Why do mental health care providers decide to practice in rural areas?

Rural Americans experience higher rates of depression and suicide than their urban counterparts, and these long-standing mental health inequities stem from a variety of factors, including affordability, accessibility, and persistent stigma around seeking care.

According to a new study published in 2011, JAMA Network OpenA research team from the University of Minnesota School of Public Health, University of Minnesota School of Medicine and School of Social Work is addressing a rural mental health worker shortage that has long been a barrier to care by analyzing factors that influence where providers choose to practice.

The study used survey data collected by the Minnesota Department of Health from February 2022 to February 2023 and garnered responses from four groups of mental health care professionals: mental health clinicians who prescribe medications, such as psychiatrists, licensed mental health professionals, including professional clinical counselors, licensed psychologists and licensed alcohol and drug counselors.

Key findings include:

• Professionals with rural backgrounds were significantly more likely to practice in rural areas. The association between growing up in a rural area and practicing in a rural area was consistent across all professional groups, but was highest for licensed alcohol and drug counselors at 75%.
• The decision to practice in a rural area varies greatly by profession, with licensed alcohol and drug counselors most likely to practice in a rural area and psychologists least likely.
• Seeking autonomy in clinical practice was an important factor for rural clinical practice among psychologists and other prescribers, suggesting that the ability to work independently and make professional decisions is an important motivator for these groups.
• Financial incentives, such as loan forgiveness programs, were important factors influencing the decision to practice in rural areas, especially for licensed mental health professionals and licensed psychologists.

“There is an urgent need to address the lack of and disparities in access to mental health care in rural areas of the United States,” said Carrie Henning Smith, SPH associate professor and lead author. “While there is no one-size-fits-all solution to this challenge, targeted, multifaceted recruitment strategies are clearly needed to encourage more people in rural areas to engage in mental health care.”

The authors suggest that policy interventions to encourage rural residents to enter the mental health professions should focus on strengthening education, training, and licensure pathways and tailoring recruitment strategies to the specific motivations of different professional groups.

The study builds on research published by the authors in 2023, which focused on factors associated with health care professionals’ decisions about where to practice.