Community-Based Mental Health Training as a Pathway to Rural Resilience
By: Adam Howell
Edited By: Rose Kores
The U.S. Department of Education recently proposed changing the classification of the Master of Social Work (MSW) and Doctor of Social Work (DSW) degrees by removing their designation as “professional.”1 This shift would make it more difficult for thousands of prospective social workers to access federal loans that fully cover tuition. Additionally, it may further constrain the pipeline of mental health professionals, especially in rural areas that already face severe shortages. As federal policy decisions make it harder to address the shortage of clinical mental health providers, it is important to ask: what else can be done?
The challenge of addressing the mental health crisis in rural America is daunting, yet state and local leaders are not powerless. Community-based mental health training and education focuses on evidence-informed programs to equip non-clinical professionals and community members with basic tools for identifying, supporting, and referring individuals experiencing mental or behavioral health challenges.
The Mental Health Crisis Facing Rural America
There is a well-documented shortage of clinical mental health service providers in rural areas across the United States. According to recent data from the Health Resources and Services Administration (HRSA), more than 29 million rural Americans live in a designated Mental Health Professional Shortage Area, with rural regions making up over 60% of all HRSA-designated mental health shortage areas.2
When the numbers are broken down further, the situation is even more alarming. According to the Rural Health Research Center, 69% of rural counties lack a psychiatric mental health nurse practitioner, 45% have no psychologists, 22% have no licensed social workers, and 18% have no counselors.3
At the same time, rural residents are more vulnerable to mental health problems than many other groups. The Centers for Disease Control and Prevention (CDC) notes that:
Over the past two decades, suicide rates have been consistently higher in rural America than in urban areas.
Between 2000 and 2020, suicide rates increased 46% in non-metro areas compared to 27.3% in metro areas.
Rural residents have 1.5 times the rate of emergency department visits for nonfatal self-harm compared with urban residents.
Unfortunately, neither the increased need for mental health services nor the shortage of professional clinical providers is likely to change quickly.4
How Community-Based Mental and Behavioral Health Programs Work
While there is no single official definition of “community-based mental health training,” there is, in my experience, enough common usage to identify many of the core elements such as:
Promoting mental health,
Reducing stigma associated with mental health treatment and care,
Recognizing signs of distress or mental health conditions,
Providing basic, non-emergent, evidence-informed support, and
Facilitating referral to appropriate services when needed.
In terms of specific training and educational pathways there are many programs and courses to choose from. Many programs allow certified trainers to adapt content and delivery for different audiences, settings, or organizations. Programs can vary in intensity, and they may be delivered in person, remotely, or through hybrid formats.
One widely known example is Mental Health First Aid (MHFA), a full-day course taught by certified instructors. MHFA provides participants with the skills to recognize when someone may be experiencing mental health or substance use challenges and how to offer initial support until appropriate professional help can be accessed.5
Another commonly used model is Question, Persuade, Refer (QPR), a suicide prevention training that typically begins as a shorter 60–90-minute program but also includes more advanced courses. QPR teaches participants how to recognize warning signs of suicide, ask direct questions, and connect individuals to help.6
In addition, more specialized programs like de-escalation training can be especially valuable for employees who regularly interact with the public, including local government employees or nonprofit service providers.7
Community-based mental and behavioral health interventions will not, on their own, solve the mental health crisis facing many rural communities. However, these training and educational programs are important tools that can help address specific gaps. They offer several potential benefits for under-resourced rural regions:
They are often more accessible in terms of time and cost than interventions such as hiring an in-house clinician or expanding employee health benefits.
They can “prime the pump” by exposing more people to mental health concepts and potentially encouraging some to pursue formal education or careers in mental health. Over time, this may help ease provider shortages in rural areas.
They draw on extensive evidence showing that instruction for non-medical professionals to obtain basic skills such as general first aid, cardiopulmonary resuscitation (CPR), and the Heimlich maneuver can save lives and improve outcomes.8
The Importance of Local Adaptation, Continuous Improvement, and Program Evaluation
A key advantage of community-based mental and behavioral health training is that many programs can be tailored to the cultural and socio-demographic characteristics of a particular region, workplace, or organization. While community-based programs have existed for years, research has only recently begun to emphasize how important local adaptation can be for success.
During the COVID-19 pandemic, the limitations of public health programming in some rural areas were clear. One-size-fits-all guidance often failed to resonate, limiting effectiveness and producing a patchwork of compliance across the country. This experience underscored the need for culturally informed approaches, especially in a system where county health departments, state health agencies, and federal entities share overlapping responsibilities for public health. 9,10
For rural mental and behavioral health training, meaningful adaptations should potentially include:
Pre-training assessments: Conducting brief surveys or conversations to understand the needs, concerns, and goals of the organization and its employees.11
Attention to power dynamics: Designing sessions that recognize differences in authority within organizations, so staff at all levels feel safe participating openly and honestly.
Partnerships with trusted local advocates: Working with faith leaders, respected community champions, local elected officials, or extension educators to increase credibility and participation.12
Ongoing organizational follow-through: Integrating training into broader organizational planning, updating policies and procedures where appropriate, and creating locally relevant mental health toolkits, so the positive effects of training do not fade over time.
Collecting participant surveys before and after training sessions to measure changes in knowledge, confidence, and attitudes.
Potentially documenting how often trainees use new skills (e.g., initiating conversations, making referrals).
Tracking outcomes such as long-term employee retention and turnover, reductions in leave for mental health-related reasons, or documented improvements in employee performance.13
These assets support continuous improvement and help local leaders justify ongoing investments in training.
Building Capacity and Mental Health Resilience for Rural America
Community-based training and education may be particularly well-suited to rural areas for several reasons:
Rural communities are often insular and rely heavily on trusted local leaders, who can play a powerful role in normalizing conversations about mental health and promoting help-seeking behaviors.
Rural residents are accustomed to finding creative, local solutions to complex problems, often out of necessity. Community-based training builds on that strength by equipping local organizations and neighbors with practical skills.
Chronic underfunding and limited access to specialized services mean that rural communities must maximize the impact of every available resource. Training non-clinical staff and community members to recognize and respond to mental health challenges is a relatively low-cost way to expand basic support and strengthen referral pathways.14
Community-based mental and behavioral health training is not a substitute for building a robust mental health workforce and adequate clinical infrastructure in rural areas. However, in a policy environment where expanding clinical capacity is slow and uncertain, this strategy offers a promising pathway to rural resilience by empowering local organizations, reinforcing social/peer networks, and ensuring that when people struggle, someone nearby knows how to notice, listen, and connect them to help.
Work Cited
Association of Schools and Programs of Public Health. 2025. “Department of Education Proposal Excludes Public Health Degrees from ‘Professional Degree’ Definition.” November 12. https://aspph.org/department-of-education-proposal-excludes-public-health-degrees-from-professional-degree-definition/.
Health Resources and Services Administration. 2025. “Designated Health Professional Shortage Areas Statistics.” December 31. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport.
Rosencrans, Jessica. 2023. “Rural Health Research Recap.” Rural Health Research. https://www.ruralhealthresearch.org/assets/5373-24554/behavioral-health-workforce-recap.pdf.
Centers for Disease Control and Prevention. 2024. “Suicide in Rural America as a Public Health Issue.” Rural Health. May 14. https://www.cdc.gov/rural-health/php/public-health-strategy/suicide-in-rural-america-prevention-strategies.html.
Mental Health First Aid. 2025. “Home.” November 6. https://mentalhealthfirstaid.org/.
QPR Institute. 2019. “Practical and Proven Suicide Prevention Training.” https://qprinstitute.com/.
National De-Escalation Training Center. 2022. “Mission, Vision, & Origin”. https://ndtccenter.com/mission.
Yu, Yang, Qingtao Meng, Sonali Munot, Tu N. Nguyen, Julie Redfern, and Clara K. Chow. 2020. “Assessment of Community Interventions for Bystander Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest.” JAMA Network Open 3 ( 7): e209256. https://doi.org/10.1001/jamanetworkopen.2020.9256.
Dudley, Lilian, Ian Couper, Niluka Wijekoon Kannangarage, Sivapregasen Naidoo, Clara Rodríguez Ribas, Theadora Swift Koller, and Taryn Young. 2023. “COVID-19 Preparedness and Response in Rural and Remote Areas: A Scoping Review.” PLOS Global Public Health 3 (11): e0002602–2. https://doi.org/10.1371/journal.pgph.0002602.
Chutiyami, Muhammad, Natalie Cutler, Sopin Sangon, Tusana Thaweekoon, Patcharin Nintachan, Wilai Napa, Phachongchit Kraithaworn, and Jo River. 2025. “Community-Engaged Mental Health and Wellbeing Initiatives in Under-Resourced Settings: A Scoping Review of Primary Studies.” Journal of Primary Care & Community Health. https://doi.org/10.1177/21501319251332723.
Eiraldi, Ricardo, Barry L. McCurdy, Muniya S. Khanna, Jessica Goldstein, Rachel Comly, Jennifer Francisco, Laura E. Rutherford, et al. 2022. “Development and Evaluation of a Remote Training Strategy for the Implementation of Mental Health Evidence-Based Practices in Rural Schools: Pilot Study Protocol.” Pilot and Feasibility Studies 8 (1): 128. https://doi.org/10.1186/s40814-022-01082-4.
Rural Minds. n.d. “Rural Health Includes Mental Health.” https://www.ruralminds.org/rural-health-includes-mental-health.
Joly, Brenda Morissette, Martha Elbaum Williamson, Kimberly Pukstas Bernard, Prashant Mittal, and Jennifer Pratt. 2011. “Evaluating Community Outreach Efforts: A Framework and Approach Based on a National Mental Health Demonstration Project.” Journal of MultiDisciplinary Evaluation 8 (17): 46–56. https://doi.org/10.56645/jmde.v8i17.327.
Sosin, Anne N., and Elizabeth A. Carpenter-Song. 2024. “Reimagining Rural Health Equity: Understanding Disparities and Orienting Policy, Practice, and Research in Rural America.” Health Affairs 43 (6): 791–97. https://doi.org/10.1377/hlthaff.2024.00036.
