The Mental Health Crisis in Rural America

Many people in rural America are on their own when it comes to mental healthcare. Nearly half a million, or 14 percent of, Coloradans are affected by mental health challenges, a 2016 report from the Colorado Health Foundation revealed, and many of them lack access to care. A 2020 report by the Colorado Rural Health Center (CRHC) found that of the state’s 64counties, 22 don’t have a psychologist or psychiatrist working there. 

According to the CRHC’s2022 Snapshot, “Nine rural counties in Colorado have no pharmacy, while eleven other rural counties have only one pharmacy.” Thirty-seven of Colorado’s64 counties (all rural or frontier) do not have any ICU beds.

The region around Durango in southwestern Colorado is a good example. Although many residents suffer from substance use disorder, treatment options are sparse. “The region has no recovery homes, no medical detox, and no inpatient substance use treatment facilities,” reported the Durango Herald in May. “While treatment resources do exist, those demanding inpatient care must usually travel to the Front Range.”

Many residents of rural America feel generally isolated and left behind by the modern world. In 2015, two Princeton economists argued that middle-aged white Americans without a college degree were now facing “deaths of despair”—suicide, overdoses from drugs and alcohol, and alcohol-related liver disease. They suggested that distress caused by globalization and rapid technological change probably drove those deadly outcomes. Middle-aged whites are now more likely than their predecessors to report pain and mental health problems and are experiencing symptoms of alcoholism at a younger age.

Middle-aged white males in rural areas are often also affected by so-called “man rules.” The rugged and self-reliant frontiersman is supposed to be able to “hold his liquor” and not “go on” about his feelings. Men, in general, face different expectations than women, which can impact their mental health and substance misuse. In the 2022 CRHC Snapshot, 21 percent of adult rural Coloradans reported drinking excessively.

Foundry Steamboat Rural Community Connection Effort

The Foundry Steamboat men's residential program treats adult men experiencing substance misuse, co-occurring mental health conditions, and trauma. The program offers comprehensive, coordinated treatment, including medical care, psychiatry, psychotherapy, fitness, and wellness coupled with gender-responsive and trauma-informed approaches. Its focus, milieu, and expertise make this program especially appropriate to men for whom previous treatment episodes have been successful. Foundry Steamboat also offers a virtual intensive outpatient program for men and women in Colorado and Wyoming and operates Chrysalis Continuing Care, an in-person IOP in Denver’s RiNo neighborhood. 

Foundry Steamboat team members are experienced with the challenges facing rural Coloradans, including steep rises in suicide and untreated mental health disorders. In 2022, Foundry Steamboat outreach representatives Amber King and Amanda Buckner, who hail from rural Colorado hometowns, established monthly virtual meetings to make connections between therapists and other behavioral health stakeholders in these rural communities. 

This rural community outreach and networking effort is beginning to yield results. Therapists, case managers, and peers are identifying new resources, and more people are being referred to treatment. The group’s recent discussions indicate that therapists are seeing positive changes that could make it easier for people in some communities to seek care. 

In Vail, for example, therapists have noticed that young people are becoming more vocal about experiencing mental health conditions, such as anxiety, depression, and suicidal ideation. Vail community members are also building a peer recovery system, which can help people seeking treatment and support those living in recovery.

Vail offers an important example of how problems facing rural Americans affect communities across the socioeconomic spectrum. Although Vail is a small community of 5,000 full-time residents, the town receives more than1.3million visitors per year who ski its slopes in winter and hike its mountains in summer. Tourism makes Vail a relatively affluent community and supports a range of businesses and healthcare facilities.

Despite its resources and infrastructure, Vail struggles from a lack of mental and behavioral healthcare and experiences stigmas affecting many rural communities, some of which are stubborn remnants of longstanding rural culture. And like many so-called mountain towns that attract a high population of visiting tourists, residents can struggle with forming lasting relationships or feel isolated despite being surrounded by people.

“While life in mountain towns and agricultural communities can differ greatly, rural communities can sometimes perpetuate unhealthy cultural cues by normalizing substance use as part of daily life. It can be easy for families to inadvertently keep cycles of substance misuse going by enabling or even encouraging substance use to overcome boredom, pain, or as a social lubricant. When communities are isolated from major population centers by hundreds of miles, it’s easier for ideas and behaviors — both good and bad — to remain unchanged while these thoughts and behaviors may be changing in the broader population,” says Foundry SteamboatCommunity Relations Manager Amanda Buckner.

"As a voice in rural recovery work, collaborating with community leaders throughout the state has transformed inspiration into action and helped build the recovery community organization in our mountain town,”says Rob Shearon, Founder of Reconnected, an app that helps people recovering from mental health and addiction to connect with others. Before foundingReconnected, Shearon was a program manager for the University of ColoradoCollegiate Recovery Center.

"At Reconnected, we're not just providing peer recovery coaches through our partnership with the local hospital, we're building a supportive community through a variety of social events, from non-alcoholic happy hours to mountain bike rides with the local rec district.We're creating a network of like-minded individuals who are there for each other every step of the way in their recovery journey," says Shearon.

“The fact that Vail is starting a peer recovery support network and getting community involvement happening represents major progress,”says Buckner. “When we started these Zoom meetings, we weren’t sure how responsive people would be or if it could help to make a change. It is still very early. But when we hear colleagues like Rob telling us about these successes, or that young people are feeling more comfortable talking about their problems, that’s a big deal. It shows that change is possible and that this effort can help to make change.”

Join the Connecting Rural Community monthly calls, which take place on the second Monday of each month by emailing amanda.buckner@foundrysteamboat.com.