Research work · 2021
Resolving Key Barriers to Advancing Mental Health Equity in Rural Communities Using Digital Mental Health Interventions
JAMA health forum
Abstract
In the United States, mental health problems and risk for suicide are inequitably higher among individuals living in rural compared with urban communities.1 This problem is complicated by numerous barriers to adequate care that affect rural communities.2 Individuals living in rural areas face stigma and have concerns about disclosing mental health problems or being seen by their neighbors when accessing mental health services.1,2 A culture of self-reliance also makes it less likely for individuals to seek mental health services.1,2 For those who do want services, many live in federally designated mental health professional shortage areas, meaning mental health clinicians are scarce. Access to available clinicians may require traveling long distances, making attendance at sessions more challenging. Digital mental health interventions (DMHIs), which use web and mobile applications to support patients and clinicians through the remote delivery of mental health services to manage mental disorders,3 offer a potential solution to address these barriers and increase access to mental health care, and may be particularly acceptable and beneficial for individuals living in rural areas. Given their efficacy and growing evidence of cost-effectiveness,3 DMHIs can expand the capacity and reach of health care settings to manage mental health. With proper privacy policies, DMHIs can provide anonymity in the use of services, which can reduce concerns around stigma and disclosure and promote engagement.4 The availability of DMHIs outside brick-and-mortar settings reduces barriers associated with accessing services. Although fewer rural adults own smartphones, tablets, and/or computers compared with urban and suburban residents, rural residents’ technology adoption and use has steadily risen consistent with their counterparts.5 These factors make digital delivery a potentially critical modality by which to scale up mental health services to many rural individuals in critical need of care. Efforts are underway to facilitate broad adoption and integration of DMHIs into the US health care system, including through establishing reimbursement mechanisms to support their delivery.3 Such efforts have the potential to help ameliorate inequities in access to mental health services that exist across geographic locations, and align with broader national imperatives to reduce health inequities for rural populations.6 However, effectively ameliorating such inequities requires an understanding of certain affordances of DMHIs that could put rural communities at a distinct disadvantage for being able to reap the full benefits of these services. Therefore, solutions to broadly integrate DMHIs into the US health care system must consider solutions that adequately account for and address these potential barriers.