Children in rural areas have poor access to mental health facilities in the U.S. — and that’s had fatal consequences.

“These barriers contribute to late diagnosis, delay in treatment, and potentially contribute to increased morbidity and mortality among rural residents,” said Janessa Graves, an associate professor at Washington State University, during a Monday APHA Annual Meeting presentation on “Nowhere to go for help: Geographic disparities in access to mental health facilities for youth.”

Janessa GravesUsing federal data, Graves and her research team broke down — by more than 30,000 ZIP codes — which areas of the country had just one mental health care facility, with a goal of teasing out factors that may be contributing to a “widening disparity (in suicide rates) between urban and rural youth,” she said.

Between 1999 and 2018, suicide among youth increased by more than 15% for youth in rural areas, nearly double the increase among their urban-dwelling peers, at more than 8%.

And a lack of access to mental health care facilities might, in part, be to blame. Graves and her research team found that rural youth younger than 12 have far fewer options for seeking mental health care than their metropolitan peers.

When looking at just rural ZIP codes, the disparity is stark: up to one in four urban ZIP codes have at least one mental health care facility, compared to about one in 20 rural areas. There are even fewer that serve youth.

The results showed that increased distance from urban centers, cities and towns means significantly reduced access to care. And even in ZIP codes where facilities may still be present, barriers remain, Graves said.

“People in rural areas have to drive long distances to seek care and especially with mental health care…and there are stigmas and concerns about confidentiality, especially in small communities where providers live in these communities,” she said.

It’s imperative that access improve, Graves told attendees, and and even though telemedicine and teletherapy have become more widely available during the COVID-19 pandemic, it’s not as much of a boon to access as one might think.

“An issue with rural areas is that broadband access is very limited…so to rely on broadband for care presents a problem,” she said. “It’s a great idea, but in reality, when 80% of individuals in an area don’t have broadband services, it’s really challenging.”

Increasing access to high-speed internet could help, she said, but brick-and-mortal solutions are also needed.

Photo of Janessa Graves presenting during the Tuesday session by Aaron Warnick, courtesy The Nation's Health.