While many Americans have experienced mental health challenges in recent years, the issue is especially acute among rural residents. Rural Americans, for example,  experience higher rates of depression and suicide than people who live in urban areas. While these long-standing inequities in mental health outcomes can be attributed to a wide range of factors—from affordability to accessibility to lingering stigmas around receiving care—a new study from the University of Minnesota School of Public Health, UMN Medical School, and School of Social Work addresses a longstanding issue—rural mental health workforce shortages—by analyzing the factors influencing where health care professionals choose to practice.

Specifically, the study investigates factors influencing mental health professionals’ decisions to practice in rural areas. Using survey data collected by the Minnesota Department of Health from February 2022 to February 2023, the study included responses from four groups of mental health care professionals: mental health clinicians who prescribe medications (psychiatrists and advanced practice registered nurses with a mental health focus), licensed mental health professionals (including licensed professional clinical counselors and licensed independent clinical social workers), licensed psychologists (LPs), and licensed alcohol and drug counselors (LADCs).

Key findings of the study published in JAMA Network Open include:

• Professionals who grew up in rural areas were significantly more likely to practice in rural settings. While this association was highest among LADCs (75%), the association between rural upbringing and rural practice location was consistent across all professional groups.
• The decision to practice in rural areas varies significantly across professional types. For example, LADCs were most likely to practice in rural areas, while psychologists were the least likely.
• The desire for autonomy in their practice was a crucial factor for rural practice among psychologists and other prescribers, which suggests that the ability to work independently and make professional decisions is a significant motivator for these groups.
• Financial incentives such as loan forgiveness programs were a critical factor influencing the decision to practice in rural locations, especially for licensed mental health professionals and licensed psychologists.

“There is an urgent need to address the shortages and disparities in mental health care access in rural areas of the U.S.,” says Carrie Henning-Smith, SPH associate professor and lead author. “While there is no one-size-fits all solution to this challenge, there is a clear need for a targeted and multifaceted recruitment strategy to encourage more people to practice mental health care in rural areas.”

The authors suggest that policy interventions to encourage rural residents to enter the mental health profession should focus on bolstering pathways and tailoring recruitment strategies to the specific motivations of different professional groups.