Impact of Limited Mental Health Services in Rural Areas

by Dayle Sharp, PhD, DNP, McPH, FNP-BC, President of the Rural Nurse Organization

October 10th is World Mental Health Day. This year the goal of the World Mental Health Day is to bring dignity to mental health illnesses (Generations Family Practice, 2023). But how can we bring dignity when we cannot offer services necessary for the evaluation and treatment of mental health illness to rural Americans?

Improving access to mental health care for rural residents has been a focus of mine since to the pandemic. Mental health care in rural America has always been challenging. There are shortages of providers and there are stigmas to treatment from family and friends of those who identify their own mental health challenges. Approximately one-fifth of the US population live in a rural area with approximately one-fifth of those living in rural areas having some form of mental illness (Morales, Barksdale, & Beckel-Mitchener, 2020).

The pandemic exacerbated the need for behavioral mental health services. In 2021, it was estimated that 57.8 million adults live with a mental illness (National Institute of Mental Health, 2023). Since the start of the pandemic, there has been a three-fold increase in the number of individuals reporting symptoms of anxiety or depression (Ettman et al., 2020).

Children and adolescents were among the individuals impacted by the pandemic. Prior to the pandemic, the Centers for Disease Control and Prevention (CDC, 2023) reported 1 in 5 children had a mental disorder with only 20% of these children receiving care by a mental health provider. During the pandemic, childhood needed continued support for changes in their mental health, with mental health cases increasing over the first two years of the pandemic (CDC, 2023). The pandemic caused major disruptions in the daily lives of young people along with impacting the use of behavioral health service for children. There was a drop in pediatric mental health visits between March and December 2020 which indicates pediatric patients’ needs were not met (Janke et al., 2022). Their unmet needs led to an increase in the number of emergency department visits among pediatric patients, frequently requiring inpatient treatment (Janke et al., 2022).

Perhaps the group that was most affected was nurses. Nurses were forced to work long hours leading to physical discomfort and extreme exhaustion all while fearing contagion and emotional distress. These high levels of stress lead to behavioral and psychiatric disorders including depression, anxiety, insomnia, psychological distress, and post-traumatic stress disorder among nurses. Unfortunately, these symptoms that increased from the effects of the COVID-19 pandemic have not returned to pre-pandemic levels. Nurses surveyed in the 2022 Frontline Nurse Mental Health & Well-being Survey (Trusted Health, 2022) rated their current mental health and well-being at an average of 5.8, a decrease from the pre-pandemic levels of 7.8%.

Like other rural residents, there are barriers for rural nurses to receive adequate mental health services. Support from the effects of the pandemic has been slow and inadequate (Jahner et al., 2020) in rural areas. Limited resources have been intensified by living in a rural area with an inadequate number of mental health providers and close community ties impacting some nurses from disclosing the details of their experiences. Some nurses preferred to remain private while others “did not seek support given their personal ties to the community, issues of confidentiality, concerns for their own reputation, or their sense of professional obligation to deal with it on their own” (Jahner et al., 2020, p. 487).

The pandemic had a negative impact on the mental health of rural residents and nurses. Due to the increase of individuals struggling with mental health worldwide, the Global Rural Nursing Exchange Network (GRNEN) is spotlighting rural mental health with a mental health series. I encourage you to visit their website at for more information.

Dayle Sharp, PhD, DNP, McPH, FNP-BC, is President of the Rural Nurse Organization and Clinical Professor and Director of the Family Nurse Practitioner Programs at the University of New Hampshire.


Centers for Disease Control and Prevention (2023). Improving access to children’s mental healthcare. Children’s Mental Health. Retrieved from

Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence of depression symptoms in US Adults before and during the COVID-19 pandemic. JAMA network open3(9), e2019686.

Generations Family Practice (2023). October is Mental Health Awareness Month. Retrieved from

Jahner, S., Penz, K., Stewart, N.J., & MacLeod, M.L.P. (2020) Exploring the distressing events and perceptions of support experienced by rural and remote nurses: A thematic analysis of National Survey Data. Workplace Health & Safety. 68(10):480-490. doi:10.1177/2165079920924685

Janke, A. T., Nash, K. A., Goyal, P., Auerbach, M., & Venkatesh, A. K. (2022). Pediatric mental health visits with prolonged length of stay in community emergency departments during COVID-19. Journal of the American College of Emergency Physicians open3(6), e12869.

Morales, D.A., Barksdale, C.L., & Beckel-Mitchener, A.C. (2020) A call to action to address rural mental health disparities. Journal of Clinical and Translational Science 4: 463–467. doi: 10.1017/cts.2020.42

National Institute of Mental Health. (2023). Transforming the understanding and treatment of mental illness. Retrieved from

Trusted Health (2022) 2022 Frontline Nurse Mental Health & Wellbeing Survey. Retrieved from

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