COVID-19 and Mental Health: Perspectives from a Rural Community

Image of Lake Superior

As new cases of COVID-19 continue to rise, it becomes closer and closer to affecting more rural parts of the United States. Rural communities generally have less access to medical care; but what about mental health care? Numerous agencies have written about the effects that COVID-19 related stress can have on our psychological functioning, but the challenges rural communities face regarding emergency preparedness, medical care, and psychiatric care make geographic isolation an extreme form of social distancing.

As with urban and metropolitan parts of the country, rural communities are advised to comply with current Centers for Disease Control (CDC) recommendations intended to help “flatten the curve.” On the surface, it may seem like this puts rural communities at an advantage: They are further removed from infection hot spots, have access to basic necessities close to home (often within walking distance), they have less outside visitors, and due to small population sizes, the chance of large gatherings or close contact with others is more limited. However, it is more difficult to transport physical resources (such as food, toiletries, hygiene items) to rural communities, which contributes to higher costs for goods. Furthermore, many rural community members have to travel long distances for access to health care services, or their hospitals may not be equipped to manage large populations. Imagine the case of a person who lives in a rural community and begins to exhibit symptoms of COVID-19: They will have to travel long distances to be tested (possibly only to find out they have not contracted the virus), which will undoubtedly give them additional time to worry about their physical health and the well-being of their community members. In elderly populations or individuals with underlying health concerns, travel for long periods of time to receive medical evaluation is not always feasible, which creates added stress for ailing individuals, their families, and the emergency response system. When it comes to mental health care, rural communities are already at a disadvantage due to geographic isolation; at our Northern Minnesota practice alone, clients travel dozens of miles to receive in-person mental health services. 

With access to resources more restricted due to geographic location, many rural community members may feel particularly uneasy as COVID-19 related stress sets in. Schools are closing and moving to online formats, large events are being postponed, and people are being asked to stay home from work or avoid public venues if they show any signs of illness. The effects of these changes can be far-reaching, especially when we have little clarity regarding how long these changes will be in effect. This can leave us feeling a lack of control and a deep sense of insecurity, which can cause us to respond with anxiety, fear, and panic. The American Psychological Association (APA) shared that in general, “Common sources of stress during this period include a drop in meaningful activities, sensory stimuli and social engagement; financial strain from being unable to work; and a lack of access to typical coping strategies such as going to the gym or attending religious services” (https://www.apa.org/practice/programs/dmhi/research-information/social-distancing). The APA also cited research that found when practicing social distancing, quarantine, or isolation, people may experience fear and anxiety, boredom, depression, anger, frustration, irritability, or stigmatization in the case of a person who has contracted (or is suspected to have contracted) a contagious illness. Researchers have also found that rural areas have higher rates of suicide compared to more metropolitan geographic regions (CDC, 2015); these statistics do not include the the inherent mental health consequences of pandemic-related stressors. For rural populations, it can be more difficult to receive the appropriate mental health services to manage these symptoms and improve their coping skills due to provider shortages (like we experience in Northern Minnesota) and geographic isolation. 

“During this time of uncertainty, it is important for rural community members to know that their voices are being heard and that their access to mental health services will not decrease; rather, they may see an increase in service availability due to advancing efforts in the area of telehealth.”

Telehealth offers more opportunities for medical and mental health providers to continue care to rural community members without placing individuals at risk of exposure to COVID-19 – or, in the case of those who have been exposed or vulnerable to exposure to COVID-19, can help individuals remain quarantined or practice social distancing without jeopardizing public health. If anything, perhaps this can reduce the effects of pandemic-related stress on our community’s mental health and physical well-being. 

This post was written by Dr. Sara Vaccarella in collaboration with MAP Behavioral Health Center, a community-based psychotherapy practice geographically located in Duluth, Minnesota. Dr. Vaccarella is a licensed psychologist and co-founder of Kartta Group, providing clinical and forensic psychological services and behavioral health consultation to rural communities throughout the state of Minnesota.

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Jana Baecker