One fifth of America’s population lives in rural areas. Rural America includes more than 2,000 counties and 49 million people. While research indicates that the prevalence of mental health and substance use disorders are generally similar to urban populations, the services and workforce present are not.
Specifically, according to the Results from the 2019 National Survey on Drug Use and Health: Detailed Tables, approximately 7.3 million “nonmetropolitan” adults reported having a mental illness (AMI) in 2019, accounting for 21.2% of all nonmetro adults. In addition, nearly 1.6 million, or 4.8%, of adults in nonmetropolitan areas reported having serious thoughts of suicide during the year. Rural Americans have higher rates, proportionately, of alcohol misuse, tobacco use and methamphetamine use than most urban areas as well as prescription and opioid misuse – with fewer prevention and treatment services available. Rural America is also home to an increasingly aging population, further highlighting the need for developing, competent integrated medical/behavioral workforce. In short, it is estimated that in America today about 60% of rural behavioral needs remain unmet, due largely to worker and agency shortage.
As of September 4, 2018, HRSA had designated 2,672 Mental Health Professional Shortage Areas in rural areas. It is estimated that today it would take 1,851 additional practitioners just to remove the designations. Beyond worker and agency shortages, t ravel distance, lack of public transportation, and uninsurance are commonly identified as further challenges to accessing healthcare in rural areas. Reimbursement issues and the social stigma of needing mental health or substance use services are also identified as significant challenges that affect access and the provision of behavioral health services in rural areas.
Realizing the many challenges faced in the workforce for rural America, the Annapolis Coalition joined with the Western Interstate Commission for Higher Education (WICHE) to support efforts in its 15 rural member states to improve their behavioral care system and better prepare its workforce. In 2007 the Coalition published an Action Plan for Behavioral Workforce Development that included 7 specific goals for rural workforce development and a further recommendation for a dedicated data resource center for rural behavioral health, including worker and service access and development.
More recently the Coalition completed the development of core competencies for health workers in the Alaskan Department of Health Department of Health and Social Services while also leading in developing similar competences for the Centers of Medicare and Medicaid (CMS) for direct service workers in integrated care. In 2019 the Annapolis Coalition awarded an Innovation Award to a large, non-profit behavioral managed care company for its pioneering work in rural and urban Pennsylvania’s workforce development. The Annapolis Coalition views rural America as a priority need for workforce and agency development. Via COVID interventions, telehealth (audio and visual) may have opened new opportunities for both workers and access to quality care.