Confronting Mental Health Challenges in Rural America

Growing up on a dairy farm in upstate New York, where the nearest town had a population of about 500 people, I have firsthand perspective on living in rural America. Rural communities are typically small and friendly — and the people are fiercely independent, yet quick to come together and help their neighbors in need.

Over the years, however, I was aware that there was something going on in my small farming community that people kept hidden — a taboo topic. As I eventually discovered that there were people in my community who had a relative or a friend living with an untreated mental illness, such as depression, anxiety, bipolar disorder or schizophrenia. Yet, their struggles were met with silence because in this community — like in much of rural America — there was little information and few, if any, resources available.

The wake-up call for me and my family was in 2012 with the suicide of my 28-year-old nephew, Brooks. Like so many people who live in small towns and remote areas of our country, my beloved nephew kept his suffering to himself and couldn’t bring himself to ask for help. Now, my mission is to end the suffering, silence and stigma around mental illness in rural America.

The third Thursday of every November has been designated as National Rural Health Day — a day dedicated to addressing the unique health care challenges that rural residents face. Mental health is an integral part of overall health, but this critical component of our well-being is often overlooked in rural America.

A Silent Epidemic

Rural Americans experience higher rates of depression and suicide than people who live in urban areas, but they are less likely to access mental health care services. Suicide rates among people living in rural areas are 18.3 to 20.5 per 100,000 residents — much higher than rates among people living in large urban areas (10.9 per 100,000). In addition, many rural communities have a shortage of health care providers. The following findings are a cause for concern:

• Rural areas have fewer primary care providers per resident than urban areas — and the workforce is growing more slowly
• 65% of rural counties lack a psychiatrist
• 81% of rural counties lack a psychiatric nurse practitioner
• 47% of rural counties lack a psychologist

Mental health challenges are often made worse when coupled with other health conditions. (Comorbidities can also exacerbate an existing mental illness). The COVID-19 pandemic had a major impact on mental health in rural America, with 53% of rural adults and 71% of younger rural adults between the ages of 18 and 34 years reporting that the pandemic has affected their mental health.

Understanding Rural Lifestyle Challenges to Mental Health

Beyond the lack of mental health resources, people living in rural areas face unique lifestyle barriers that play a role in determining whether they get the mental health care they need. They often fear negative judgement from family, friends and members of their communities (concerns include being perceived as weak or ”incompetent” if they admit to having a mental health condition). As members of small, close-knit communities, many rural residents also worry about being able to maintain confidentiality concerning a mental illness.

Other rural lifestyle challenges to mental health include:

• Many rural Americans live in areas where there are too few mental health care providers to meet demand and must travel long distances to receive care. There are nearly 37 million rural Americans — more than half of rural residents — who live in mental health professional shortage areas.
• Many rural residents lack adequate insurance to cover the costs of mental health services.
• Rural residents often have limited access to affordable, reliable broadband internet, with nearly 30% of rural Americans lacking internet in their homes. This means that telehealth appointments are not an option.
• There are stress factors unique to rural life that contribute to the mental health crisis in rural America, including a weakening agricultural economy, financial instability and a solitary lifestyle.

Overcoming the Stigma in Rural Communities

The stigma associated with mental health challenges can be a major barrier to seeking help for many people living in rural communities. Some people don’t readily understand or accept that mental illness is a legitimate medical condition but rather view it as a personal weakness or character flaw. Much of the stigma surrounding mental illness is a result of this unwarranted shame, which adds to the burden for someone already suffering from mental illness.

After Brooks’ passing, many of our friends and neighbors urged my family not to talk about what really happened to my nephew, to instead say that he died from natural causes. But my mother, the matriarch of our family, insisted on confronting this issue to make sure it didn’t happen to anyone else in our community.

I was given the privilege of delivering Brooks’ eulogy, and I spoke in detail as to what led to his untimely death. Following the service, we had several other farm families approach us about their own journeys in dealing with mental illness and thanked us for finally giving them permission to talk openly and freely about it.

Increasing awareness that mental illness is a health condition — just like cancer, heart disease or diabetes — is one way to help overcome the stigma in rural communities. In addition, talking openly with others about lived experiences with mental health challenges helps to normalize the conversation and diffuse the stigma surrounding mental illness. The simple act of sharing stories can be an important first step for people to seek help for their own mental health challenges and encourage others to admit that they are struggling.

It took my nephew’s death to be my family’s wake up call, and for me to come forward and provide a voice for the often-forgotten people of rural America. While some members of our community had wanted to sweep my nephew’s tragic passing under the rug, my mom took a bold stand to talk about it with the goal of helping others. I carry on this legacy today through Rural Minds, a nonprofit organization that is committed to making a difference by pulling back the veil of silence about mental illness in rural communities.

As we move forward at Rural Minds to fulfill this mission, we recognize that there are established mental health organizations, like NAMI, that provide excellent mental health information and services. Through collaboration, we are working to develop mental health initiatives to better serve the mental health needs of people in rural communities and empower rural Americans with the resources to become part of the solution to improving mental health.

Jeff Winton is the Founder and Chairman of Rural Minds, a nonprofit organization that aims to end the suffering, silence and stigma surrounding mental illness in rural America. He is also the founder and owner of Wall Street Dairy, LLC — a working dairy farm in Chautauqua County, New York — and a member of a multigenerational farm family. In addition, he is the chief executive officer of Jeff Winton Associates, a full-service communications and corporate affairs agency he co-founded in 2020.