UAlbany Researcher Leads ‘Listening Tour’ to Explore Mental Health in Rural New York

By Erin Frick 

ALBANY, N.Y. (Jan. 31, 2023) — Rural communities face many challenges around mental health, including limited access to care as well as risk factors associated with isolation. In New York, the suicide rate in rural areas (15.2 per 100,000 people) is significantly higher than in urban areas (7.5 per 100,000 people). It is also accelerating more quickly. Between 2004 and 2020, the suicide rate in rural New York increased by 83.1 percent, while urban New York saw a 27.9 percent rise.

Earlier this month, University at Albany’s Brett Harris, clinical associate professor in the School of Public Health and senior research scientist at NORC at the University of Chicago, released a new report detailing the results of an 18-month study on mental health in rural New York.

The work, which is the first of its kind in the state, took the form of a “listening tour” comprised of 32 group interview sessions that engaged 289 participants representing 16 rural counties. It includes key insights from participants, with recommendations for strategies to improve mental health in rural areas in New York and beyond.

“Rural communities, especially those most isolated that lack access to public transportation and internet services, often contend with deep-rooted issues that impact residents’ mental health,” said Harris. “These can include things like poverty, economic and employment challenges, substance use, domestic violence, child abuse and neglect, a lack of affordable housing and homelessness.

“In 2019, the New York State Suicide Prevention Task Force issued recommendations for addressing mental health and suicide in New York, with special attention to several priority populations. Yet, the report did not address rural communities — which are distinctly vulnerable to mental health challenges, have limited care options and are home to nearly 20 percent of all New Yorkers. We undertook this study to address this critical gap.”

Identifying Common Threads

The research team invited community members from 16 rural counties in New York to share their perspectives and experiences concerning the local accessibility and utilization of mental health services during group interviews called “listening sessions.” Participating counties included: Clinton, Columbia, Cortland, Essex, Franklin, Fulton, Genesee, Greene, Lewis, Montgomery, Otsego, Seneca, Sullivan, St. Lawrence, Wyoming and Yates. 

They held two listening sessions for each county — one for residents 18 years of age and older, and one for professionals who play a role in community mental health. These were conducted first in person, then via Zoom, between March 2020 and September 2021.

Through these conversations, a number of common themes emerged. For example, many participants spoke about the effects of social isolation on mental health, pros and cons of living in close-knit communities, barriers around delivering and accessing mental health services, and how tenets of rural culture contribute to stigma around mental health issues and seeking help.

Many of the issues commonly raised by the mental health professionals centered on state-level policies that limit access to care. For example, the state allocates funding for mental health services to communities based on population size. Areas with smaller populations receive less funding, making it harder to implement mental health programs. There are also limitations around how the funds can be used, with approved services favoring treatment instead of prevention. Finally, professional participants explained that they must treat a certain number of patients in order to secure funding. There is no shortage of demand. Yet, without adequate funds to support programs and staff, it is difficult to meet these quotas.

“The constant discussion around restrictive regulations and funding algorithms was surprising and unexpected,” Harris explained. “As an exploratory study, we were looking to identify missing elements in our efforts to prevent suicide. We thought this issue may come up once or twice, but it came up in most, if not all, of the listening sessions with professionals. Adjusting these state-level policies could help providers more effectively serve their communities.”

Learning What Works

Throughout the study, the team also paid close attention to aspects of rural living that promote social cohesion and community welfare, as well as suicide prevention and mental health strategies that have proven effective. These are detailed in the report, and Harris pointed to several standout examples:

“Seneca County has taken a county-wide approach to suicide prevention using the Zero Suicide framework,” Harris said. “They are universally screening for suicide risk in primary care settings and are implementing an evidence-based school suicide prevention program called Sources of Strength in all school districts. The county also developed a uniform lethality response that was adopted in all schools, and they maintain an active suicide prevention coalition.”

Genesee County’s approach is another model that could prove effective in other communities.

“Firearm safety is especially critical in rural areas, where gun ownership is so engrained in the culture,” said Harris. “Genesee County partnered with a local gun range to promote firearm safety with an eye to suicide prevention through public educational programming. Working with the gun-owning community to deliver this sort of messaging is key.”

Rolling Out Recommendations

“In order to alleviate growing mental health concerns in rural New York, we first need a clear understanding of the challenges on the ground,” Harris said. “Learning from residents and mental health professionals living and working in these communities sheds much needed light on the ways that rural living can at times support, yet often impede, residents’ mental health.”

Working in collaboration with study participants, the team developed recommendations to help improve mental health and access to supportive resources in rural communities. These include goals like increasing community cohesion, expanding access to transportation and broadband services, improving and sustaining workforce capacity and increasing awareness of the mental health and suicide prevention programs that are available.

“The ultimate purpose of this listening tour was to effect policy change,” Harris said. “We have begun disseminating this report to policymakers, and we look forward to working with community partners to put our findings to work.”

Looking ahead, the team is seeking funding to develop and distribute tools for leaders in rural communities to help them implement a comprehensive approach to suicide prevention that addresses both risk and protective factors.

If you are experiencing a mental health concern or are considering suicide, help is available by calling the National Suicide Prevention Lifeline at 988.