A new report spotlights some of the challenges to accessing behavioral health care for the one in seven Americans who live in rural areas.

Kendall Strong, senior policy analyst at the Bipartisan Policy Center, said integrating behavioral health into primary care can help improve health outcomes, and get patients the mental health and substance-use treatment they need. She noted just like physical health issues, if you do not tackle behavioral problems that arise, it can develop into something much more serious.

"If you are having issues with substance use, or depression, anxiety, and you let it fester, we know it gets worse," Strong pointed out. "When that happens, you often need more acute care later on. More acute care, as we know, is often more expensive."

One of the report's recommendations is to boost training and other resources for Wyoming's 25 federally qualified health centers, which have pioneered a team-based approach to care. When patients go in for their annual medical checkup, they can also meet with mental health, dental and even vision care professionals during the same visit.

The lack of mental health professionals is one of the biggest barriers to accessing care in rural America. The report recommended strengthening workforce development programs, including the Teaching Health Center Graduate Medical Education Program.

Strong emphasized providers are more likely to work in places where they get their training, and most medical schools and residencies are in cities and suburbs.

"If you don't practice in a rural area, if you're not from a rural area, if you don't live in one already, you're less likely to train there and stay there," Strong explained. "We think that allowing the program to be expanded, continued and built upon, will allow more providers to train in rural areas."

Strong added stigma continues to be a barrier to accessing mental health care. Many patients in small towns are uncomfortable if their car is parked outside a psychologist's office. Strong stressed it is important to continue pandemic-era flexibilities for telehealth services, especially in rural areas.

"A lot of those flexibilities are going to expire at the end of 2024," Strong noted. "But in rural areas, we've seen that the use of audio only is really important for folks who can't afford or don't have access to broadband."

Sen. Richard Blumenthal, D-Conn., is introducing federal legislation to boost mental health equity.

The Pursuing Equity in Mental Health Act allocates $995 million in grant funding over five years for states to use to reduce disparities in mental health care, which comes as a new report showed Connecticut teen suicides doubled from this time last year.

Janelle Posey-Green, founder of the Connecticut BIPOC Mental Health and Wellness Initiative, said teens need more education on the language of mental health.

"I really think we need is more education on what to look for so that way friends can check in on friends and they know the warning signs and even have, maybe, a script or a narrative that they can go to," Posey-Green suggested. "Let's normalize that at some point you may feel depressed."

She recommended it should be done through a community initiative involving schools and parents. Aside from the bill's funding, Connecticut is receiving more than $4 million from the Health Resources and Services Administration to expand mental and behavioral health, and substance use disorder services.

However, disparities in care are not the only thing preventing people from accessing mental health care. Studies show women of color are at higher risk for mental health issues but are less likely to seek treatment.

Posey-Green observed as much as the Black community can lift people up, things such as "strong Black woman syndrome" can hold women of color back from talking about their mental health.

"Where does this woman who is expected to be so strong get the opportunity to talk about how hard it is that from childhood to adulthood she's faced with many microaggressions and major aggressions over her life period that impact her mental health?" Posey-Green asked.

Other issues such as cultural differences can pose a challenge. Posey-Green works with a collective of providers for patients to access mental health professionals with similar backgrounds. She argued providers should be trained in cultural humility rather than cultural competency.

"Why it's important for providers to lean towards cultural humility and be trained well with understanding how cultural humility can help with providing better service is because it also teaches you to check your unconscious biases," Posey-Green stressed.

A 2024 study showed almost 26% of Nebraskans reported having a mental-health illness in the past year -- nearly 3% higher than the national average.

Providers and stakeholders of Nebraska's behavioral health care system face uncertainty as more budget cuts loom. In the last legislative session, $15 million was cut from the state's behavioral health services budget and the heads of state government divisions are now being asked to find more cuts.

Tiffany Gressley, regional administrator for Region 3 Behavioral Health Services, questioned how cuts to behavioral health align with Nebraska's conservative values.

"We're being fiscally conservative by serving these people early; as early as we can," Gressley pointed out. "We're saving money and we're saving, on top of that, the human cost that goes along with untreated mental health conditions. "

Gressley explained last year's cut brought the total budget reductions to Nebraska's behavioral health system to nearly $50 million over the past six years, much of it from unfunded provider rate increases. She stressed budget cuts mean fewer Nebraskans receive services.

Among Nebraska counties, 88 of 93 had a shortage of behavioral health providers in 2023, and 29 had none at all. Many rural Nebraskans face considerable challenges accessing behavioral health care, which advocates said further budget cuts will only exacerbate.

Sadie Thompson, chief innovation officer for the Lincoln-based Wellbeing Initiative, an organization providing services for mental health, substance use and chronic physical health conditions, said after a nearly 12% cut to its budget this fiscal year, the organization had to close satellite locations in Fairbury and Geneva and was unable to open one planned for Seward.

"All of these rural communities that we were really starting to see lots of engagement with and impact basically got the rug pulled out and weren't able to continue to have these services," Thompson noted. "These communities don't have services anyway."

Bob Shueey, CEO of South Central Behavioral Services in Hastings and Kearney, said they are constantly looking for qualified therapists and frequently have to turn patients away as a result. Shueey added the state's low provider rate combined with retirements has depleted the state's behavioral health workforce. He argued without attention, the situation will only worsen.

"Even if we raise the rates to a sustainable rate today, it's a multiyear pipeline before someone's even able to start working," Shueey emphasized. "Then that information has to be out there to new students and to young people. 'I'll be able to make my house payment and pay my student loans if I do this; I'm not going to be poor my whole life.'"


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One in four Californians is an immigrant and a new report showed many are refugees who may need mental health services but have trouble finding treatment.

Researchers from the California Pan-Ethnic Health Network found a pressing need for culturally-responsive behavioral health services.

Vincent Chou, community advocacy manager for the group, said many barriers can hinder access.

"These communities face distinct challenges such as trauma from displacement, stress, language barriers, and systemic discrimination," Chou outlined. "All of which contribute to why they're not really utilizing the mental health services that are available to them."

Community groups said they have seen a huge increase in demand for mental health services since the pandemic. The report also called for training on trauma-informed care for providers and county workers who assist immigrants.

Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance, said California faces a dire shortage of bilingual, bicultural mental health providers; people who can better connect with patients.

"When they see a counselor who can speak their language, they're more apt to be able to describe what's going on with them," Foo pointed out. "Or to be able to participate fully in their care."

Ruqayya Ahmad, policy manager for the network, said the state needs to better fund community-based organizations so they can recruit mental health professionals from the populations they serve and offer competitive pay to retain them.

"They're the ones who have these trusted relationships," Ahmad emphasized. "They're helping to normalize mental health conversations and reducing that stigma that exists in some communities."

Vattana Peong, executive director of The Cambodian Family Community Center in Santa Ana, said the state also needs to make it easier for groups like his to get credentialed to accept Medi-Cal insurance.

"There are a lot of barriers for community-based organizations who want to become Medi-Cal mental health providers," Peong stressed. "That is something we need to fix."

He added community groups often offer wraparound services, like child care and transportation, making it easier for low-income families to access health services.