Introduction​

Mental health assistance is often inaccessible for rural residents for a variety of reasons. Nonmetropolitan regions historically have had substantially less access to behavioral health professionals in comparison to their metropolitan counterparts (Andrilla, Patterson, Garberson, Coulthard, & Larson, 2018). Likewise, marginalized groups are more likely to lack proper mental healthcare services (Murry, Heflinger, Suiter, & Brody, 2011). Even when these limited services are geographically accessible to rural populations, cultural barriers related to lack of awareness or stigma of mental health disorders lead to limited use of these services (Gamm, Stone, & Pittman, 2010). The absence of behavioral health professionals within rural regions has been linked to a lack of incentives and difficulties associated with living in remote areas, both leading to low rates of retention and vacant behavioral health positions (Buche et al., 2016). To address this widespread issue, it is vital to integrate well-trained, community-based professionals into rural areas. This publication highlights the role the established presence of UF/IFAS Extension in rural regions can play in the dissemination of community-based professionals into these areas. The integration of these professionals and the various programs and services they offer will serve as a buffer to the many stressors faced by rural residents, the complexities of which often lead to overall poor mental health.​

Mental Health among Rural Youth

The World Health Organization (2021) reported suicide as the fourth leading cause of death for youth aged 15–19. As we know, rural communities lack sufficient access to mental healthcare; therefore, youth among this population are disproportionately likely to die by suicide than those residing in metropolitan areas (Centers for Disease Control and Prevention, n.d.). Rural youth often find themselves geographically isolated from peers and support systems, and for members of marginalized groups, these feelings of both social and geographical isolation are even more severe (Murry et al., 2011). These experiences of isolation are identified as a risk factor for poor mental health and suicide (Centers for Disease Control and Prevention, n.d.).​

Why should this be a priority for UF/IFAS Extension?​

While rural residents face many risks related to poor mental health, these factors have only intensified due to the COVID-19 pandemic (Monteith, Holliday, Brown, Brenner, & Mohatt, 2020). The specific needs of rural communities are often overlooked in interventions and policies, since they are viewed as difficult to reach, with too many barriers related to distance and mistrust of outsiders. Over the years, UF/IFAS Extension has cultivated long-term, positive relationships among many rural communities. Additionally, Cooperative Extension's newly developed National Framework for Health Equity and Well-Being encourages Extension educators to partner with other health professionals to improve protective factors among rural residents through the implementation of community-based programs and activities that increase social support and work to destigmatize mental illness and the search for mental health services (Burton et al., 2021).

What exactly are community-based professionals?

The term ​“community-based professional” is meant to serve as a catch-all word for well-trained individuals exhibiting the following qualities:

• Exemplary emotional intelligence, which includes the ability to assist individuals in the identification and processing of emotions. ​​
• Awareness of the various strengths and strains of communities. ​
• Knowledge regarding community engagement and the promotion of social support. ​​
• Cultural sensitivity that considers the intricacies of the communities in which they work. ​​
• The capacity to actively engage with and listen to community members in order to facilitate programming that is as efficient and effective as possible. ​
• ​Persistence and resilience required to cultivate long-lasting, high-impact relationships within the community. ​
• The ability to identify resources within the community and best ways to harness them for furthered growth and connection. ​

How can community-based professionals improve rural mental health?​

In their most recent policy brief addressing rural mental health, Centers for Disease Control and Prevention identified isolation and a lack of connectedness as major risk factors for suicide in rural areas (Centers for Disease Control and Prevention, n.d.). These feelings of distance and isolation can be mitigated through the presence of community-based professionals. When trained properly, community-based professionals have the ability to cultivate programs ​and experiences to promote social support and act as a protective factor for proper mental health and suicide reduction. Additionally, it is crucial to take into consideration the culture of rural communities which reflects a general distrust for professionals and a strong preference for informal, non-specialty services (Murry et al., 2011). This informal tone of support directly aligns with the ideals of the community-based professional approach and the basis of Extension programming. Not only is this intervention culturally appropriate for these settings, but Extension has the opportunity to make these practices financially accessible. This affordability component is essential; one report found that 15.4% of rural residents in the United States were living below the poverty line (Economic Research Service, 2019). Both the nontraditional, informal tone of Extension programming and the associated affordability exhibit a level of flexibility and accessibility necessary for the overall improvement of quality of life among rural youth.

UF/IFAS Extension Recommendations​

UF/IFAS Extension offices are located within each county in the state of Florida. Over half of these counties are designated as rural (United States Department of Agriculture, 2019). This widespread, established presence provides the perfect avenue by which to increase the presence of community-based professionals in rural areas at little to no cost for residents. Additionally, Extension’s 4-H programming provides an accessible way to reach rural youth in particular. ​

​The following ways may help to further incorporate the work of community-based professionals into Extension programming:

• Recruit staff and interns exhibiting characteristics of community-based professionals.​​
• Identify current community-based partners and integrate their presence into programming.​​
• Seek out new partnerships with community-based professionals through various networking opportunities.​​
• Create and implement training materials that instill community-based principles into Extension and 4-H programming.

Summary​

The mental health of rural residents is a facet of wellness which is often overlooked by policy and intervention practices. To mitigate the cultural and financial barriers related to access to mental health services in ​rural communities, it is vital to integrate the informal support structures of well-trained community-based professionals who can increase feelings of connectedness. There are many opportunities to engage with community-based professionals through UF/IFAS Extension internships, partnerships with the University of Florida, and more traditional avenues of recruitment.​

References​

Andrilla, C. H. A., Patterson, D. G., Garberson, L. A., Coulthard, C., & Larson, E. H. (2018). Geographic Variation in the Supply of Selected Behavioral Health Providers. American Journal of Preventive Medicine, 54(6), S199–S207. ​ https://doi.org/10.1016/j.amepre.2018.01.004

​​Buche. J., Beck, A. J., Page, C., Singer, P., Casemore, B., & Nelson, D. (2016). Health Workforce Policy Brief: Behavioral Health Service Delivery for Vulnerable Populations. Behavioral Health Workforce Research Center, University of Michigan. https://behavioralhealthworkforce.org/wp-content/uploads/2016/11/FA2P2_Vulnerable-Populations-Policy-Brief.pdf

Burton, D., Canto, A., Coon, T., Eschbach, C., Gutter, M., Jones, M., Kennedy, L., et al. (2021). Cooperative Extension’s National Framework for Health Equity and Well-Being. Washington, D.C.: Extension Committee on Organization and Policy. https://www.aplu.org/members/commissions/food-environment-and-renewable-resources/board-on-agriculture-assembly/cooperative-extension-section/ecop-members/ecop-documents/2021%20EquityHealth%20Sum.pdf

​Centers for Disease Control and Prevention. (n.d.). Rural Health Policy Brief: Preventing Suicide in Rural America. Centers for Disease Control and Prevention. https://www.cdc.gov/ruralhealth/suicide/pdf/18_290906-A_Turner_Policy-Brief_Suicide-002_508.pdf ​

Economic Research Service. (2019). Rural Poverty & Well-Being. United States Department of Agriculture. https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/

​Gamm, L., Stone, S., & Pittman, S. (2010). Mental Health and Mental Disorders—A Rural Challenge: A Literature Review. Rural Healthy People, 2(1), 97–114.

Monteith, L. L., Holliday, R., Brown, T. L., Brenner, L. A., & Mohatt, N. V. (2020). Preventing Suicide in Rural Communities during the COVID-19 Pandemic. The Journal of Rural Health. https://dx.doi.org/10.1111%2Fjrh.12448

​Murry, V., Heflinger, C., Suiter, S., & Brody, G. (2011). Examining Perceptions about Mental Health Care and Help-Seeking among Rural African American Families of Adolescents. Journal of Youth and Adolescence, 40, 1118–1131.​ https://doi.org/10.1007/s10964-010-9627-1

United States Department of Agriculture. (2019). State Fact Sheets: Florida. https://data.ers.usda.gov/reports.aspx?StateFIPS=12&StateName=Florida&ID=17854  

World Health Organization. (2021). Suicide: Key Facts. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide  ​