The recently signed One Big Beautiful Bill Act includes a provision to invest $50 billion in creating the Rural Healthcare Transformation Program aimed at offsetting the loss of healthcare coverage nationwide. But leaders are questioning whether this effort will be sufficient.
A slew of complex challenges have consistently emerged in rural behavioral healthcare that go beyond healthcare costs, Nikita Duke, DNP, RN, vice president of operations for behavioral health at Waynesboro, Tenn.-based Fast Pace Health, and Robert Trestman, MD, chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine in Roanoke, told Becker’s. These issues include a lack of broadband access, stigma surrounding mental health and the need for consistent transportation to service locations.
Conversations and awareness surrounding mental health conditions have become more prevalent in recent years, making significant social progress toward acceptance, Dr. Trestman said. But stigma still plays a part in people’s lack of willingness to seek necessary mental health and substance use disorder care, Dr. Duke said.
One study found rural youths are less likely to participate in online therapy sessions compared with their suburban and urban counterparts, highlighting stigma as a cause. Smaller communities often present challenges when it comes to stigma.
“‘Oh look, Karen and Sam are at marital counseling — I can see their car.’ People kind of know your business,” Dr. Duke said. “We are trying to increase accessibility and provide anonymity.”
Other factors, such as transportation, play a role in lack of access to services. In rural communities, complications can lead to a variety of outcomes, such as not having gas to make it to an appointment or not having a ride to services, Dr. Duke said. Even when transportation is a viable option, some rural health providers provide care for numerous towns.
“The footprint that we care for is 250 miles in Appalachia, and so that presents many challenges in terms of both transportation, and many of our patients have very limited resources,” Dr. Trestman said.
Telehealth and other digital platforms have allowed patients to access mental health professionals and to stay in their communities to receive care. But at least 17% of Americans in rural areas lack access to a service speed of 25/3 megabytes per second, a common benchmark for high-speed internet, according to a 2021 Federal Communications Commission report.
In the wake of the COVID-19 pandemic, telehealth and broadband access expanded across the country, allowing therapists to provide services outside of clinical settings, Dr. Trestman said. But digital solutions remain dependent on broadband availability and although access has increased, a significant number of rural residents remain without internet. One survey pointed to a lack of internet access being an issue concerning access to mental health services, especially for youths.
