Mental Health Literacy, Stigma, and Acceptance in Rural Settings: A State-Wide Qualitative Study of Mental Health Professionals

Rooted in social isolation, a culture of self-reliance, and compounded factors of marginalization, rural communities in the United States face high levels of mental health stigma ( Crumb at al., 2019; Jensen et al., 2020). A culture of low levels of acceptance of mental health help is founded in ideas that folks should “fix and power through” their struggles and other attitudes that promote rugged individualism and denying the need for treatment (Jameson & Blank, 2007; Jensen et al., 2020). Labeling and devaluing oneself and others and worrying about status loss due to mental illness is a common experience among small, “fishbowl” rural communities where word seems to travel fast (Crumb et al., 2018; Jensen et al., 2020). This study sought to explore how mental health professionals experience stigma in their everyday practices in rural areas, among other service access barriers, when working with youth and older adults.

Methods: 25 focus groups with 119 service providers and 6 focus groups with 28 public insurance providers were conducted from June until October, 2020. The focus groups were conducted online in real time using Zoom teleconferencing technology and lasted approximately 1-1,5 hours. Each session was audio-recorded and auto-transcribed by Zoom, and each transcript was then reviewed and cleaned to prepare it for analysis in NVivo 12 qualitative analysis software. The intercoder reliability assessment of seven transcripts (23% of the total documents) produced an agreement of 96.7%.

Findings: Two major themes emerged with regard to stigma: 1) lack of awareness and limited mental health literacy and 2) stigma rooted in rural culture and lack of acceptance. There exists a lack of awareness about what mental health is, available services, and opportunities for prevention rather than crisis treatment. In small rural towns, where most people know each other, cultures of either community or individualism, paired with stigma pose risks to privacy and confidentiality. Generational and “rural mentality”contribute to an idea that one must work through life’s difficulties without any help from others. Some of the most common aspects of stigma identified by service providers were clients’ feelings of embarrassment, fear, and shame. The role of family culture was also a prominent discussion related to stigma and mental health awareness and acceptance.

Conclusion and Implications:

Ways of destigmatizing and normalizing mental health were widely discussed as help cannot begin without awareness and acceptance. To alleviate stigma and increase awareness and acceptance of mental health, policy makers should establish funding streams for existing outreach programs in schools and communities with the purpose of education about mental health.

We recommended enforcing and funding mental health training for staff in all healthcare settings so that early onset of mental illness can be identified and appropriately treated. Developing programs for ease of collaboration between primary care providers and mental health providers was also a recommendation shared by study participants. Proactive education programs to promote mental health literacy through schools, churches, and other rural community settings would help normalize mental health as an integral part of health and general well-being.