More than 113,000 American Indians and Alaska Natives (AI/AN) live in 492 counties that lack mental health providers, according to a new report from GoodRx Research. 

Over 90% of these areas are in rural parts of the U.S., where healthcare resources are already limited, the report stated. 

“In fact, there are fewer than one psychiatrist or psychologist for every 30,000 people living in these counties,” said Amanda Nguyen, a health economist at GoodRx Research.

Nguyen said mental health access is lacking in the South Central, Midwest, and Alaska regions of the U.S.: These regions have the highest number of mental health care deserts, including Texas (30 mental health desert counties), Kansas (13), Oklahoma (8), Nebraska (8), and Alaska (7) have some of the highest numbers of mental health deserts. In addition to Alaska (11,171), South Dakota (14,650) has one of the highest numbers of AI/AN residents living in mental health deserts.

“It’s important to note our analysis focused on psychiatrists and psychologists, due to their ability to diagnose and prescribe medication for mental health disorders,” she added. “It did not take into consideration the important mental health care and support that therapists, social workers, primary care physicians, and traditional healers may also provide to these communities.”

The report also found that poor broadband access limits access to telehealth services, which could help with mental health resources. 

“Generally speaking, rural communities are more likely to lack access to both traditional healthcare infrastructure as well as telehealth, which increased in popularity during the Covid-19 pandemic, especially for mental health providers,” Nguyen said.

“Living in a rural area with limited broadband internet access presents a challenge in accessing mental health care because broadband is often necessary for care to be delivered via video or online call.”

She said that the study found that counties with a higher population of AI/AN residents had a lower percentage of households with any form of broadband. For example, the vast majority of counties (94%) with 50% or more AI/AN residents – like Apache County in Arizona – have broadband access below the national average. 

“The internet is a valuable resource, and most often the quickest, for those seeking mental health guidance and support,” Nguyen said. “Without broadband access, mental health care is harder to come by and people may no longer be able to receive services from their psychiatrist or psychologist if those providers have switched to providing online care only.”

Although most Indian Health Service (IHS) clinics and hospitals provide services at no cost to tribe members and are located on reservations, 87% of those who identify as AI/AN live outside of tribal areas, according to U.S. Census data. 

“This means it’s not always feasible for all Native Americans/Alaska Native individuals to find accessible, affordable, high-quality, or culturally competent mental health care that meets their needs, which could in turn lead them to forgo care altogether,” she said. 

Nguyen hopes this study will increase awareness of the mental health disparities that the AI/AN community faces and leads to more solutions to support mental health care access.

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