Rural & Greater Psychologists: How They Connect, Protect, and Serve

Most psychologists practice in the seven county metro areas of Minnesota, where approximately half of the state’s five million-plus residents live. The other eighty counties represent the greater land area of the state, where the population is more dispersed and people live in smaller or rural communities with fewer mental health providers and services. The psychologists in rural and greater Minnesota are a hidden and valuable resource who not only provide high-quality behavioral health services to their communities, but in many ways benefit the entire state.

Rural and greater psychologists are quite resourceful, but may face considerable challenges such as longer traveling distances, fewer revenue streams, smaller client base, less mental health and other resources, fewer career options, and less training opportunities. While most of the state has some practitioners, there are nine Minnesota counties with no mental health professionals, and several counties with only one. In such areas, practitioners have to be broadly trained, and have the professional skills necessary to manage extensive and often complicated community relationships.

Concerns such as diversity, poverty, and sexual preference are ever growing issues. As you know, every rural county in the state has diverse groups. There are African Americans and       bi-racial persons living in every county, even in many remote areas. Other rural residents of color include Native Americans, South East Asians, Somali, and Latino cultures. In addition, there are “low profile” gay and lesbian families just trying to have a quiet life without harassment. Some rural persons of color are permanent long-term residents who have lived in the community for generations. Others having arrived in the past 20 years, working low-wage jobs in packing or manufacturing plants, or working as seasonal agricultural workers. Some may be more recent arrivals seeking a new life and others are mobile people who are less invested in the community, and trying to escape their past troubled life in large cities such as Chicago, St. Louis, or Kansas City. The new arrivals often have different behaviors and values, and may not participate in local celebrations. Such persons may burden a small town’s social service resources as the community attempts to accommodate high-need families who may require specialized services.

Rural and urban psychologists treat similar emotional problems such as depression, anxiety, substance abuse, and relationship conflicts. They also treat the more complicated issues of HIV, suicide, trauma and disasters, sexual assault, domestic violence, and child abuse. However, rural psychologists encounter unique practice and boundary dilemmas. Often, their own families live within the communities they serve; and participate in the same social, work, support, medical or educational networks as their clients. Rural psychologists and their family members are often personally acquainted with both the victims and perpetrators when incidents occur. They are also acquainted with the emergency responders who take risks such as police, firefighters, and medical personnel. Most people in small communities either know each other, have crossed paths in some way, may even have common friends or family members, and/or attend the same church or school. So when a major incident happens, a large number of people are affected, and the psychologist is the sought after as the mental health “first responder.” Sometimes the psychologist may be stressed by the event, but not have the peers available for her/his own support and debriefing.

At times the rural psychologist’s own family members or friends are impacted by community emergency events. While individual crime and urban violence are the most common critical incidents in the Twin Cities metro area, rural psychologists more often see trauma victims of house fires, suicides, wildfires, train derailments, farming and industrial accidents, recreational accidents, and fatal car crashes in addition to the latest biological threats such as the avian flu, West Nile virus, and industrial pollution. These are events that affect the entire community, both emotionally and financially.

Rural psychologists across the nation are often called into service when urban areas experience disaster. In Minnesota all areas of the state are economically connected and share the same government systems. Metro and rural areas benefit one another.  Large cities have population density, which frees up land for agriculture and manufacturing. If the entire population was dispersed throughout the state, then farming and livestock would not have the land area to produce at current levels. Also, the larger cities cannot exist without the goods and services produced in greater Minnesota. Rural psychologists support productivity and reduce the costs of goods and services by playing a critical role in helping to generate and maintain a stable and productive rural workforce.

Rural psychologists also contribute to the safety and security of the state and country. Many rural residents serve in the National Guard or military branches, and retain their home and community attachments. Many have been deployed to Afghanistan and Iraq, and served their duty often in combat zones or other critical situations. Military service or disaster deployments may be very disruptive to families and communities. Rural psychologists help military personnel and their families cope with pre- and post-deployment adjustments.

In addition, rural psychologists are available as emergency providers in the event of a state disaster or terror event. After the 911 and Katrina events, rural psychologists played a quiet but significant recovery role. Mental health professionals in the affected areas either evacuated to safe areas or were also trauma victims in need of interventions themselves. The damage from disaster events often cause transportation restrictions such as closed roads and airports, which limits outside support and access to affected areas. If the Twin Cities should have a major event requiring evacuation to greater Minnesota, and massive mental health support, an available resource would be rural psychologists.

As we enter the new era of behavioral health care and adapt our practices to the Affordable Care Act, integrated care, electronic health records, tele health, and alternative cost models, we can expect a blending of rural and urban practice. Technology will eventually narrow the gaps between rural and urban behavioral health practice by increasing access to all the mental health resources in the state.

To learn more about rural psychological practice, please join members of the MPA Rural and Greater Division, at our 7th annual conference this fall on October 9, 2015. Conference participants will be persons from twenty states and territorial regions, reflecting a wide range of psychological practice experiences. You can register on the MPA website.  The conference theme is “Innovation in Rural Behavioral Health.”  Up to seven CE’s are offered, and you may attend in person at the University of Minnesota Morris or by webcast.

Willie Garrett, M.S., L.P., Ed.D., is a licensed psychologist in private practice. He is a long-term MPA member, and a former Director of Professional Affairs. He has been the chair of the rural division, and part of the planning for the Rural Behavioral Health Practice Conference for the past four years.


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