How is mental health treatment burdened by geography?

People living in urban areas have better access to mental health care, as well as lower costs, than those living in rural areas – generating a crisis of geographical location

People living in rural areas are not able to access mental health treatment as much as those living in urban areas, even if they have private insurance.

Additionally, substance abuse continues to increase for those in rural areas, heightening the mental health crisis.

Disparities in rural and urbans costs of care

Published recently in the Journal of Rural Health, researchers evaluated over 10 years of insurance claims data from the years 2005 to 2018. This data features how adults with employer-based, private insurance used and paid for mental health care services in urban and rural areas.

The data revealed that urban enrolees used more mental health care than rural ones – although the usage gap narrowed from 2005 to 2018 – the quality and cost of care weren’t equal, even for privately insured patients.

Rural patients additionally paid higher out-of-pocket costs for mental health care – however, researchers are currently unsure of the reason for this, but suggest that is likely that rural enrolees had to use providers outside of their insurance networks more often due to a lack of specialists in their areas, which would mean paying additional costs for those services.

The study highlighted that urban enrolees had higher rates of depression, though this was difficult to interpret because it’s indistinct whether city residents were struggling with depression or just had better access to care, noting down more patients on their system.

Zhuo “Adam” Chen, at the University of Georgia College of Public Health, said: “Rural enrollees have a higher share of copays, and they are relying on primary care physicians and nurses much more than the urban area enrollees.

“Even among those in better economic conditions – they have a job and they have health insurance – I do think that this highlights the burden of substance abuse in rural areas.”

Expanding telemedicine could increase access

Data additionally underlined the rise of substance abuse in rural communities in the last ten years, which authors suggest may be due to this issue of access to appropriate care.

Geography continues to affect people’s abilities to access mental health care, predominantly due to the lack of availability of specialists in rural areas, as well as the increasing demand for mental health services.

The authors consequentially recommend the incentivisation of mental health providers to practice in rural areas and expand telemedicine, to better connect patients with mental health services.

Moreover, the authors suggest more research is needed to grasp how provider shortages, geography and insurance networks correlate in contribution to the disparities they observed from mental health care access.