Life in rural America appears to render today's children and adolescents especially vulnerable to mental health problems.
An analysis of mental health risk factors and service access conducted by the South Carolina Rural Health Research Center (SCRHRC) found that nearly one child out of every four living in rural America has a potential mental health problem. The conclusions were based on responses to the 2001 National Health Interview Survey's Strengths and Difficulties Questionnaire.
Among African American children living in rural areas, the risk is even higher, at 36% (http://rhr.sph.sc.edu/report/SCRHRC_MH_Risk_Children_Exec_Sum.pdf).
Substance use and abuse also are prevalent among rural adolescents. A recent study by the Substance Abuse and Mental Health Services Administration using data from the 2002-2004 National Surveys on Drug Use and Health showed that whereas past-year illicit drug use was generally similar among adolescents in rural, urbanized nonmetropolitan, and metropolitan counties, rural youth had a significantly higher prevalence of stimulant and methamphetamine use. Additionally, rural youth had a higher prevalence of past-month use of tobacco and alcohol (J. Rural Health 2007;23[suppl.]:10-5).
In a report titled "No Place to Hide: Substance Abuse in Mid-Size Cities and Rural America," produced by the National Center on Addiction and Substance Abuse at Columbia University in 2000, the authors reported that 8th graders in rural America were 83% more likely than those in urban areas to use crack cocaine, 43% more likely to smoke marijuana, and 29% more likely to drink alcohol.
Violence and suicidality also are pressing concerns in rural America. An SCRHRC report on teen violence indicates that of 15 measures of exposure to violence--including carrying weapons, fighting, and fear of violence at school--none was significantly less prevalent among rural teens than among suburban and urban teens. With respect to suicide, adolescent males in rural areas have higher suicide rates than their urban counterparts do (http://rhr.sph.sc.edu/report/SCRHRC_TeenViolence.pdf).
Despite the obvious need for mental health services, children and adolescents in rural areas largely are not receiving them. For example, in the SCRHRC report on mental health risk factors, investigators determined that fewer than one out of five parents of rural children with subclinical mental health problems had seen or talked to a mental health professional about the child in the past 12 months.
The low availability of services appears to be the most substantial roadblock to serving these youth, according to the SCRHRC investigators. Among the roughly 2.9 million rural children with a potential mental health problem identified by the Strengths and Difficulties Questionnaire score in the analysis, two-thirds lived in regions designated as mental health professional shortage areas. That translates to more than 1.9 million children with mental health problems living in areas with minimal to no resources available for their care.
Bridging the supply and demand gap is not easy, according to a recent report by Dr. Christopher Thomas and Charles Holzer III, Ph.D., of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch, Galveston (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:1023-31).
It is not economically or practically feasible to bring all of the rural children and adolescents who need mental health services into the metropolitan areas where such services are more available. But it is feasible to bring the metropolitan services and providers to the rural areas, if not physically, at least virtually, according to Dr. Thomas, a staunch advocate of pediatric telepsychiatry.
Having been involved with telepsychiatry since 1999, when he began providing such services to remote victims of domestic violence, Dr. Thomas most recently has employed the technology to deliver adolescent behavioral health services to the Galveston Independent School District in Texas. …