Study finds significant inequities in school-based mental health services in rural areas

Proportionally fewer rural public schools have the ability to get kids diagnosed with mental health issues than their urban counterparts, according to a study led by researchers at Washington State University.

Supporting recent calls for increased mental health services, the study revealed 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.

We're seeing a pretty consistent pattern across the country that rural schools just don't have the resources. This is especially troubling given the rapid rise in youth suicide rates, which is disproportionally affecting rural areas."

Janessa Graves, associate professor in the WSU College of Nursing and study's first author

Published in the American Journal of Preventive Medicine, the study looked at geographic disparities in the availability of mental health services in a weighted, nationally representative sample of U.S. public schools. 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.

Perceived major barriers to providing school-based mental health services included lack of funding and lack of access to qualified mental health professionals, which was true for all schools but particularly for those in rural areas. One positive finding that surprised Graves was that rural schools were 30% less likely to call lack of community support a barrier than urban schools.

"Given the stigma around mental health in rural areas, we thought lack of community support would be a major barrier," Graves said. "The fact that only 6.5% of rural schools called it a major barrier gives me hope that communities are rallying behind this issue that there just aren't enough services and kids' lives are impacted as a result."

To get a sense of how the COVID-19 pandemic impacted the availability of school mental health services, the researchers plan to repeat their analysis using not-yet-released data from a 2020 SSOCS survey. One thing Graves said may have changed the availability of services during the pandemic is the more widespread adoption of telemental health, the use of telecommunications or videoconferencing technology to provide mental health 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.

"Offering mental health services in schools-;a place where kids are already congregating-;makes sense and could have downstream impacts on substance use disorders, school-based violence and other societal issues," Graves said. "Yet, many rural school districts barely have a school nurse and definitely don't have a mental health therapist on hand."

She pointed to the way budgets are allocated to rural and small schools as one potential issue. For instance, 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.

Graves hopes that the study findings might compel policymakers to advocate for better funding for rural schools to reduce these disparities.

"I think we really need to support our schools more," she said. "By providing these services to our kids, we are giving them tools in their toolkit to be able to get through life a little more smoothly. And we're also serving our communities better at the same time."

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.