Rural schools are significantly less likely to offer mental health services compared to urban schools, according to a new study led by researchers at Washington State University.

The study, appearing in American Journal of Preventive Medicine, showed that only a little more than half of all public schools, 51.8%, reported providing assessments for mental health disorders. The researchers’ analysis showed that schools in rural areas, towns and suburban areas were significantly less likely to provide those assessments than city schools by a respective 19%, 21% and 11%. Treatment was being offered in only 38.3% of schools overall with suburban schools the least likely to provide treatment compared to city schools.

“I think that rural youth are not getting services, the same equal access to services within the schools,” Janessa Graves, an associate professor in the WSU College of Nursing and the study’s first author, told the Daily Yonder. 

“But we also know that rural youth have faced a lot more, or they face significant barriers in terms of accessing services geographically, that there’s an issue around access to providers, and transportation and scheduling that are facing rural residents in general. And so I think that it puts them sort of doubly at a disadvantage for accessing these services.”

A resident of rural northeastern Washington, Graves conducts research focused on rural disparities in access to and quality of health care. She started specifically looking at youth mental health after seeing the impacts of the youth mental health crisis on rural communities just as the Covid-19 pandemic started.

“I’m familiar with a lot of these issues,” she said. “And so for a lot of us who live in rural, it’s sort of a no brainer. But my hope is that it brings some of these issues in a very pragmatic way to the front of the conversation and makes those in power and legislators and people who are making decisions around funding models and access to services, more aware of the issues facing rural, because if we don’t have a voice, then we can’t make any changes.”

In Washington state, funding for school support staff is based on student numbers. For a school to get funding for one full-time nurse it would have to have around 5,000 to 7,000 students. That means a small, rural school with only 150 students would receive funding for a tiny fraction of a nurse position.

“It’s really hard to hire somebody in a rural area for a fifth of their time when they’re employed,” Graves said. “They have potential for full employment elsewhere. And so schools we’ve seen have shared across districts, that’s very common. But it also results in the mental health therapist or school personnel driving for a significant amount of time, and also some discontinuity of care. They’re in this school one day, and I think that also results in some degree of burnout. So it’s hard for recruitment, it’s hard for retention. And then the kids aren’t getting the services that they need, and they can’t necessarily get locally for the same staffing reasons.”

The study is based on data from the School Survey on Crime and Safety (SSOCS) for the 2017-18 school year, the most recent timeframe for which the survey data is available.

One thing that Graves found as a bright spot was that rural schools were significantly less likely to indicate that lack of community support was a barrier, suggesting that there is community support and communities are rallying behind providing mental services for youth in schools.

“I think that’s really encouraging,” she added. “Because it’s saying that…rural is really driven by community. And so if our community members and the families involved are really supportive of those services perhaps those barriers are easier than the barriers of providers and funding might be easier to overcome. Because people want those services. And there’s demand.”

Funding for the study came from a faculty pilot grant program supporting health disparities research administered by the WSU Institute of Research and Education to Advance Community Health.

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