Bradshaw & Nguyen: How Schools Can Help Bridge the Mental Health Care Gap for Rural Students

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As children across America return to the classroom this fall, the reality is that those in rural communities will face an especially steep uphill climb to success.

Research documents the ever-expanding achievement and opportunity gaps that 9 million of America’s children face, largely due to matters of geography, lack of awareness of extracurricular programs and opportunities, and limited availability of essential, nonacademic supports. Multiple studies illustrate the gap that rural youth face in accessing professionals who can provide high-quality mental health care. In fact, the majority of children in rural America are likely to live in a federally designated mental health shortage area, left without access to lifesaving treatment. In nearly two-thirds of non-metropolitan counties, where the effects of the opioid epidemic are most significantly felt, young people are likely unable to access a psychiatrist. That proportion dips even further when accounting for access to psychologists and other mental health resources.

As a result, rural children experience significant, and largely unsatisfied, needs for counseling and mental health services, a lacking that has significant repercussions. The rural suicide rate for adolescents is nearly double that of their urban peers over a 15-year period, and that gap appears to be widening.

There are, however, research-based strategies that can help offset these negative outcomes. A growing number of schools have adopted preventive, building-wide approaches to improving mental health like positive behavior intervention supports (PBIS) and social-emotional learning (SEL), which promote a positive school climate that positions all students to succeed. However, rural schools have less access to these and other research-based models and lack the capacity to identify students who stand to benefit most from these types of supports.

What strategies can we pursue to help rural youth overcome these and other such barriers to care this school year? We can start by leveraging telehealth practices that already connect doctors and their patients in rural and remote areas, and adapting these types of video and mobile-based remote consultations to include educators, families and mental health specialists. We can then use these technologies to expand access to training and resources for evidence-based models like PBIS and SEL, which together enhance students’ mental health and social and behavioral well-being.

We must also ensure that rural health professionals can identify students in need of these types of supports. That can happen only if practitioners have the tools with which to detect early signs of mental health issues and can offer treatments that reflect the cultural and contextual realities of rural communities and schools. By adapting proven models to the unique needs of rural schools, we can take a significant step toward bridging the mental health gap.

Given that only a handful of educators in rural areas have access to these types of cutting-edge and research-based approaches, state legislatures must ensure that these professionals possess the training and expertise to support the positive development of young people, leveraging the latest in prevention science. They can follow the example of the U.S. Department of Education’s Institute of Education Sciences, which recently funded the National Center for Rural School Mental Health, a five-year, $10 million initiative designed to support research that tests, adapts and scales existing evidence-based practices to meet the specific needs of students in rural settings. As a result, mental health researchers in Missouri, Virginia and Montana are partnering with rural schools to address these research-to-practice gaps.

Schools should serve not only as hubs for instruction but also as holistic partners with mental health experts in identifying youth at need and providing research-based services and programs to their communities. Bringing services to rural schools is just one step, albeit a significant one, in helping to address the specific stigmas and barriers to care that children and families across rural communities experience.

By expanding access to dedicated training, support and research-based programs, we can begin to bridge the mental health care gap this school year. If successful, we can also chip away at an enduring achievement and opportunity gap that continues to hinder 9 million students’ prospects for success.

Catherine Bradshaw is senior associate dean for research and faculty development and Amanda Nguyen is an assistant professor at the University of Virginia Curry School of Education and Human Development. Bradshaw is one of the principal investigators of the Institute of Education Sciences-funded National Center for Rural School Mental Health. The opinions expressed are those of the authors and do not represent views of the Institute of Education Sciences or the U.S. Department of Education.

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