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14 March, 2023.

Challenges to Mental Health Treatment in Rural Areas

The Family Counseling Center is highlighting issues regarding mental health care in rural areas. The agency, a behavioral health care facility working primarily in Fulton and Montgomery counties, provides services to clients in rural and urban settings. Its Fort Plain office serves clients in western Montgomery, eastern Herkimer, Schoharie and Otsego counties.

Across the country, approximately one-fifth of the population deals with mental health issues. Mental health includes social, emotional, and psychological well-being and affects nearly all aspects daily life including physical health. While statistically the occurrence of mental health illness is consistent regardless of location, the incidents of depression and suicide are twice as high in rural communities as in more urban settings.

Experts have identified three major barriers to mental health care in rural settings: availability, access, and acceptability. Any one issue can greatly impact an individual’s ability to address their mental health – but the combination of these factors can have a significant correlation to overall wellbeing.


While there is a national mental health care provider shortage, rural areas are especially hard hit with fewer mental health providers serving rural communities compared to urban ones. More than 90% of psychologists and psychiatrists work exclusively in metropolitan areas, creating a shortage of mental health professionals in rural communities.

The Family Counseling Center, among other Capital District and Mohawk Valley providers, have increased their efforts to recruit qualified candidates for outpatient mental health therapists and psychiatric nurse practitioners. The Family Counseling Center is taking a unique approach to their recruitment efforts by hosting Hiring Happy Hours at local restaurants, promoting a low-caseload for practitioners, and staff engagement efforts focused on work-life balance and employee appreciation. Interested candidates with their LMCH, LMSW, or LCSW credentials are welcome to attend.

The agency’s Hiring Happy Hours will be held:

In addition, rural residents are more likely to be uninsured or underinsured and more likely to receive Medicaid adding complexity to reimbursement for services – a complexity that limits the number of providers who will accept clients with Medicaid.

The Family Counseling Center is a designated National Health Services Corps site, meaning that it serves all patients – regardless of their ability to pay. This designation, the agency’s ability to accept Medicaid, Medicare, and managed care coverage, and a sliding fee scale for clients who pay out-of-pocket means that access to care increases.

Experts including the National Rural Health Association (NRHA) recommends the expansion of rural mental health care providers by:

  • Strategic recruitment and retention strategies including stipends and paid internships for students working toward health and human services degrees,
  • Offering advanced incentives for providers who practice in rural areas,
  • Retaining quality health care workforce by addressing stress, burnout, and compassion fatigue through federal grant support,
  • Expanding certified peer support networks to support care in rural communities.


Due to the nature of rural communities the distance individuals need to travel for services is significantly farther than their urban counterparts. In addition, lack of public transportation and low rates of car ownership create barriers to accessing health care services. Limited broadband access and cell phone dead zones also impact access to telehealth options.

Since the early days of the pandemic, the Center has worked in partnership with Fort Drum Regional Health Planning Organization, Adirondack Health Institute, and the New York State Office of Mental Health, the Center has built the capacity to provide a full spectrum of behavioral telehealth services including crisis evaluation, therapy, and psychiatry. This partnership has provided the Center with the platform to serve individuals beyond the Fulton County area, accessing clients throughout New York State and providing services to clients in areas suffering from critical mental health workforce shortages. While telehealth is an important tool to care, face-to-face treatment remains the most impactful treatment method.

Experts recommend increasing access to quality, culturally responsive rural mental health care services by:

  • Co-locating mental health and substance use treatment with physical services at other, more traditional, healthcare providers such as hospitals and community health agencies,
  • Broaden eligible mental health professionals for Medicare reimbursement to provide full costs for all mental health workers,
  • Offering mobile mental health services,
  • Support state and federal broadband legislation that directly and indirectly impacts improved access to rural mental health services.


Small communities can mean a lack on anonymity when accessing mental health care, meaning that individuals are reluctant to seek treatment. In addition, cultural acceptability of seeking mental health services in rural communities can also add a significant stigma to seeking care. Rural communities often pride themselves on their independent nature and self-reliance.

The Family Counseling Center has over 47 years of experience in the treatment of clients from rural and semi-rural communities. The agency’s Fort Plain office is located in a facility that includes a dentist and podiatrist – allowing for co-located services and a level of anonymity for clients who are seeking our services. The organization’s Gloversville headquarters includes a pharmacy that is open to general public use and other services.

Experts recommends highlighting the importance of rural mental health wellness and reduce the stigma of seeking services by supporting:

  • The creation of social and public media campaigns specific to rural audiences,
  • Youth-based mental health literacy initiatives,
  • Community engagement, outreach, and education efforts specifically tailored to rural communities.