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Blue @ Work

An employer's guide to rural mental health care

Support mental health despite health care provider shortages

An estimated 122 million Americans External Link live in an area experiencing a mental health professional shortage. Iowa and South Dakota continue to feel the effects of the shortage first-hand with two thirds of shortage areas being in rural or partially rural parts of the U.S.

Access to mental health care in rural areas

For Midwesterners, rural living isn’t a lifestyle — it’s a reality.

According to the 2020 U.S. Census Bureau External Link, more than half of Iowa’s 99 counties are considered rural, with 36 percent of Iowans calling one of these rural counties home. In South Dakota, 43 percent of residents live in a rural and/or frontier county. For many, rural living can present some challenges when it comes to accessing mental health care.

The reality of rural mental health care shortages

Mom, dad, and two children check in at the doctor's office.

Imagine sharing your mental health professional — i.e., counselor, therapist, psychiatrist — with at least 500 other people. That’s the reality in both Iowa and South Dakota.

According to County Health Rankings, the population to mental health provider ratio in Iowa External Link is currently 570:1 statewide. South Dakota’s ratio is not much better, with a 500:1 population to provider ratio External Link. These ratios particularly impact individuals living in rural areas.

This problem is not unique to Iowa and South Dakota. An overwhelming 81 percent External Link of rural counties nationwide don’t have a psychiatrist. As a result of this lack of access to mental health care, rural Americans are dealing with increasing mental health concerns.

The second-leading cause of death in Iowa and South Dakota for ages 10–24 years old is suicide, and rural communities in South Dakota are disproportionately affected External Link.

Additionally, adults living in rural areas report higher substance abuse rates External Link than those living in urban areas and may face greater barriers to receiving treatment and staying in recovery.

"Many small communities lack economic diversity, so the loss of an employer or a poor harvest can impact an entire community," said Dr. Matt Stanley, senior medical director of behavioral health at Wellmark Blue Cross and Blue Shield. "Substance use — especially alcohol — is as high or higher in rural communities [than in suburban or urban communities], and someone attempting recovery has few options to change their social group or adopt new social outlets."

Iowa and South Dakota’s efforts to improve mental health

With these stats in mind, the question of how to improve access in rural areas and what can be done to support mental health is a focus for key organizations and state agencies in Iowa and South Dakota.

The Iowa Department of Health and Human Services is currently developing a strategic plan to address the barriers rural residents face to receiving mental health care. The state health improvement plan PDF File highlights three goals the state of Iowa has for reducing stigma surrounding mental health and improving access to mental health resources by 2027.

Similarly, the South Dakota Office of Prevention and Crisis Services has developed a five-year strategic plan PDF File focused on preventing mental health crisis and substance abuse. Their goals include expanding prevention education, reducing risk factors that contribute to substance abuse and mental illness as well as increasing access to mental health resources.

While government organizations continue to work to address these issues, many employers are wondering what they can do to support their rural employees’ mental health.

Supporting the mental health of your rural employees

There are ways you can support your employees who don’t have access to a local mental health professional.

Make mental health a priority

Make your employees' mental health a priority by offering an employee assistance program that provides wellness resources such as free counseling sessions, stress relief tactics or financial advising. Encourage your employees to use their PTO and designate company-wide mental health days for your employees throughout the year.

Be open about the availability of these programs and benefits and use them yourself. Lead by example by modeling a good work/life balance and advocating for your own mental health. Employees may be unaware of the mental health care support their existing primary care provider (PCP) can provide. When your employees bring up mental health concerns to their primary doctor, their doctor can diagnose a condition and coordinate their care with mental health care professionals or prescribe medication so they get the support they need.

One of the most powerful things an employer can do to help employee mental health is to normalize conversations about mental health in the workplace. Whether leaders address concerns in 1:1 meetings or create a space for dialogue in team meetings, bringing up mental health at work often highlights its importance for all employees, regardless of where they live.

Promote virtual mental health care

Offering a virtual mental health solution can help your employees avoid taking extended time off work to travel to a provider and give your employees more control over where and when they receive care.

Most Wellmark health plans include access to virtual mental health visits through Doctor On Demand External Link. Rural employees can virtually connect with a mental health therapist or psychiatrist from the privacy of their own home.

Virtual health coaching meets your employees where they're at

Your employees have access to health coaching no matter where they are located. With behavioral health coaching from Doctor On Demand®, your employees can reach certified coaches to discuss a range of wellness and preventive concerns such as stress, life issues, career challenges and more. Learn more by downloading the flyer today.

Available to 101+ self-funded and fully insured groups

Embrace the community

Embracing the community around you can help employees struggling with their mental health feel connected and supported by an external support network beyond the work place.

Connect with other rural employers to host mental health speakers and professionals, create community-wide support groups for employees in the same career field or profession, or partner with other local organizations to hold mental health events for the whole family. Through these efforts, you may find you're not alone in wanting to improve the mental health of your rural community.

Engaging with your community doesn't just benefit your employees, it benefits your bottom line as well. Research by the University of California, Riverside PDF File found that health care costs fall by $3.27 for every dollar invested in workplace wellness programs and absenteeism costs are reduced by $2.72 for each dollar spent. An investment in the mental health of your employees is an investment in your business.

Want to know more about mental health care in the workplace?

Everyone, regardless of geographical location, deserves access to mental health care. By supporting your employees' mental health, you're also supporting their whole health. Continue to talk with your employees about their mental health and encourage them to use their benefits.

Contact your authorized Wellmark Blue Cross and Blue Shield account representative or email us at Send Email to learn more.

Doctor On Demand physicians do not prescribe Drug Enforcement Administration-controlled substances, and may elect not to treat conditions or prescribe other medications based on what is clinically appropriate.

For plans that include benefits for mental health treatment, Doctor On Demand benefits may include treatment for certain psychological conditions, emotional issues and chemical dependency. Services performed by Doctor On Demand psychologists are covered. For more information, call Wellmark at the number on your ID card.

Doctor On Demand by Included Health is a separate company providing an online telehealth solution for Wellmark members. Doctor On Demand® is a registered mark of Doctor On Demand, Inc.