Hope Down Every Road: Bringing mental health care to rural America
When we think of rural America, we often picture pastoral towns and rolling farmlands, framed by unimpeded horizons. And while these small communities are as beautiful as they are tightknit, a large crisis looms. For the past two decades, suicides in rural areas have remained substantially higher than in urban areas, and they are climbing at a much faster rate, according to the US Centers for Disease Control and Prevention. While the prevalence of mental illness itself is similar between rural and urban Americans, those in rural areas face a significant added hurdle that greatly increases their susceptibility to suicide: lack of access to care.
According to the , lack of access to mental health care is a main driver of rural suicide rates. Barriers to access include distance to a provider clinic, lack of provider availability, cost, and stigma. Huntsman Mental Health Institute knows that its neighbors in rural communities deserve better. This is why our institute is committed to comprehensively addressing these barriers鈥攖o bring parity to the underserved and expand access for all.
Stepping up to fill a need
According to the US Centers for Disease Control and Prevention, both Utah and Idaho consistently rank in the top 15 states for highest annual suicide rates among adults and youth. Additionally, both states are considered 鈥渉ealth care deserts鈥濃攎eaning the existing mental health care workforce can only meet a fraction of the need.
and 鈥攂oth recognized for their academic health care programs鈥 stepped up to address this crisis. It took several years to plan the rural track program, with extensive involvement from both institutions鈥 health care leaders to address the logistics of funding, insurance, resident supervision, and creating new clinics.
For residents in this educational track, their first two years look just like those of other residents. They spend the majority of their time in Salt Lake City, working in the to master skills in general medicine and complete required inpatient and subspecialty psychiatric rotations.
By year three, residents transition to Pocatello, Idaho, and continue to refine their skills as psychiatric specialists. While year three focuses on outpatient training, year four is dedicated to trainee-specific interests, passions, and individualization.
The rural track has doubled the number of psychiatrists in the area and also helped to establish a mental health consult service with other hospitals. Where there were previously only a handful of sites in the area, there are now more than 10 sites where patients can access mental health care.
Building tomorrow鈥檚 rural mental health workforce
Expanding the mental health workforce in rural areas is the most direct鈥攁nd perhaps the most formidable鈥攅ffort in the institute鈥檚 mission to eliminate barriers to care. The complexity of the problem requires new thinking, which is why Huntsman Mental Health Institute partnered with Idaho State University to create a specialized rural education track that embeds psychiatrists in training into rural communities.
Learn more on shifting from challenge to change in mental health
200 miles to the nearest psychiatrist
Though the need for rural mental health care providers has never been higher, the rural track remains one of a few of its kind in the country. Interest in the program has more than tripled since its creation; while there are currently only three spots available, more than 550 people applied last year.
Beth Botts, MD, Associate Training Director for the rural track, believes the program can serve as a model for others: 鈥淲e can off er the best of both worlds for trainees who want in-depth experience in inpatient and consult psychiatry in an academic setting, along with exposure to subspecialties like addiction, geriatrics, and forensics. When trainees relocate to Idaho, they become fully immersed in rural psychiatry and the community鈥攁nd then, they鈥檙e likely to continue living where they trained,鈥
鈥淚t truly feels like a full-circle moment. I鈥檓 so excited to meet and train future cohorts鈥攁nd to continue to build the network of rural psychiatrists.鈥
For Daisha Orchard, MD, the program鈥檚 first chief resident, this couldn鈥檛 be more true. Even before graduation, Orchard accepted a psychiatrist position with the new Idaho State University Community Psychiatric Center. As fate would have it, this new center was soon announced as another training site for Rural Track residents, whom Orchard will now supervise.
Call the doctor
Mental health crises happen all the time, all around us. Building a rural mental health workforce takes long-term, dedicated planning to ensure viability and sustainability. Meanwhile, there鈥檚 still an immediate need for expanded mental health care.
To combat barriers to care here and now, Huntsman Mental Health Institute is committed to finding new approaches to expanding services. These approaches require a lot of fresh thinking as well as a good deal of collaboration.
Because mental health is a specialty area in which most primary care providers aren鈥檛 deeply trained, Huntsman Mental Health Institute established a program called CALL-UP in partnership with the Office of Substance Use and Mental Health. This statewide phone consult program gives primary health care providers across the state access to our psychiatrists for guidance in treating patients with mild to moderate mental health needs. Funded by the Utah State Legislature, the program serves patients at no cost to either providers or patients across the state.
The program is already impacting underserved communities. While rural Utahns make up only 10% of the state鈥檚 total population, 17% of all calls received by CALL-UP come from rural doctors tapping into crucial help for their patients.
鈥 In many ways, stigma is the last piece of the puzzle. Even in situations where distance, provider availability, and cost aren鈥檛 impeding care, stigma often prevents people from seeking help.鈥
BETH BOTTS, MD
Associate Training Director, rural track
Rooting out shame and stigma
Stigma is a powerful social mechanism, and in small communities where everyone knows everyone, concerns over privacy and confidentiality are often heightened. In 2023, in an effort to tackle that stigma head-on, Huntsman Mental Health Institute partnered with the Ad Council to develop a national communications campaign called 鈥溾 The campaign aimed to normalize conversations about mental health and connect people with needed resources.
Knowing rural Americans experience mental health challenges at disproportionate rates, the campaign soon released its first rural-centered public service announcement featuring World Champion Bareback Rider Kaycee Feild. Three additional ads for the rural demographic followed, garnering over 92 million impressions across television and radio.
driving discovery
From our patient care to our education programs, research grounds and drives the work we do, ensuring our efforts are concentrated and effective. This is why, in 2021, in partnership with University of Utah鈥檚 College of Education, we formed the to form a better understanding of the challenges that children and adults alike face within schools.
Our research aims to improve functional outcomes for students struggling with mental health symptoms. And through early detection and intervention of mental illness in youth, we can prevent the need for higher levels of care.
Written by: Tanner Telford