Why mental health care providers decide to practice in rural communities

Americans living in rural communities experience higher rates of depression and suicide than people who live in urban areas. These long-standing mental health inequities are attributed to a wide range of factors including affordability, accessibility and lingering stigmas around receiving care.

A new study, published in JAMA Network Open, from the University of Minnesota School of Public Health, U of M Medical School and School of Social Work addresses rural mental health workforce shortages—a longstanding barrier to care—by analyzing the factors that influence where health care professionals choose to practice.

Using survey data collected by the Minnesota Department of Health from February 2022-2023, the study included 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 from rural areas were significantly more likely to practice in rural settings. The association between rural upbringing and rural practice location was consistent across all professional groups but was highest among licensed alcohol and drug counselors at 75%.
• The decision to practice in rural areas varies significantly across professions. Licensed alcohol and drug counselors were most likely to practice in rural areas, while psychologists were the least likely.
• The desire for autonomy in their practice was a crucial factor for rural practice among psychologists and other prescribers, which suggests the ability to work independently and make professional decisions is a significant motivator for these groups.
• Financial incentives such as loan forgiveness programs were a critical factor influencing the decision to practice in rural locations, especially for licensed mental health professionals and licensed psychologists.

"There is an urgent need to address the shortages and disparities in mental health care access in rural areas of the U.S.," said Carrie Henning-Smith, SPH associate professor and lead author. "While there is no one-size-fits-all solution to this challenge, there is a clear need for a targeted and multifaceted recruitment strategy to encourage more people to practice mental health care in rural areas."

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

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