In rural America, mental illness is often regarded as a character flaw rather than a disease, leaving many suffering in silence. The fear of judgment from one’s close-knit community forces adolescents and adults alike to avoid seeking care, if they even have access to a provider in their area. The combination of limited availability of and access to mental health professionals, and rural attitudes about mental health has created a crisis plaguing rural areas across the country.

Rural Minds, founded by Jeff Winton, is a new organization dedicated to addressing mental health in rural America. After the loss of his nephew to suicide, Winton recognized a need for mental health education, resources, and conversations that acknowledged the unique barriers, lifestyles, and beliefs of rural areas. The vision of Rural Minds is a rural America where there is no more silence, suffering, or stigma around mental illness.

Winton recently shared his family’s personal experience with suicide in a webinar titled, “The Rural Mental Health Crisis,” as part of a partnership with Mental Health America (MHA). In the webinar, he also provided an overview of how Rural Minds is working to address rural mental health needs, including eliminating the stigma of mental illness in rural areas.

“What we’re attempting to do is shine a light on this growing pandemic – that will be a pandemic long after COVID-19 has been resolved – and to get the resources in the hands of people that we represent in a language that makes sense to them and delivered by trusted messengers in the community,” Winton said.

Suicide and Stigma

A decade ago, Winton and his family gathered for a wedding near his childhood home in rural upstate New York. As they were leaving the reception, his nephew Brooks – a big, burly man at 6’8” and 320 pounds – gave Winton a tight hug and thanked him for everything he’d done over the years. Winton didn’t think too much of it as, despite his stature, Brooks was known to be grateful, gregarious, and a stranger to no one, always the first to thank somebody for their help.

The next day, Winton paid a visit to the cemetery where generations of the family were buried. Following tradition, he sent a picture to Brooks, letting him know he was thinking of him and that the family said hello. He didn’t receive a response but wasn’t overly concerned, assuming Brooks was tied up with work or caring for his twin daughters. Five minutes later, while approaching Brooks’ house, he was met by a sea of police cars with lights on.

“I jump out of the truck and one of the neighbors comes running across the country road and grabs me, crying hysterically, and just said, ‘Jeff, I don’t know how to tell you this, but you need to hear from someone, and I don’t want you to see this, but I just found your nephew hanging from a tree in the backyard,’” Winton said. “Even 10 years later, I still get choked up about that day.”

In the chaos of that surreal moment, his mind immediately turned to the twins. With help from the police, he discovered the children were out shopping with their mother. He quickly realized Brooks had planned this tragedy for when the house would be empty. It became painfully clear that the trip he had taken his girls on to Niagara Falls just a week prior was also a deliberate step in a carefully thought-out plan.

It had never occurred to Winton or the rest of the family that Brooks, a generally happy and gentle giant, was struggling. Another member of the family had attempted suicide a number of times, so the attention had always been on them – “never in a million years” did they suspect Brooks was suffering in silence.

When Brooks died, several close friends and even family members inquired about how his death would be handled. Winton’s mother, who had helped raise Brooks, was bombarded with suggestions to not disclose the suicide, to make up a reason for his death such as a farming accident, or to even say he died of natural causes, despite being 28 and physically healthy.

“My mom, who is a very quiet but very courageous woman, sat in the study of that small town United Methodist church with tears running down her face, pounded on the pastor’s desk, and said, ‘Of course we’re going to talk about this. It’s about time people confronted what’s been going on up here for years.’”

Rather than succumb to the stigma and appease her uneasy small town of 500, Winton’s mother knew the truth of Brooks’ death needed to be addressed. Seeing how uncomfortable it was for people to talk about suicide and mental health, she decided it would stop with her family, and that they owed it to Brooks to ensure this didn’t happen to other families in the area.

Hundreds of people filled the church for the funeral, after which they stood in line for hours to talk to Winton’s family. Not only did they express their condolences, but they began sharing stories of their own personal and family struggles with mental health. Although his family had been in this town and known this community for generations, it was the first time people felt permission to speak openly and honestly without fear of shame or judgment.

The Rural Mental Health Crisis

On that day 10 years ago, the seed for Rural Minds was planted with Brooks’ death. At the time, Winton was working for pharmaceutical companies in the corporate world. He reached out to his connections to see if there was a need for a group focused solely on the 60+ million rural Americans who have been forgotten and left out of conversations about mental health.

“The resounding answer was yes,” he said. “We have been so focused on urban and suburban audiences and people struggling in those communities that we really haven’t spent too much time talking about people in rural America nor, quite honestly, do we even know how to reach them.”

Winton spent the last decade working with colleagues and partners to ensure this new group would be filling a need and not duplicating efforts. Rather than create new programming and materials, he wanted to ensure people in rural communities are aware of and able to access existing resources. He also wanted to prioritize having transparent conversations about mental health in these areas to break down the stigma that prevents so many people from receiving much-needed support.

“The stigma is something that we are really focused on because our goal is to get people talking about what is happening in any given community, just like my family did 10 years ago when my nephew died,” Winton said. “Even if it’s one person, if they can confide their story in one person, that’s where the healing begins, not only for the individual who is suffering but for the community that’s been so tragically impacted.”

A number of factors unique to rural attitudes and lifestyles, including stigma, contribute to the mental health crisis prevalent in rural areas. Some of these factors include:

  • Self-imposed barriers of asking for help when taught to pursue self-reliance as a virtue.
  • Lack of trust in anyone to maintain confidentiality in a small, close-knit community.
  • Fear of negative judgment from others as being incompetent or less capable.
  • Difficulty getting an appointment with limited availability of mental health professionals.
  • Time and transportation required for long-distance travel to meet with a mental health professional.
  • Unreliable, expensive, or nonexistent internet service for online video or telehealth appointments.
  • Feeling of isolation without having access to talk with someone outside of the community who understands mental health challenges in rural America.
  • Weakening agricultural economy, financial instability, and a solitary way of life.

These factors create mental, physical, and societal barriers to seeking and accessing care. Because mental illness is regarded as a character flaw rather than a disease, people feel ashamed and as if they have to hide their struggle, rather than discuss it as they would cancer or diabetes. Even if they want to seek help, the risk of a neighbor seeing them or their truck at a mental health professional’s office and telling others may be enough to avoid doing so.

In rural areas, the lack of mental health providers and telehealth options may render it nearly impossible to receive timely help. According to data presented by Winton, nearly three-fourths of rural counties lack a psychiatrist, including his hometown. In addition, 81% of rural counties do not have a psychiatric nurse practitioner.

Even in rural areas with providers available, factors such as distance to and from the facility and its operating hours can affect one’s ability to get an appointment. Many rural adults work on farms and blue-collar jobs and may not be able to leave during business hours, especially if they have to drive for several hours. Although telehealth is making waves, especially in response to the COVID-19 pandemic, most rural counties lack the adequate broadband infrastructure to make mobile and internet service a reliable option.

Rural areas not only face healthcare deserts, but a generally solitary lifestyle due to the expansive landscape that leaves individuals keeping mostly to themselves. Though this may seem peaceful to outsiders used to the hustle of big cities, the solitude comes with consequences. According to the National Institute of Health (NIH), the COVID-19 pandemic likely caused an increase in suicide in rural areas. Three out of five rural adults, and two-thirds of farmers and farmworkers, reported their mental health being affected by the pandemic.

Isolation especially impacted youth across the country, with nearly two out of three young people ages 15-24 expressing feeling down or depressed during the pandemic due to missing out on school and social functions and gatherings. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association have declared a national emergency in child and adolescent mental health. The U.S. Surgeon General has released an advisory focused on supporting youth mental health, in which he writes, “It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place.”

Rural Minds

To combat the rural mental health crisis, Rural Minds is working to help eliminate the stigma of mental illness in rural America by:

  • Recognizing suicide and mental illness in rural America as an emergency.
  • Normalizing conversations about mental illness and reducing stigma through rural Americans sharing personal lived experiences.
  • Recognizing mental illness as an illness rather than a character flaw.
  • Empowering people in rural America with the resources to become part of the solution to improving mental health.

Rural Minds aims to provide forums for rural Americans to share personal experiences with mental health and connect rural communities to existing mental health information and services. The organization hopes to achieve health equity by identifying gaps in rural mental health information and resources and collaborating with mental health organizations to develop mental health initiatives.

At the conclusion of the Rural Mental Health Crisis webinar, Winton shared a quote credited to Harlan Coben, reading, “Sometimes the loudest cries for help are silent.”

“That was certainly in the case of my nephew, Brooks,” he said. “Looking out around at the pastures and the barns on our farm, I miss him tremendously, I miss him every single day, but the work we’re doing in Rural Minds is keeping his memory alive and it’s allowing us to use his death as a platform to ensure that other people know they’re not alone.”

To learn more about Rural Minds, access resources on rural mental health, and get connected to help, visit https://www.ruralminds.org/.

Watch “The Rural Mental Health Crisis” webinar presented by Rural Minds and MHA: https://www.youtube.com/watch?v=Bh_oup9GtQ4