Where are the mental health care providers?

Rural residents have dealt with diminishing access to health care for decades, largely because increasing costs of services makes sparsely populated areas less economically feasible to serve than densely populated urban areas.
This problem applies just as much to mental health services as to any other aspect of health care in the United States.
But now more than ever, as the demand for mental health services increases everywhere, mental health providers are struggling to hire and hang on to workers.
In rural areas, where demand is on average higher and the supply lower than in population centers, providers and their clients are especially feeling the strain of a workforce shortage.
Based on a survey and a series of interviews conducted in the fall of 2022 by researchers at the Center for Rural Behavioral Health at Minnesota State University Mankato, it’s apparent that the mental health care workforce shortage is being aggravated by a handful of quite specific and identifiable problems.
They include graduating workers, recruiting them, and keeping them once they are hired.
Bringing these challenges to light and solving them may not fix the workforce shortage completely — the wave of retiring baby boomers plays a significant part in the shortage — but resolving them could help with the supply of mental health care professionals and workers going forward, especially in rural communities.
The disparity in mental health care between urban and rural areas is seen in provider-to-client ratios. There is one licensed provider for every 197 residents in metro areas compared with one provider for every 741 residents in isolated rural areas.
The study looked at why these disparities exist and considered solutions.
To attract licensed workers to rural areas, researchers suggest increasing the number of internships in rural places.
The rationale is that students are more likely to stay and practice near where they interned.
They also suggest financial assistance for rural clinics to make more internships and training available.
And they recommend introducing students early to mental health care as a profession, especially in rural areas.
High school and middle school is not too early for students to start considering a career in mental health.
Uneven reimbursement from Medicare and Medicaid is a federal issue, but the low pay disincentivizes students.
But even the students who want a career in mental health are limited by lack of college faculty in their field.
Two-thirds of programs responding said they turn qualified students away every year, and 90 percent cited lack of teaching faculty as a reason.
The reason for this, not surprisingly, is financial limits on colleges and universities.
Students are also discouraged from pursuing mental health work in rural areas because of low pay in outstate clinics, so it’s thought that upfront tuition waivers and scholarships could offset this trend. Also, grants could support students at the beginning of the educational process.
 
Lack of access to mental health care leads to ER, jail, addiction, suicide
Early intervention is key when dealing with mental health concerns, and left untreated, mental health challenges often progress to drug addiction and suicide.
Other outcomes are often emergency rooms or jails, especially in rural counties with few alternatives. There they consume valuable resources to treat what could have been an out-patient issue, had care been available.
Unmet need is difficult to measure, but we do know Minnesota is experiencing an unprecedented demand for mental health services, and rural Minnesota is being hit especially hard.
The rates of suicide in rural Minnesota are higher and rising faster than in the Twin Cities or other population centers.
In 2021 suicide accounted for two-thirds of gun deaths in Minnesota, and the largest proportion of those deaths were in the state’s most rural areas.
 
The full report can be found at ruralmn.org.