Behavioral Health
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Behavioral health disparities in Appalachia and rural Ohio

Kyle Thompson
Policy Associate
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March 25, 2024
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Previous research at The Center for Community Solutions analyzed disparities distinctly experienced by people in Appalachian and rural counties of the state. Across many health, economic, and social indicators, people in these regions also suffer from higher rent burden,  poverty, and less diverse political representation. Behavioral health disparities exist in Appalachia and rural areas as well. A report released by the Ohio Department of Health (ODH) indicated that 14 out of the 15 counties with the highest suicide rates in the state were in rural regions and Appalachia.

14 out of the 15 counties with the highest suicide rates in the state were in rural regions and Appalachia.

Broken down regionally, nine counties are rural Appalachian areas, and five counties are rural non-Appalachian regions. Overall, Appalachia consists of 423 counties across 13 states. In Ohio, thirty-two counties are served by the Appalachian Regional Commission, and these areas are notable for poor health outcomes, economic disparity, and infrastructural challenges that impact the wellbeing of its residents.Challenges facing these regions are also compounded by fewer than necessary mental health professionals working in Appalachia and rural Ohio, making it difficult for those in need to receive timely behavioral health treatment. The recent release of the Ohio Suicide Prevention Foundation’s (OSPF) 2024-26 prevention plan sparks a few questions: what efforts exist to address suicide in Appalachia/rural Ohio, and what can be done to strengthen current initiatives?

What programs currently exist to support rural and Appalachian behavioral health?

There are several statewide and national level initiatives working to support behavioral health in rural and Appalachian Ohio. The Substance Abuse and Mental Health Services Administration (SAMHSA) has several programs that work to support positive behavioral health outcomes. SAMHSA has several grants that improve treatment and recovery, as well as rural emergency medical services. These grants improve health outcomes by focusing on treatment and workforce to provide emergency crisis support.

A considerable amount of work is focused on increasing the behavioral health workforce, with programs such as the Great Minds Fellowship or the Appalachian Children’s Coalition Behavioral Health Workforce Hub.

Coalitions and task forces in Ohio work toward increasing behavioral health supports to communities. A considerable amount of work is focused on increasing the behavioral health workforce, with programs such as the Great Minds Fellowship or the Appalachian Children’s Coalition Behavioral Health Workforce Hub. These programs work to recruit students and professionals to enter careers into the behavioral health profession.Beyond the scope of behavioral health, there are also initiatives on a state level that work to support community and economic development. The Ohio Department of Development has a Governor’s Office of Appalachia, which seeks to support development and partnership to improve the lives of people living in the region economically and socially. The office works to accomplish five goals established by the Appalachian Regional Commission:

  • Supporting Appalachian businesses
  • Workforce ecosystems
  • Infrastructure
  • Culture
  • Community leadership

What can be done to further support behavioral health needs in Appalachia and rural Ohio?

Many federal and state programs are working to promote and support the well-being of people in Appalachia and rural areas of Ohio. Despite these efforts, there are still some significant gaps that exist which must be addressed. Doing so can improve the efficacy of current efforts and identify new challenges that face the region through ongoing support and collaboration with advocates, communities, and behavioral health providers.

Closing the digital divide

The Bipartisan Policy Center published a report with analysis on issues facing rural regions of America, and solutions to dealing with these problems. One recommendation from the study proposed closing the digital divide by providing broadband access in rural communities. The digital divide exacerbates disparities mainly because a huge portion of our health care industry relies on high-speed internet to deliver services promptly and efficiently.

Without sufficient connectivity, communities most in need of services suffer.

Without sufficient connectivity, communities most in need of services suffer. Closing the digital divide expands opportunities for virtual health treatment such as telehealth. Telehealth services expand access to behavioral health care by making appointments more accessible to residents living in communities with limited access to a healthcare provider. This would be beneficial during public health emergencies, and day-to-day operations in treating individuals or families without access to transportation.

Strengthening the behavioral health workforce

Strengthening the behavioral health workforce is another way to close disparities in behavioral health needs in Appalachia and rural Ohio. The Ohio Department of Medicaid, the Ohio Department of Mental Health and Addiction Services, and the Ohio Department of Higher Education announced a request for proposal (RFP) to strengthen, improve, and construct behavioral health workforce programs in areas identified as U.S. Human Resources and Services Administration Mental Health Shortage areas or Ohio Health Improvement Zones. Creating programs and grants to support the matriculation of behavioral health professionals allows for further employment opportunities in rural or Appalachian parts of the state.

Support integrated health networks

Integrated rural health networks are formal organizational connections among rural health practitioners, social service providers, and health care services. These entities collaborate to address gaps in care and administer needed services to individuals seeking care. Integrated rural health networks are impactful to rural communities because they can address needs that cannot be addressed by an organization individually. Investing in a shared provider network is also cost efficient when investment in individual providers is difficult. Investment in cross collaboration resources and health information technology can make sharing information more efficient when navigating resource distribution among small providers.

Investment in cross collaboration resources and health information technology can make sharing information more efficient when navigating resource distribution among small providers.

One example of this work in Ohio is the Integrated Services for Behavioral Health (ISBH). This agency works to deliver several services to communities in Southeastern and Central Ohio. ISBH works to aid family or individual behavioral health concerns by providing access to care. This assistance includes recovery housing, family counseling, and community behavioral health work. All services are offered via community, telehealth, home, or in-person.

Takeaways: What can Ohio do to better support rural and Appalachian Behavioral Health

Improving the health needs of rural Ohioans will not happen overnight, and it certainly won’t be accomplished through singular entities that are already stretched thin supporting community members. Working to expand coalitional efforts and health networks is a good start, a future platform to advocacy for services like broadband and a larger behavioral health workforce. In doing so, policymakers and health providers will support behavioral health needs in areas of Ohio that need them most.Resources for further information (Note: Not an exhaustive list)Appalachian Children’s Coalition: https://www.appchildren.org/Appalachian Children’s Behavioral Health Workforce Hub: https://www.acchub.org/Ohio Rural Health Association: https://www.ohioruralhealth.org/Health Policy Institute of Ohio (HPIO): https://www.healthpolicyohio.org/Mental Health Advocacy Coalition: Mental Health & Addiction Advocacy Coalition – changing minds, changing lives (mhaadvocacy.org)Ohio State Office of Rural Health: https://odh.ohio.gov/know-our-programs/state-office-of-rural-health/sorh/

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