Rural communities in the Northwest are facing a shortage of people who can help them with mental health challenges.
According to the Department of Health and Human Services, roughly one-third of the U.S population lives in an area short on mental health providers. Of that group, over two-thirds are in rural or partially rural places.
Alyssa Robinson is a therapist in St. Maries, Idaho, which has a population of around 2,500. She said it’s especially difficult to find providers who take Medicaid.
Her clinic is one of just three in the town and one of the few in that area to take Medicaid. As a counselor, she said, there isn’t much financial incentive to take Medicaid, which is why providers who do are harder to come by.
“They’re the ones that have the most hoops to jump through and the lowest reimbursement,” she said. “You’re doing more work for less pay.”
Robinson has some clients drive from as far away as Post Falls and Coeur d’Alene — well over an hour in the winter — simply because she takes Medicaid.
She says for some rural patients, telehealth services can help bridge the gap. But internet access isn’t always reliable in remote areas, and some patients don’t want to seek therapy over a video call.
“I don’t know if this is across all rural communities or just here, but a lot of them prefer in person,” she said.
In addition to a preference for in-person appointments, Robinson said, she’s seen more patients who struggle with stigma surrounding mental health challenges while working in a rural community.
“While the stigma is definitely decreasing compared to what it used to be even 10 years ago, I think in the rural communities, it takes longer for that to recede compared to, like, Portland or Boise,” Robinson said. “I still have clients whose husbands aren’t on board with them coming to session, or whose families are really confused why they would need therapy.”
Nichole Konen Giraldo lives in Walla Walla, Wash., a town of about 30,000. This past summer, she lost her husband.
“You’re struggling, you’re sad, you’re depressed, you’re suicidal,” she said. “I mean, you have all these things going through your brain and you just need someone to talk to.”
Giraldo has been searching for a long-term grief counselor for five months. She’s called every therapist she can think of. Most don’t even call her back.
“You’re left to basically just sink or swim,” Giraldo said.
Denise Metzger is a social worker in Coeur d’ Alene. She said even though her part of the state isn’t rural, it’s still underserved. All the good therapists usually have wait lists, and that’s not counting those who serve clients with specialized needs or limited insurance.
“If you have Medicaid or Medicare, then the amount of people that you can see are very limited. I give out the same names and same numbers to pretty much a lot of the people,” she said. “In terms of children’s therapies, that’s pretty limited as well.”
The challenges can be even greater for immigrant populations, who may experience a range of cultural and structural barriers, including language, stigma and cost, according to a systemic analysis published in the Psychiatry Online.