a question of quality, and money if they don’t have insurance.” She later added that increased cadence of support is often limited by cost and that she has had to continue to support patients who lost coverage due to unemployment.
More Innovation Is Needed To Prevent A Widening Equity Gap
Overcoming the cost barrier will open up access to virtual mental health solutions for the larger part of Americans. For rural communities, being able to identify or treat individuals in need of care bolsters the provider and insurer business case of providing connectivity to individuals via connected devices, 3G booster devices, or hot spots. In all communities, lowering the cost barrier is an important step toward greater mental health and out-of-network benefits. Potential cost innovations that could play a role here include:
- Bringing together multiple stakeholders that benefit from a mentally healthy individual to more efficiently co-fund these programs.
- Using AI and questionnaires in widely adopted, low-cost DTC “preventive” care apps to assess for greater clinical needs such as coach and therapist interactions.
- Including mental health screening with physical health checkups to catch conditions before they deteriorate.
- Permanent, nationwide reimbursement parity for virtual mental health.
(Paul-Julien Giraud contributed to this blog.)