Rural clients face barriers that can make accessing behavioral health services particularly
challenging — not just tangible ones
like physical distance and lack of time,
transportation and insurance, but a
stoical culture that emphasizes self-reliance and a related stigma about using
mental health care.
“Their personal needs tend to get put
on the back burner,” says Emily Selby-Nelson, PsyD, a clinical psychologist
who works at Cabin Creek Health
Systems, a federally qualified health
center with several locations in rural
Thanks to her rural psychology
training, though, Selby-Nelson is well
versed in the nature of these problems
— and the system she works in helps to
effectively address them.
Cabin Creek Health Systems uses
integrated primary-care services, a
patient-centered approach, integrated
electronic medical records and an
understanding that behavioral factors
can play a major role in health outcomes.
As a consequence, patients see Selby-Nelson as a health-care professional who
can help them sort out their problems
in a brief chat after a visit with their
primary care physician, rather than as a
stranger intent on analyzing their mental
What’s more, because the system
receives federal funds and grants to
serve underserved populations, Selby-
Nelson’s clients aren’t as worried about
payment or billing concerns. And
thanks to technology’s ability to connect
people and resources, she participates
— conducting research, training future
rural integrated-care psychologists, and
serving in professional leadership roles.
Selby-Nelson’s practice is a striking
example of how far rural psychology
has come in the last few decades. While
rural practitioners still face challenges
like professional isolation and navigating
multiple relationships, mental and
behavioral health are becoming a more
vital and embedded part of rural health
care, thanks in part to psychologists’
efforts (see sidebar for a short history).
In fact, rural practice has sometimes
led the charge toward more progressive
forms of health care, says Paul L. Craig,
PhD, a neuropsychologist in Anchorage,
Alaska, and longstanding advocate for
improved mental health care in rural
“Rural settings have been in the
vanguard of demonstrating the viability
and efficacy of integrated care,” he says.
Expanding care Perhaps
the greatest boon to rural health care
has been the National Health Service
Corps, or NHSC, the federal program
that repays the student loans of health-care providers who work in underserved
areas. Since 2002, 263 psychologists have
completed the program.
Today, there are 3,277 NHSC mental
health providers in service nationwide.
A 2012 survey found that 82 percent of
all health-care providers stayed on for at
least a year after completing their service
commitment, while 61 percent of mental
health providers continued to work at the
site four years after service completion.
“The program gives people access
to mental health services and help they
would otherwise not have received,” says
Darryl Salvador, PsyD, a former chair of
APA’s focus on rural communities continues to
improve access for underserved populations.
By Tori DeAngelis