While rural residents are facing a growing mental health crisis, an initiative to direct them to the help they need is seeing success across the country.
The National Council for Mental Wellbeing’s Mental Health First Aid for Rural Communities works with people not necessarily in the health professions to give them the tools they need to recognize and respond to the signs of mental health or substance use challenges. Once trained, those rural residents can provide critical support to their rural neighbors until professional help is available.
“I took a training in our community, and then my colleague and I wrote a supportive funds grant to bring the program to our community because we felt that it was definitely needed, especially in our rural communities,” said Jamie Hagenbuch, program manager at the Mental Health First Aid at Madison County Rural Health Council in Cazenovia, New York. Her office serves 10 rural counties in central New York between Syracuse and Albany. So far, her office has trained more than 6,000 community members in their area.
“I think rural communities definitely don’t have the resources that cities and urban communities do, so having the initial skills to be able to recognize if somebody’s becoming unwell and how to approach them and know what resources do exist, as well as being able to navigate them to those resources, is critical,” she said.
About a quarter of people in non-metropolitan counties experienced a mental health condition last year, and an estimated 1.8 million rural residents reported having suicidal thoughts, according to the Substance Abuse and Mental Health Services Administration. But access to mental and behavioral health care in rural communities is lacking.
In fact, a 2020 study published in the Journal of Clinical and Translational Science found that nearly two-thirds of rural counties lack access to a mental health professional.
“There is a significant lack of access to specialty mental health care in rural areas in the U.S.,” according to the study by a team of researchers from the National Institute of Mental Health. “It is estimated that as many as 65% of nonmetropolitan counties do not have psychiatrists, and over 60% of rural Americans live in designated mental health provider shortage areas. …Specialty mental health services are scarce in rural areas, which is likely to contribute to these disparities in care.”
Approximately one-fifth of those living in rural areas, or about 6.5 million individuals, have a mental illness, the 2020 study found. But while the prevalence of serious mental illness and most psychiatric disorders is similar between rural and urban areas, adults in rural areas receive less mental health treatment and often have fewer providers with less specialized treatment than those in urban areas.
The training helps anyone in a rural community to spot the signs of someone struggling with a mental health issue and to be able to step in to help.
“We go into these community organizations, or we train parents in the community, and we always hear, ‘I don’t have a role because I’m not a clinician,’” Hagenbuch said.
“Then they leave saying, ‘Wow, I’ve never realized I could help somebody even though I don’t have a college degree behind my name.’ We teach them that they’re not there to diagnose or provide treatment but rather be that first person that can respond and recognize those warning signs and be able to have that conversation.”
The training is for anyone with contact with others, Hagenbuch said.
“We’ve gone to the Office of the Aging… We’ve gone to churches and trained pastors. We train teens,” she said. “It’s one of the most important things we can do in our rural communities because sometimes it could take an hour for an ambulance to get there. Being able to give our teens the tools to recognize if somebody’s becoming unwell and to stay with them and not to leave somebody, especially if they’re having a substance use crisis, it’s critical. It could really, truly save a life.”
Some rural residents have approached the training with some resistance, she said.
“I remember going into a school district and training bus drivers,” she said. “They didn’t want to be there.”
The bus drivers were hesitant and felt like they didn’t have a need for the training, Hagenbuch recalled. To them, it seemed at first like it was a waste of time, she said. By the end of the training, the bus drivers realized that, as the first people to see students in the morning and the last ones to release them to their home environments in the evening, they had a role to play as well.
Sometimes, the training had immediate results, she said. In one instance, they trained a group of teenagers on Mental Health First Aid, including the recovery position for people in a substance-use crisis.
“The teen came back at the next session, and said, ‘If it wasn’t for doing last session’s training, this weekend, I wouldn’t have been able to support an individual that was pulled over on the side of the road, having a substance-use crisis,’” Hagenbuch said. “If it wasn’t for those skills, she wouldn’t have known what to do.”
Studies have consistently shown that it works — more than 90 peer-reviewed studies over the past 15 years have shown that MHFA has a lasting impact, the National Council for Mental Wellbeing said on its website.
A study in 2021 of Cooperative Extension agents in Mississippi found that 62.5% of the participants in the MHFA training programs used their skills six months after training.
“Over 60% of the agents reported using the skills learned from the MHFA training, and nearly 15% of agents reported having an encounter with someone in crisis since completing the MHFA training,” the study found. “Agent participants reported using the skills learned from the training with farmers, 4-H youth, volunteers, and parents, family members, colleagues, and friends.”
Individuals interested in getting training can find more information at https://mentalhealthfirstaid.org.
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