Workforce Considerations for Rural Mental Health Programs

Having an adequate workforce is essential to delivering mental health services in rural communities. Rural programs can ensure access to quality services by having enough well-trained and diverse healthcare providers and other staff. Recruitment and retention are central to ensuring an adequate mental health workforce.

Staffing

There are a variety of professional roles within a comprehensive mental health system. These include primary care doctors, nurse practitioners, psychologists, nurses, psychiatrists, counselors, and social workers. Rural communities should include a variety of professional roles within mental health programs, whenever possible.

Rural programs should also consider developing a mental health workforce that is representative of the demographics and cultures in their community to help reduce disparities. This can help ensure the provision of culturally competent care.

Many rural communities face a mental health workforce shortage. Programs should consider nontraditional roles and engaging community members when providing mental health support. Community members may be trained in Mental Health First Aid so they can provide informal support to other community members struggling with mental health issues. Community members who may provide more formal mental health services in rural areas include peer support workers, community health workers, clergy and other faith leaders, teachers and others in the school systems, and police and other first responders. Community members are also essential to addressing issues of social isolation and loneliness, which are closely tied to mental health outcomes.

Recruitment and Retention

Recruitment and retention are essential to consider when developing a quality rural mental health workforce. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the mental health workforce is growing due to reimbursement changes and increases in demand for services. Despite this growth, there is a shortage of mental health workers and this severely impacts rural communities.

The following strategies can be used to help rural communities with recruitment and retention of mental health professionals:

• Recruiting foreign healthcare professionals, including using the J-1 Visa Waiver for physicians
• Online job listings that can reach a broader network of providers
• Telehealth investments, which can improve access to mental health services and help providers receive support from peers
• National Health Service Corps Loan Repayment Programs
  • Federal programs
  • State programs
• Pipeline/Pathway Programs, for example, Club Scrub

When establishing a rural workforce, burnout can significantly affect retention. The mental health workforce often faces high stress levels, lower salaries, understaffing, full caseloads, and high student debt. SAMHSA created guidelines and tips for addressing burnout at the organizational level for behavioral health providers. Additionally, the National Rural Health Association recommends policies that improve workforce reimbursement, bolster wellness among mental health professionals, and support Medicaid reimbursement for resident physicians.

For more on this topic, refer to our Recruitment and Retention for Rural Health Facilities topic guide.

Workforce Training

Healthcare staff should be equipped with the necessary skills to provide effective and efficient services to patients. In the field of mental health, specific skills are essential for staff to provide proper patient care. Trauma-informed care, Mental Health First Aid, and cultural competence training are all examples of important trainings for mental health providers. For more information on trauma-informed care and Mental Health First Aid, see Module 2.

Cultural competency is an essential factor in addressing health disparities. Providers who are culturally competent are aware of a person's background, language, practices, and beliefs, which can help them correctly diagnose and treat their patients. Cultural competence is especially important in rural areas because patients already experience numerous barriers to receiving care, including stigma, distance to care, and mental health provider shortages. Substance Abuse and Mental Health Services Administration (SAMHSA) created a Treatment Improvement Protocol: Improving Cultural Competence which includes a multidimensional model for developing cultural competence. Becoming a culturally competent healthcare organization may lead to significant improvements in mental health services, by creating a more inclusive and accessible environment, enhancing communication, and encouraging a better understanding of cultural norms.

Resources to Learn More

State Strategies to Recruit and Retain the Behavioral Health Workforce
Document
Presents an overview of the behavioral health workforce supply in the U.S. and highlights strategies for recruiting and retaining this workforce especially in rural areas.
Organization(s): National Conference of State Legislatures
Date: 05/2022

Using Cultural Humility to Address Rural Mental Health Gaps
Document
Provides information on the challenges and solutions to addressing rural mental health gaps through cultural humility.
Author(s): Bullard, J.
Organization(s): RTI Health Advance
Date: 10/2022