By Dia Arpon, M.D., DFAPA

Dr. Dia Arpon is a psychiatrist in Delaware who has been practicing since 2006. She has a Bachelor of Science degree in biology from the University of Maryland, Baltimore County. She earned a Doctor of Medicine degree from the Medical College of Philadelphia–Hahnemann School of Medicine, now Drexel University College of Medicine. She completed an internship with the Crozer-Keystone Family Medicine Residency program in Springfield, Pennsylvania, and finished her psychiatry residency at Thomas Jefferson University. She is a psychiatrist at LifeStance Health. Dr. Arpon is a member of the APA Caucus of Women Psychiatrists and APA Caucus of Black Psychiatrists.

Rural communities in the United States face unique challenges that significantly impact mental health outcomes, many of which are shaped by social determinants of mental health (SDoMH) such as economic instability, limited access to health care, education disparities, and geographic isolation.¹ These determinants contribute to higher rates of mental illness, increased stigma, and underutilization of mental health services in rural areas.² Structural barriers, including provider shortages, transportation difficulties, and inadequate broadband infrastructure, further restrict access to timely and culturally competent care.

One of the primary challenges contributing to provider shortages in rural areas is the tendency for physicians to practice in urban settings, where larger populations and greater resources are concentrated.^2,3 The smaller population size in rural communities makes it difficult to recruit and retain physicians, often resulting in designated health professional shortage areas. For example, during my time in rural Montana, I was the only psychiatrist within a two-hour radius. In addition, limited internet infrastructure poses a significant barrier to accessing care virtually. Telepsychiatry, while promising, becomes impractical without reliable broadband.^4,5 As a result, patients are often forced to rely on in-person visits or emergency departments for mental health needs. This overreliance on emergency care contributes to staff burnout and strains already limited resources. Furthermore, when patients lack reliable transportation, their ability to access routine care becomes severely restricted, increasing the risk of delayed diagnoses, poor treatment adherence, and worsened health outcomes.^2,3

Another significant challenge in rural communities is the prevalence of food deserts. Often, there may be only a single local grocery store serving an entire region, making it difficult for residents to obtain fresh fruits, vegetables, and high-quality meat regularly.⁶ When available, these items are frequently more expensive than their processed counterparts. As a result, many rural supermarkets primarily offer lower-cost, shelf-stable foods that are high in salt, sugar, and saturated fats. This dietary restriction increases the risk for chronic conditions such as hypertension, diabetes, and cardiovascular disease. For individuals living with mental illness, maintaining a nutritious diet can be even more challenging, compounding the effects of poor nutrition on overall health.⁷ Ultimately, this limited access to healthy food options reinforces broader social determinants such as food insecurity and contributes to persistent health disparities.

Addressing the determinants and challenges that plague rural areas requires a concerted effort in advocacy and the implementation of well-defined policies. Advocacy is crucial to ensure that everyone, regardless of their location, has equitable access to resources that enable a high quality of life, such as clean water. Government regulation, particularly in rural areas with geographical challenges, is crucial for preventing water pollution and ensuring the proper disposal of chemicals. To address the shortage of clinicians in rural areas, psychiatrists can form partnerships with faith-based organizations, schools, agricultural networks, and rural health clinics to establish referral networks, offer consultation services, or cohost mental health literacy initiatives. Leveraging telepsychiatry, combined with high-quality internet access, can significantly increase access to care in remote or underserved areas.4 Psychiatrists can champion policies that expand broadband access and sustain telepsychiatry reimbursement, which has proven effective in increasing rural access to mental health care. They can also choose to serve as key voices in shaping rural mental health policies by providing testimony, publishing op-eds, or participating in rural health task forces. It will be important for clinicians to support programs that recruit and retain diverse rural mental health professionals.

In conclusion, understanding and addressing the intersection of rurality and SDoMH is crucial for developing equitable mental health policies and interventions that cater to the needs of these often-overlooked rural populations.

Resources

• Pathways to Population Health Equity (P2PHE) provides tools for public health leaders to enhance population health, well-being, and equity. It offers various tools to help public health practitioners.
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• The Mobilizing for Action through Planning and Partnerships is a community-driven strategic planning process to achieve health equity. MAPP provides a structure for communities to assess their most pressing population health issues and align resources across sectors for strategic action.
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• The Coronavirus Response and Relief Supplemental Appropriations Act served as a funding opportunity to address COVID-19 health disparities among high-risk and underserved populations, including racial and ethnic minority populations and rural communities.
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• The World Health Organization reports on the social determinants of health on a global scale.