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Bringing improved health and care to rural America

January 17, 2014
by Ron Manderscheid, PhD
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We must recognize the importance of the “tweeners” and address their needs through the ACA.

Many Americans, including some federal officials, seem to think that the United States consists of the east coast and the west coast linked by a flight on United Airlines. Nothing could be more removed from our actual reality. A huge part of our cultural traditions, our work ethic, our food, our fuel, and our technology comes from those “tweeners” who live in the rural areas connecting our coasts. Fully 25% of our population and 90% of our land mass are rural. Thus, rural issues must be an essential part of our national agenda.

To help accomplish this mission, we are very pleased to announce that the National Association for Rural Mental Health (NARMH) has joined us as a close affiliate on January 1 of this year. NARMH members now will have all of the benefits of NACBHDD membership, and NACBHDD members will have all of the benefits of NARMH membership. We do intend to work very closely together on behavioral health and ID/DD issues that affect our rural and urban populations.

A critical issue for us in 2014 is to assure that our rural populations do not become the backwater of the Affordable Care Act (ACA).  Our rural areas have more poverty than urban areas and thus have populations with higher rates of disability, including mental health, substance use, and intellectual disability/developmental disability (ID/DD) conditions.  They also have larger percentages of elderly persons with unmet health needs.

What actions can we take to assure that our rural areas participate fully in the implementation of the ACA? Much like Franklin Roosevelt brought electricity to our farms and rural communities in the 1930s, we must bring the ACA today. Here is our short list of some important next steps:

  • For every ACA activity, we must ask whether and how it is being implemented for our rural populations. Key issues for attention right now are promoting health insurance enrollment and appropriate care access.
  • We must design and implement new community collaboratives that extend needed health and associated social services into our rural communities.
  • Where no services exist, we must implement technology solutions that extend behavioral health and ID/DD services into rural areas through telemedicine and the internet.
  • We must encourage and train rural residents to become community health workers who understand behavioral and ID/DD conditions, and who know what actions to take when they encounter rural residents with these conditions. Wherever possible, our peer supporters should be trained for these roles.
  •  We must work with the local infrastructure already in place in our rural areas, such as the USDA County Extension Agents and their programs, so that duplicative infrastructure is not developed. For example, we must ask whether County Extension Agents can help us to enroll uninsured rural residents in health insurance.

Obviously, this list is intended to be suggestive rather than exhaustive. We will work together to refine it.

I invite you to work with us as we seek to implement better behavioral health and ID/DD care in rural areas, and as we seek to improve the health of our rural populations. The “tweeners” are exceptionally important for all of us!



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid



Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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