Rurality, Internet Access and Mental Health Professional Shortage: A Descriptive Spatial Analysis

Nearly 1 in 4 rural Americans lack access high speed internet access. Rural residents also lack access to mental health care; more than 60% of all mental health professional shortage areas are in rural areas. Telehealth services are often offered as a solution to the mental health provider shortage in rural areas. However, lack of adequate internet access inhibits the effectiveness of this solution.

This study is an exploratory spatial analysis of the relationship between internet availability and access to mental health care in the rural US. We hypothesized that more rural/remote areas will have a higher percentage of households with inadequate internet access and greater mental health professional shortage. We expected that spatial analysis may reveal hotspots where these two factors converge, highlighting those areas of severe provider shortage and high occurrence of unconnected households.

We combined current county-level data for internet access and mental health professional shortage in the United States. Internet access was measured using data from the FCC Broadband Data Collection. Mental Health Provider Shortage was measured using data from the Health Resources & Services Administration. Rurality was measured using USDA rural-urban continuum codes. Analysis was restricted to 50 US States. All data were joined and analyzed at the county level using FIPS codes. All analyses were performed using ArcGIS online.

Initial hotspot analysis revealed 749 counties with high percentages of inadequate household internet access with concentrated areas of need in the Mississippi Delta region, sovereign tribal lands in the southwest, and the northern Rocky Mountain region and Michigan's Upper Peninsula. Initial hotspot analysis highlighted 948 counties with most urgent mental health professional shortage in cocentrated areas of need in northeast Florida, middle Appalachia, upstate New York, the Ozark/Delta region, sovereign tribal lands, South Dakota, and the northern Rocky Mountaints. Joint overlay revealed areas of convergence concentrated in the Ozarks, Lower Mississippi and Mississippi Delta, the Florida panhandle, and a small cluster of counties in the Blue Ridge Mountains on the border of Virginia and West Virginia. The majority of counties within the joint overlay are rural.

This analysis identifies areas of significant mental health professional shortage and inadequate internet access. The areas specified in the joint overlay may require targeted intervention to alleviate mental health provider shortage, as lack of adequate internet access will limit the reach of telehealth interventions in these areas. As federal infrastructure improvements continue, underserved areas should gain access to high-speed internet and with it, the potential for telehealth service to increase access to mental health care. This analysis provides insight to create targeted interventions in counties of highest need and provide support for internet infrastructure projects, particularly within the Ozarks and Lower Mississippi. Results may be used to guide policy related to internet expansion projects by prioritizing those counties with the greatest mental health provider shortage and highest rate of households with inadequate internet access.