Ending Stigma, Changing Rural Minds

Asked to picture rural America, most will conjure bucolic images of rolling hills, green meadows, and livestock peacefully grazing on pasture, dotted by the silhouettes of the hardworking, salt-of-the-Earth folks who work the countryside. These communities, however, conceal a darker secret.

Having grown up on a dairy farm in upstate New York, where the closest town was populated by a mere 500 people, I am a rural American. My firsthand perspective was shaped by living in a small community of industrious, independent, resilient people who were kind and quick to lend a hand.

When I was young, my farming community seemed idyllic, but as time passed, I began to sense that something was wrong. There were unexplained circumstances. People were dying in the prime of their lives, very suddenly, but no one was talking about it.

As I came to find out, members of my community had been living with untreated mental illnesses, like depression, anxiety, bipolar disorder, and schizophrenia. The topic was taboo, and their struggles were often met with silence, because in my community, as in much of rural America, mental illness was stigmatized. Information was scarce and there were few, if any, resources available.

Years later, tragedy found my family. We had just celebrated the wedding of my eldest nephew when less than two days later, his younger brother, my 28-year-old nephew, Brooks, died by suicide.

How long had he suffered in silence? Why did he feel that he couldn’t seek help? In the wake of his passing, my family and I asked ourselves these painful questions. Like so many living in remote rural areas of the U.S., our beloved Brooks had concealed his struggles, suffering alone until he was overcome.

Before the funeral, I spoke to my mother. I asked her, “Mom, how much detail do you want us to go into at the funeral?” With tears streaming down her cheeks, my mother replied unflinchingly, “Of course we’re going to talk about it. It’s about time that this rural community started facing what is going on here.”

A Sobering Portrait

A glance at the mental illness statistics in rural America is sobering. Rural Americans have higher rates of depression and suicide than urbanites, but are less likely to seek mental healthcare services. The suicide rate in rural populations is 18.3 to 20.5 per 100,000, which is much higher than the 10.9 per 100,000 rate in urban populations.

According to the CDC, suicide rates have increased by 45% in non-metro areas from 2000 through 2020. Rural residents have a 1.5 times higher rate of emergency room visits for nonfatal self-harm than urban residents.

The challenges facing rural communities in the United States are daunting:

• Rural areas have fewer primary care providers per resident than urban areas and the workforce is growing at a slower rate
• 65% of rural counties lack a psychiatrist
• 81% of rural counties lack a psychiatric nurse practitioner
• 47% of rural counties lack a psychologist
• Nearly 37 million rural Americans—more than half of rural residents—live in mental healthcare shortage areas.

The COVID-19 pandemic, which exacerbated existing issues of isolation and unemployment, had a significant impact on mental health in rural American communities, with 53% of rural adults and 71% of younger rural adults between the ages of 18-34 reporting that the pandemic had affected their mental health.

Unique Rural Lifestyle Challenges to Mental Health

In addition to a lack of mental healthcare resources, rural Americans must deal with lifestyle barriers particular to them, which can impede their ability to access the help that they need.

As of 2020, 46 million U.S. residents, which comprises only 14% of the entire U.S. population, live in rural areas. In addition to increased isolation, residents of rural communities also face greater obstacles to accessing goods and services, endure longer commutes, and generally struggle with economic hardship.

As of April 2020, mere months into the COVID-19 pandemic, unemployment rates hit levels unseen since The Great Depression, peaking at 13.6% in rural areas. In 2019, 15.3% of rural citizens lived in poverty. With unemployment and poverty come a lack of health insurance, rendering mental healthcare inaccessible.

Compounding the issue, internet service providers underserve rural communities. In addition to decreased access to telehealth services, rural residents without broadband internet lack access to information, online schooling, ecommerce, and work-from-home options.

Overcoming Stigma

Given the small, close-knit nature of rural communities, residents worry about whether they can maintain confidentiality of care. They fear word getting out that they are receiving treatment, believing that family, friends and community members will judge them as weak or incompetent.

Stigma looms large over the issue of mental health, especially in rural communities, and can be a major impediment to people reaching out for help. Many view mental illness as a weakness, or a character flaw, instead of seeing it for what it is: a legitimate, treatable medical condition.

In the days following Brooks’s passing, my family was urged by friends and neighbors to avoid mentioning suicide. They suggested that we say that he died of natural causes. My mother, the matriarch of our family, insisted on addressing the issue head-on, hoping to prevent it from happening again.

I had the privilege of eulogizing Brooks, and I spoke in detail about what led to his death. Following the service, several community members revealed to us their own families’ experiences with mental illness, thanking us for allowing them to finally talk freely about it.

Raising awareness liberates people living in the shadow of stigma to not only seek help, but also to step forward and speak publicly about their stories. Shifting the perception of mental illness, and ultimately ending the stigma surrounding its discussion, is my mission, and the mission of Rural Minds.

Jeff Winton is the Founder and Chairman of Rural Minds, a nonprofit organization that aims to end the suffering, silence and stigma surrounding mental illness in rural America. He is also the founder and owner of Wall Street Dairy, LLC — a working dairy farm in Chautauqua County, New York — and a member of a multigenerational farm family. In addition, he is the chief executive officer of Jeff Winton Associates, a full-service communications and corporate affairs agency he co-founded in 2020.

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