Creative Mental Health Care in Rural Communities: Bringing Innovation to Patients and Their Families
Nanci S. Claus, DNP, RN, CRNP; Shawona C. Daniel, PhD, RN, CRNP; Laura A. Steadman, EdD, RN, CRNP
Rural families face significant mental health challenges due to factors such as geographic isolation, stigma, and shortages in the healthcare workforce (Mack et aal., 2022). Similar to urban areas, approximately one in five adults living in rural areas experience some form of mental illness (NAMI, 2022). However, rural residents encounter barriers to care. According to the National Rural Health Association, these barriers are summarized by the "4 A’s": accessibility, availability, affordability, and acceptability (University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis, 2024). Rural communities are often designated as Health Professional Shortage Areas, with limited access to primary care and mental health professionals, including psychiatrists, psychologists, and psychiatric nurse practitioners (NAMI, 2022).
Additionally, many rural residents lack insurance coverage for mental health services. Stigma plays a significant role as well—individuals may fear being judged or perceived as weak for seeking help. Concerns about confidentiality, particularly in small communities where providers may be well-known, further discourage people from accessing care. Despite these challenges, innovative solutions are emerging that enable healthcare providers to deliver effective, compassionate mental health care directly to patients and their families.
Improving Access to Rural Mental Health Care
Telebehavioral health has greatly expanded access by allowing patients, especially older adults and those without reliable transportation or broadband—to connect with providers via video or phone. Virtual visits ensure privacy, reduce travel burdens, and help reduce stigma in tight-knit communities. To support patients lacking internet access, connectivity can be offered in schools, libraries, senior centers, and other community spaces (NORC Walsh Center for Rural Health Analysis, 2023).
- The Primary Care Behavioral Health Integration Model brings medical and mental health services together in a single setting—such as clinics, hospitals, or mobile units—offering a comprehensive approach to care (University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis, 2024). This model enables providers to assess both physical and mental health concerns and create personalized treatment plans for rural patients.
- SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based model that integrates mental health screening into routine medical care. Administered by nurses or medical assistants using tools that are specific to mental health, SBIRT helps normalize mental health care and reduces stigma by embedding services within general medical visits. Virtual consultations with mental health professionals are available when needed.
- Mobile Health Units deliver mental health services directly to rural communities, eliminating transportation barriers. Staffed with trained personnel, these units provide crisis care, counseling, case management, medication support, and education.
- School-Based Health Centers (SBHCs) address mental health needs of children by placing interdisciplinary teams—primary care providers, mental health professionals, and social workers—on school campuses. These teams screen for behavioral and developmental issues, create individualized treatment plans, monitor medications, and support educators in developing IEPs.
Nurses can provide valuable resources to their patients and families. By combining telehealth, integrated care, mobile services, and school-based support, rural communities gain access to high-quality, stigma-free, and culturally sensitive mental health care—bringing services closer to home and ensuring no one is left behind.
References
Mack, B., Whetsell, H., & Graves, J. M. (2022, February). Mental health in rural areas. National Rural Health Association Policy Brief. https://www.ruralhealth.us/getmedia/cf3c3922-25cb-49a0-bb04-0bad81d634f9/NRHA-Mental-health-in-rural-areas-policy-brief-2022.pdf
National Alliance on Mental Illness (NAMI). (2022, November 17). Confronting mental health challenges in rural America. https://www.nami.org/advocate/confronting-mental-health-challenges-in-rural-america/
NORC Walsh Center for Rural Health Analysis, 2023. Rural Telehealth Toolkit [online]. Rural Health Information Hub. https://www.ruralhealthinfo.org/toolkits/telehealth
University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis. (2024). Mental Health in Rural Communities Toolkit [online]. Rural Health Information Hub. https://www.ruralhealthinfo.org/toolkits/mental-health
