Like all US programs of that era, the rural healthcare system de-emphasized mental health. The clinics can opt to hire psychologists or clinical social workers, but are not required to do so. Through 2013, Medicare beneficiaries even pay a larger copay for mental health care.
How can we change the experience of mental illness in rural America? One possibility is to try a Chinese healthcare innovation – the itinerant rural healthcare worker, known until the early 1980s as the barefoot doctor.
Starting in the late 1950s, the Chinese sent thousands of health workers into the countryside trained to deliver preventative medicine, speak about hygiene, and treat common chronic illnesses. When health workers encountered more complicated medical situations, they referred people to more formal facilities. The effort improved Chinese rural health significantly. Variations on this strategy are used throughout the world today.
There is no reason why this strategy could not work for mental health. Most mental health issues are not so complicated. Health workers could deliver basic education, start support and self-help groups in schools and churches, create linkages for more formal services, and even work out suicide prevention protocols with healthcare and law enforcement. These low-cost efforts can help preserve the health of people in rural communities, and preserve economic capacity put at risk when people cannot access the basic help they need.
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