International Summit Delivers Perspectives on Rural Behavioral Health

This week, the International Initiative on Mental Health Leadership (IIMHL) conducted its cross-country summit, which is held every 18 months in a different country. Originally intended to occur in Christchurch, New Zealand, in March 2021, the summit was postponed until now because of COVID-19 concerns. Subsequently, it was disaggregated into meetings in 3 regional hubs—Christchurch, Dublin, Ireland, and Washington, DC. In preparation for this summit, the IIMHL Rural Behavioral Health Collaborative hosted 3 virtual sessions for interested participants from member countries. This is a report on these sessions. In each instance, I will identify those persons who one might contact for additional information.

The first session, “Fostering Engagement and Ownership in Rural Communities,” was led by Dennis Mohatt of the Western Interstate Commission on Higher Education (email: dmohatt@wiche.org) and me. This session explored how to address the rapidly growing problem of psychological and financial disengagement in rural communities. The expansion of agri-corps and big-box and online stores is destroying family farms and small, locally owned businesses, as well as the surrounding communities that support them. These developments have led to the growth of the “diseases of despair”—suicides, increased drug use, and cirrhosis of the liver from alcohol consumption—in these communities.

Three efforts were described that can counter this trend. Project Thrive, in Allen County, Kansas, has converted a dying rural community into a vibrant, engaging place to live (contact: Lisse Regehr, lisse.regehr@thriveallencounty.org). Similarly, the Together with Veterans Program seeks to place US military veterans into rural settings, where they can become engaged in local community life (contact: Jason Alves, jalves@wiche.edu). Finally, new national legislation in the Philippines has made possible a novel approach to behavioral health in rural communities, including deployment of local primary care physicians, nurses, and peers (contact, Rodney Boncajes: rodneyrboncajes@gmail.com).

The second session, “COVID-19 and Rural Wellbeing,” was led by Hazel Dalton (hdalton@csu.edu.au) and David Perkins (davidallanperkins@gmail.com), 2 experts in rural behavioral health from Australia. This session described results from a recent survey conducted to assess the effects of COVID-19 in rural Australian communities, particularly its effects on personal and community wellbeing.

The survey results show clearly that COVID-19 has had adverse consequences on rural community life in Australia. Further, the session documented the movement of people from urban to rural settings during the COVID-19 pandemic. This has created additional housing shortages in rural communities, as well as increased the prices of houses. These effects of COVID-19 are in addition to other adverse events already present in rural communities, such as social isolation, increases in the diseases of despair, and especially farmer suicides, which also have grown during the pandemic. One of the recommendations that emerged during the session was for innovative approaches to national, state, and philanthropic funding in these communities, as traditional short-term grants are not adequate to address the severity of the current issues.

The third session, “Community Wellbeing” was led by Tammy Heinz from the Hogg Foundation (tammy.heinz@austin.utexas.edu) and Gerard Vaughn from New Zealand (gerard_vaughan@xtra.co.nz).

The focus for this session was a project undertaken by the Hogg Foundation to facilitate the growth of empowered communities in 5 Texas counties. This work emphasizes the importance of listening to the community, incorporating historically excluded groups, promoting local leadership, and engaging the full community in social events. The session also examined farmer stress.

Broad agreement emerged in this third session that development and maintenance of empowered communities is essential to improving their ongoing behavioral health and wellbeing. Such efforts also will improve the social and physical determinants of health in these communities and thus reduce trauma and subsequent behavioral health conditions, including for farmers.

All these sessions documented very clearly that empowered communities that function well are essential for the survival of rural life. They are the wellhead of both personal and social wellbeing. This is equally true across cultures—in Australia, New Zealand, Canada, and the United States. We must continue international collaboration to develop new funding streams, new mechanisms, such as cooperatives, and new social opportunities to make this goal a reality for rural communities everywhere.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.