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Access to mental health care a challenge for rural areas

Jonathan Bailey | NIH

Every day, LaDonna Haley talks to patients who can’t find a psychiatrist or counselor who takes new clients in the St. Louis area. She estimates that 10 percent of those callers live in a rural county.

“More and more we are hearing of people having a difficult time accessing mental health services,” said Haley, who is a director at Mental Health America of Eastern Missouri. “In the more rural areas, there are less people but there are hardly any services to be found.”  

The psychiatrists, counselors and therapists that are based in Missouri’s Warren, Jefferson and Franklin counties are often swamped with requests for appointments, Haley said. If someone can find a provider, they might pay out-of-pocket if their insurance plan doesn’t cover mental health. That can be an expensive investment, and driving all the way to St. Louis may not be feasible for everyone, she said.

“Because mental health is so fundamental to your overall well-being, it starts to impact other areas of your life. So, a woman who is severely depressed, if she doesn’t get treatment, she may not be able to maintain her job, she may be less capable to care for her children,” Haley said.

The Robert Wood Johnson Foundation’s annual County Health Rankings report, released Wednesday, backs up Haley’s observation about the paucity of mental health services in rural areas.

The study shows that for many of the counties that ring the St. Louis metro area, counselors can be few and far between. For example, there is one mental health provider per 399 residents in the city of St. Louis. But in nearby Warren County there are just 11 providers to serve a population of 33,000 residents.

In Illinois, Jersey County has six providers for a population of more than 22,000, one of the lowest provider-to-population ratios in the state.

The Missouri Department of Health has long tracked health disparities for rural residents, and publishes outcome measures that suggest access to mental health treatment may be lacking. Between 2001 and 2011, the suicide rate in rural parts of Missouri rose twice as quickly as in urban areas, according to the state’s last biannual survey of rural health issues. Hospitalization rates for mental health concerns such as depression, bipolar and anxiety disorders were 6.3 percent lower in rural counties than in urban ones between 2007 and 2011, although the disparity is smaller than it was in 2001.

Haley said she hopes the emergence of telepsychiatry—where mental health professionals who see patients over a video conferencing system—will play a role in making services more accessible to people in rural areas.

Here is a break down of their findings for the St. Louis metro area:   

  • St. Louis City: 789 providers for 318,400 residents


  • Warren County: 11 providers for 33,000 residents 
  • Franklin County: 85 providers for 101,800 residents
  • Jefferson County: 150 providers for 221,400 residents


  • Jersey County: 6 practitioners for 22,600 residents
  • Clinton County: 8 practitioners for 37,900 residents
  • Macoupin County: 12 practitioners for 46,900 residents 
  • St. Clair County: 210 practitioners for 267,000 residents 

The report defines mental health providers as psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and nurses who specialize in mental health care. Because the numbers are based on the National Provider Identification data file, some providers included in the count may no longer be practicing, leading to an overestimate of available professionals.