Rural attitudes toward those with mental health illnesses are changing, researchers say, and it's mostly along generational lines.

New research from the Rural Health Equity Research Centers at East Tennessee State University finds that rural residents are less likely to have negative attitudes toward those with mental health illnesses than previously thought. Prior studies had found that there was more of a stigma around mental illness in rural communities.

According to researchers Kate Beatty and Michel Meit, previous studies found that perceived prejudice against rural residents with mental health concerns not only reduced treatment but that rural residents felt that treatment wouldn’t work. For instance, a study of Appalachian parents of children with mental health concerns in 2015 found that 28% of parents worried about others finding out their child was being treated for a mental illness, compared to 22% of parents in urban areas. Another study that same year found that older rural residents have higher levels of public and self-stigma than older adults in urban areas.

In interviews with the Deesmealz, Beatty and Meit said those attitudes toward mental illness, mental illness treatments and whether treatment helped improve mental health no longer fit that perception.

“What we found actually, compared to the original studies that look at stigma in terms of recovery and outcomes and negative stereotypes, is that compared to the original studies, there are lower negative stereotypes and higher opinions around the ability to have recovery and have positive outcomes than there was a decade ago,” Beatty says. “In general, I think there are these trends that are happening nationally and globally around stigma toward mental illness.”

Researchers asked more than 2,000 people in both rural and urban areas about their views on mental illness, mental illness treatment and whether or not treatment could result in positive outcomes. The responses indicated that respondents were fairly neutral in their attitudes toward mental illness and that they were fairly positive about an individual's ability to recover from any mental illness.

Researchers found that rural respondents did not differ significantly from urban respondents when it came to negative stereotypes toward mental illness. Only one of the four negative stereotype items (“I believe a person with mental illness is hard to talk with”) scored significantly higher for rural residents.

“Once you control for age and race, there's no more stigma about mental illness (in rural communities than in urban ones),” Meit said. “I believe that there are stigmas against people who live in rural areas – that people have negative views about people who are rural. What I love about this study is that we're showing they are really no more biased than anyone else. To me, that's a positive.”

Within different demographics, however, some subcategories had more negative views of mental illness than others. Black rural residents and older rural residents were more likely to view mental illness with negative stereotypes.

The study found that rural residents between the ages of 18 and 29 had the lowest scores on negative stereotypes, while respondents 60 and older had the highest. Older rural residents were more likely to believe that an individual with a mental illness was a danger to others, was unpredictable, and was hard to talk to. Black and Hispanic rural residents were more likely than their white counterparts to believe those same stereotypes, the researchers found.

One reason for this may be changes in the way mental illness is perceived - not only in pop culture, but also through outreach. Recently, celebrities like Megan Thee Stallion, Prince Harry and Meghan Markle, Selena Gomez, and Michael Phelps have spoken out about their struggles with mental health. These cultural touchstones for younger populations – both rural and urban — may be changing the way people view mental illness.

“One powerful destigmatizing strategy is awareness,” Beatty said. “The more people talk about and normalize mental illness the less stigmatized folks will be.”

Using the information in the study will help the field do more to eliminate stereotypes that can prevent individuals from accessing the care they need.

This can be done “using similar techniques—celebrities and trusted peers normalizing mental health in older adults could have a positive impact,” Beatty said. “It is a bigger lift, I would imagine, to change this in older adults due to the lifetime of negative stereotypes toward mental illness.”

Now, Meit said, more than ever is an important time to find ways to help individuals access mental health treatment.

“The timeliness of this topic is really important because we are facing a huge mental health crisis in the United States right now that has been exacerbated by Covid-19,” he said. “So I think knowing that there is (no higher amount of) stigma in rural areas, and that there is an openness and willingness in rural areas to address these issues, is important and timely. But you can only take that so far... We need more access to treatment services for mental illness in our rural communities as well.”

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