A new report spotlights some of the challenges to accessing behavioral health care for the one in seven Americans who live in rural areas.

Kendall Strong, senior policy analyst at the Bipartisan Policy Center, said integrating behavioral health into primary care can help improve health outcomes, and get patients the mental health and substance-use treatment they need. She noted just like physical health issues, if you do not tackle behavioral problems that arise, it can develop into something much more serious.

"If you are having issues with substance use, or depression, anxiety, and you let it fester, we know it gets worse," Strong pointed out. "When that happens, you often need more acute care later on. More acute care, as we know, is often more expensive."

One of the report's recommendations is to boost training and other resources for Wyoming's 25 federally qualified health centers, which have pioneered a team-based approach to care. When patients go in for their annual medical checkup, they can also meet with mental health, dental and even vision care professionals during the same visit.

The lack of mental health professionals is one of the biggest barriers to accessing care in rural America. The report recommended strengthening workforce development programs, including the Teaching Health Center Graduate Medical Education Program.

Strong emphasized providers are more likely to work in places where they get their training, and most medical schools and residencies are in cities and suburbs.

"If you don't practice in a rural area, if you're not from a rural area, if you don't live in one already, you're less likely to train there and stay there," Strong explained. "We think that allowing the program to be expanded, continued and built upon, will allow more providers to train in rural areas."

Strong added stigma continues to be a barrier to accessing mental health care. Many patients in small towns are uncomfortable if their car is parked outside a psychologist's office. Strong stressed it is important to continue pandemic-era flexibilities for telehealth services, especially in rural areas.

"A lot of those flexibilities are going to expire at the end of 2024," Strong noted. "But in rural areas, we've seen that the use of audio only is really important for folks who can't afford or don't have access to broadband."

By Nathalia Teixeira for Kent State News Lab.
Broadcast version by Nadia Ramlagan reporting for the Kent State-Ohio News Connection Collaboration.

The "STAR room," or Student Tranquility Amygdala Reset Room, is a place to self-regulate at Euclid Middle School in Euclid and Kinder Elementary School in Miamisburg.

The student checks in and the Student Assistance Program (SAP) - which connects students with resources in order to remove obstacles to learning - records where they are. Using a pulsometer, the student checks their heart rate and identifies their own zone of regulation. The student chooses two or three activities to calm themselves.

The STAR room, like many sensory rooms, has a little bubble lamp, a beanbag chair and a VR headset with a calming app.

Kids can review their biometrics and see the connection between a body and mind in anxiety and one that is not.

Debora Robison, director of outreach and collaboration for the Ohio School Wellness Initiative, described a student who was having trouble with his self-regulation going to the office for several days in a row. He started going to the STAR room daily to use the VR headset after lunch, which was when he struggled most. He went from going to the office often to not being in the office at all.

"This is a success story of how you integrate mental health into a school in a way that's not a therapist and not a psychiatrist," Robison said. "We're teaching kids how to regulate their bodies so they can take care of themselves."

The Ohio School Wellness Initiative (OSWL) was implemented during the COVID-19 pandemic in response to disruptions to schooling. Since the initiative's start, the principal of Kinder Elementary School, Rebecca Huber, said that school has seen a 58.9% reduction in office referrals and a 57% reduction in major incidents.

They also had a 48.5% reduction in suspensions, a 46% reduction in fights and a 43% reduction in classroom-based referrals, Huber said.

"It's helping people focus on the whole child and the whole community. Instead of just teaching kids to read, it's teaching them how to be citizens," Huber said.

The initiative started because of a grant through Gov. Mike DeWine's emergency education relief fund. The Ohio Department of Mental Health and Addiction Services, Ohio Department of Education and Miami University sponsored the initiative. The OSWI staff developed all the materials, did coaching and technical assistance and piloted the program with 80 schools.

"We've tweaked our system to be more of a problem-solving community," Huber said.

Beyond the STAR room

One of the Ohio School Wellness Initiative's goals is to give power to anyone willing and interested in helping someone struggling with their mental health.

"If we can help people be confident as a citizen, not everybody has to be a mental health therapist to help somebody with mental health," Robison said.

Robison said that other programs include Youth Mental Health First Aid training and a website containing information about mental health for young people.

"It's like a one-stop shop for parents, teachers and really anybody in the community," Robison said.

They are also working with a company called CampusWell, which creates short videos made by young people about mental health and well-being, which they push out on YouTube and advertise to other teens and young adults.

The behavioral health and wellness specialist of Euclid Middle School, Sylvia Green, brought yoga and dance therapy to her summer classes, which she hopes to continue throughout the year.

"It gives [students] an opportunity to, in the space, to talk about their problems, what's going on with them," Green said. "It also gives them social-emotional learning and how to deal with your stress."

Helping kids recover from COVID-19's mental health effects

Green said that after the pandemic, anxiety and depression went up among Ohio's children, and there's still more need to pay attention to mental health in schools.

"Our kids have been through so much lately, and we live in a society that is so dysregulated, that even when we think students are sitting and paying attention, they're dealing with a lot of whole other things," Huber said. "So we need to teach them through these activities how to self-regulate so they can actually open themselves up and be ready to learn."

Kinder Elementary School implemented a new social-emotional learning curriculum that uses purposeful people and focuses on the power of being kind, strong and well.

"All of these things are interrelated," Robison said. "When we have schools that really prioritize mental health and well-being and not just for students but for staff as well, then they're starting to see some real differences in the way their students come prepared to learn and are able to learn."


Nathalia Teixeira wrote this article for Kent State News Lab. This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


get more stories like this via email

School is back and one way parents can set their kids up for success is ensuring screen time is not getting in the way of sleep.

Dr. Maida Chen, professor of pediatrics at the University of Washington School of Medicine, said there is a strong connection between sleep and mental health, and they affect each other in a circular way, which Chen pointed out screens can exacerbate.

"The screens sort of work in both directions so that if you have underlying mental health issues, screens will worsen sleep," Chen explained. "If you have sleep issues, it'll worsen sleep issues to the point of, perhaps, further triggering the development of mental health issues."

Chen noted it's not just the screens themselves affecting sleep. The content, especially on social media, can be activating. It can trigger anxiety, for instance, which makes it hard to sleep. Mental health is a major issue for youth. A study from the Centers for Disease Control and Prevention found 42% of high school students felt persistently sad or hopeless in 2021.

Chen believes social media heightened social isolation during the pandemic, leading to greater mental health and sleep challenges for young people. But she also emphasized adults have to model the behavior they want to see in their children.

"It makes no sense for us to be chastising our teens for being on their phones and on social media when they turn around and that is all they see the adults in their world doing," Chen contended.

To help with the issue, Chen added families do not have to change their habits all at once. She suggested having screen-free time about 30 minutes before bed, when families can instead spend time together. If media is involved, Chen advised families should watch something together.


get more stories like this via email

This is National Suicide Prevention Week, part of National Suicide Prevention Month, a time to raise awareness of the problem, and ways to prevent it. The California Parent and Youth Helpline reports a dramatic increase in calls about suicide - making up about 60% of the calls, texts and live chats received since May of last year.

Dr. Lisa Pion-Berlin, president and CEO of Parents Anonymous Inc., runs the helpline.

"In 2022, we had the highest rate of suicide ever, 49,449 deaths," she said. "So, that doesn't include the fact that 12 million adults in 2021 thought about suicide. And 3.5 million people made a plan, and 1.7 million attempted it."

She added that suicide deaths increased in 2021 and 2022, whereas they had been going down in prior years. Statistics show that 20% of children and adults in America suffer from some kind of serious mental health condition. Trained counselors are online at 'CAParentYouthHelpline.org'.

Pion-Berlin added it is crucial to take people seriously if they mention suicidal thoughts.

"It is very important if anybody mentions any thoughts they have - or a plan, or any concerns they have about suicide - that you take them seriously," she implored. "Don't brush them off."

Data show that youth of color living in rural areas are the fastest-growing category of people attempting suicide, and completing those attempts.