While accessing mental health care is a challenge nationwide, rural Americans face especially steep barriers, resulting in worse mental health outcomes than their urban counterparts, including higher rates of depression, anxiety, suicide, and substance use.

To help address the lack of mental health care services available in rural communities, some congregations offer a range of services, including counseling, classes, support groups, workshops, and structured discussions. A new study from the University of Minnesota School of Public Health (SPH) explores the extent to which these services are helping to meet the critical need for mental health care services in communities across the country.

To conduct the study, researchers analyzed data from 1,262 congregations (which include churches, synagogues, mosques, and other local places of worship) located in urban, suburban, and rural communities nationwide. Using data from the 2018–2019 National Congregations Study, they looked at which congregations offered mental or behavioral health programming, including support groups for substance use and mental illness, and examined how factors such as location, congregation size, theology, and community engagement shaped each congregation’s offerings.

The findings, published in the Journal of Religion and Health, included:

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  The size of the congregation matters. Urban and suburban congregations with more than 500 members were over three times more likely to offer mental and behavioral health programming compared to smaller congregations.

• Civic and social engagement was linked to mental health services. Congregations that organized voter registration drives or held discussions on science, religion, or social issues were significantly more likely to provide mental health support.
• Rural churches face unique barriers that urban and suburban congregations did not. Concerns about confidentiality in small communities, fewer financial and staffing resources, and higher stigma around mental health challenges tended to discourage some rural congregations from offering programs. Due to these and other factors, rural congregations were overall less likely than urban and suburban ones to provide mental or behavioral health programming.
• The prosperity gospel plays a role.  Both rural and urban congregations that followed the prosperity gospel (a Christian belief that emphasizes personal success and good health among its followers) were more likely to offer mental and behavioral health programs.

“Faith-based communities are often the first place people turn when they’re struggling, especially in areas where mental health care is scarce,” said CeRon Ford, SPH PhD Candidate and lead author. “While rural churches are often trusted and accessible community anchors, many rural congregations remain under-equipped and less able to offer a range of mental health support services to their congregants. Policy makers should explore programs that support greater access to mental health care services, especially in rural areas where people have fewer healthcare options. ”

The study calls for further research into the quality and effectiveness of mental and behavioral health programming offered by congregations.