This article is published as part of a collaborative effort by students in the School of Journalism and Strategic Communication at Ball State University and the Ball State Daily News. Produced in a classroom setting under faculty guidance, the initiative aims to provide hands-on experience while informing the public through responsible, student-driven journalism.
Hiley Ward’s rural hometown of Wabash, Indiana, takes her about 10 minutes to drive through. She said the town is made up mainly of cornfields past the small downtown area. Growing up, Ward didn’t think much about the size of her town or how that affected her day-to-day life.
This changed nearly five years ago when Ward needed what’s considered specialty healthcare for her mental health.
Ward said there are two specialty care places in Wabash: a small counseling center and one dedicated to bone care. When she started to attend counseling at her local center, she quickly realized the care she was receiving wasn’t right for her.
“Anytime that I would try to talk about how I was really feeling or [my] intrusive thoughts, they would just want to send me to the ER to get evaluated,” she said. “We ended up moving because it just wasn't helpful.”
Ward began traveling multiple times a month to a hospital three towns over in Huntington, Indiana. While she said she fit in well at the new location, the specialist she was seeing didn’t offer long-term care.
By the time she ended up with her current counselor, an hour away in Fort Wayne — after starting, but having to end another counseling intake due to her insurance — it had been about four years since she began counseling in Wabash.
“It was really hard for me to tell my story, and then get up and do it all over again,” Ward said.
In the U.S., just over 66 million people live in rural areas, or about 20% of the nation's population, according to the USDA. In Indiana, the number of rural residents is 900,000, or about 14% of the state's population. For a large number of Indiana’s rural residents like Ward, access to specialty care — specifically that for psychiatry and mental health — is a struggle. Solving this struggle has been difficult for rural health professionals.
According to a 2022 series of reports from the WWAMI Rural Health Research Center, fewer behavioral health counselors, psychologists and social workers provide mental health services in rural areas than urban areas, despite these practitioners increasing in total numbers.
Joyce Fillenwarth, Indiana’s state office of rural health manager, has found this true. Fillenwarth spends her days developing relationships with rural communities and healthcare providers to assist in “finding solutions” to the issues they face daily.
The office focuses on delivering grants to rural hospitals and offering various training programs for their staff who “otherwise would not get that type of support.”
She said transportation and service availability are the biggest barriers for rural Hoosiers when receiving health care.
When it comes to specialty care, Fillenwarth said this barrier is heightened.
“Those specialty services do not exist within [the most] rural communities. Extensive travel time to urban settings is necessary to receive these services,” Fillenwarth said via email.
She said behavioral health care is “non-existent” or takes upwards of “six months to receive” in some communities.
A study by the Bowen Center for Health Workforce Research and Policy backed up Fillenwarth and found that rural health care in Indiana “faces significant challenges.”
The study also said, “Workforce shortages are acute, particularly in mental health, where rural areas have two-thirds fewer behavioral health professionals than urban areas.”
According to Mental Health America, telehealth is one resource introduced to bridge the gap in mental health care for rural residents. When accessibility and availability are barriers to this care, telehealth allows rural individuals to connect with therapists and mental health professionals online without the need for travel.
This is a solution for some, but the availability is limited by internet access. According to a recent report by the Federal Communications Commission, 22.3% of Americans in rural areas and 27.7% of Americans in Tribal lands lack coverage from fixed terrestrial 25/3 Mbps broadband, as compared to only 1.5%of Americans in urban areas.
While access is a large barrier to specialty care, cost is another issue.
According to the National Alliance on Mental Illness (NAMI), rural residents are more likely than urban residents to be uninsured. On top of this, most insurance companies do not cover the cost of different mental health services.
Although Ward has found effective counseling in Fort Wayne, she said she’s begun to worry about how long this will last due to her insurance beginning to require “proof or notes that show improvement” from her therapist.
“If I'm going to therapy for myself, I don't understand why I have to show progress to help pay for it with my insurance,” she said.
If this “proof” cannot be produced through notes that showcase mental improvement, Ward will soon lose access to her therapy.
Cost has become a barrier for the hospitals and rural providers themselves, said Dr. Randolph Hubach, professor of public health and director of the Center for Rural and Migrant Health at Purdue.
For example, IU Health Primary Care in Albany, Indiana, closed its doors earlier this year, condensing and redirecting patients to the Muncie location 20 minutes away.
“Nearly half of rural hospitals operate in the red [financial area] today, and over 170 rural hospitals have closed since 2010,” Randolph said via email. “The low population density of rural areas can make it difficult for hospitals to cover operating costs when their patient volume is low.”
At the Center, though it is fairly new, he works with a team of faculty, staff, students and community members to bring solutions to rural healthcare barriers. Through its initiatives, the Center has begun to address issues that disproportionately impact rural populations in Indiana, while also further informing the public through outreach, community support and advocacy.
While the Center, much like Fillenwarth’s office, has been making an impact in addressing critical health issues, there is inevitably a lot of work. According to a NAMI study, 37 million, more than half of rural America, live in mental health professional shortage areas.
Those looking for more information and resources on mental health care in rural areas can head to ruralminds.org, a website tailored toward managing rural isolation, loneliness and suicide prevention in rural America.
Contact Trinity Rea via email at trinity.rea@bsu.edu.
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