Older Coloradans who live in the state’s rural counties are facing increasing mental health challenges coupled with limited access to mental health care. The Colorado Rural Health Center (CRHC) states that the pressures of agricultural work, the isolation of rural living, financial strains, instability in the commodities market, and even the negative impacts of climate change are all conditions that can weigh on rural elders. The Center estimates 1 in 5 rural Coloradans experience depression due to factors such as these.
CRHC describes 17 of the state’s counties as urban, 24 as rural, and 23 as “frontier” (meaning they have noticeably low population density.) Among Colorado’s rural population of roughly 720,000, 22% are age 65 and older. By contrast, adults age 65+ account for only 17% of all urban dwellers.
Knowing about Resources Coloradans Can Tap Is Crucial
As part of what’s called the Senior Access Points project, Colorado State University (CSU) teamed up with community partners in an effort to better understand the challenges and needs of aging in rural areas. CSU noted that whether individuals move to a remote area upon retirement, or whether they have lived there for decades, “the experiences of rural aging are complex and multifaceted.” While there are pluses such as living amidst natural beauty and a sense of independent and productive living in cooperation with the land, “rural aging comes with a host of challenges.” Among these, CSU listed lack of medical services; infrastructure needs regarding transportation and internet connectivity; affordable, safe, and manageable housing; and an increased risk of social isolation.
CSU goes on to say that being able to access appropriate supports and resources can make the difference in whether someone can safely remain in their rural home or not. But research finds most people do not plan ahead for the care needs they might face. CSU says families can prepare better by learning what aging-related resources exist — i.e., programs, services, technologies, agencies, and professionals that can assist with changing needs and challenges — and also by addressing the tendency in rural areas to underutilize aging-related resources despite documented higher rates of chronic illness and daily care needs among rural elders. CSU says various resources available can support practical needs (e.g., daily activities such as bathing and dressing); emotional needs (such as stress reduction, comfort and reassurance, companionship, and connection); and family needs (caregiver support and information, family communication and involvement). Each of these, of course, can affect one’s mental health.
Shortage of Mental Health Practitioners, Stigma Affect Getting Help for Rural Coloradans
Colorado as a whole has sometimes been referred to as a “mental health desert.” Which is generally taken to mean demand for services far outpaces supply. The state has taken steps to address this, but the “desert” conditions are particularly evident in rural areas. There are simply fewer mental health facilities in rural Colorado, and it’s more difficult to persuade a mental health practitioner to give up the amenities of city living and locate in a town without those benefits. According to CRHC, there is 1 mental health provider for every 1,282 residents in rural Colorado, while there is 1 for every 755 residents in urban areas.
But a behavioral health specialist in a CSU-affiliated project designed to provide information and services to farmers, ranchers and other ag workers has been quoted as saying even if mental health providers were available in rural areas, residents in many cases would be wary of seeking help for fear of being judged. The close-knit nature of rural living means everyone often knows everyone else’s business, and there is a “go-it-alone” mentality instilled in rural settings more so than in other locales.
This individual reluctance to seek mental health support may be alleviated somewhat by access to telehealth, which can be done from one’s home with greater privacy. Telehealth might also be able to accommodate the rural resident’s personal schedule, which can be quite variable, especially if that person is still actively farming or ranching. At the same time, telehealth could potentially fill at least some of the gap in not having enough mental health providers available for in-person consultation and service. (More on this shortly.)
Here again, however, the rural setting has its own drawback in that lack of broadband access is a significant issue. More than a dozen Colorado counties have reported that close to a quarter of their population lack at-home internet service. Policymakers in the state legislature this year did establish a Cell Phone Connectivity Interim Study Committee, which will focus on addressing internet connectivity gaps in rural Colorado.
Examples of Mental Health Support Sources for Older Rural Coloradans
There are indeed a number of challenges to getting mental health care in rural Colorado for older adults who need it. But there are also sources of support available. Here are some key ones:
Area Agencies on Aging. A good place to start exploring available support services is the Area Agency on Aging serving your particular region. AAAs typically contract with local service providers to deliver a menu of direct aging services, such as meals, transportation, and in-home services. Some AAAs also provide information and referrals for case management, benefits/health insurance counseling, mental health professionals, and family caregiver support programs. Learn more about AAAs here. Colorado’s AAAs are AgeWise Colorado Providers, and you can link to specific AAAs here.
Telehealth. As mentioned above, telehealth may be an option for some rural Coloradans. The Colorado Agricultural Addiction and Mental Health Program (CAAMHP) provides residents in rural communities six free therapy sessions with “an ag friendly, licensed behavioral health professional.” CAAMHP says it is anonymous and can be accessed remotely in many cases. It can be a really hard time to be in agriculture right now, CAAMHP says, but “we are here to help; you don’t have to go it alone.” There is a voucher request form for therapy sessions on the (CAAMHP) website.
Federally Qualified Health Centers. Federally qualified health centers (FQHCs) are community-based organizations that provide comprehensive primary care and preventive care, including mental health/substance abuse services, to persons of all ages, regardless of their ability to pay or health insurance status. FQHCs receive grants under Section 330 of the Public Service Act. To receive enhanced reimbursements from Medicare and Medicaid, FQHCs must serve an underserved area or population (which may be located in a rural or urban area), offer a sliding fee scale, provide comprehensive services, and have an ongoing quality assurance program. FQHCs can devote up to 49% of their services to mental health care. Click here to look for FQHCs in Colorado by city locations.
Colorado Farm Bureau Foundation. The Colorado Farm Bureau Foundation says it exists to strengthen agriculture and rural communities through funds that support educational programming, farm safety training and resources, disaster relief, and rural health initiatives. In May of 2024 the Bureau, in conjunction with Mental Health Awareness Month, launched the Good Neighbor Project for the third consecutive year. The Bureau states: “The Good Neighbor Project, a vital initiative in our ongoing efforts to address mental health in rural communities, was created to foster connections. The data underscores the urgency of our mission, with suicide and mental health diagnoses disproportionately affecting rural and agricultural communities. We aim to remind people that a simple act of kindness . . . can make a world of difference, letting them know they’re not alone and that someone cares.” Farm Bureau members were to receive postcards through the month of May with resources, including the Colorado Agricultural Addiction and Mental Health Program (CAAMHP) and Colorado Crisis Services.
Colorado Crisis Services. Although not targeted specifically to rural concerns, Colorado Crisis Services (CSS) provides free, confidential and immediate support from trained professionals and peer specialists. Service is available 24/7/365 by calling 844-493-TALK (8255), or texting TALK to 38255. Colorado residents can also seek services in-person at CSS walk-in centers, regardless of ability to pay. CSS says, “If you don’t know where to begin getting help with a mental health, substance use or emotional concern — for you, or for someone you know — start here.” Full details available at Colorado Crisis Services. CSS is an AgeWise Colorado Provider.
Colorado Office of Behavioral Health. The Behavioral Health Administration (BHA) in the Office of Behavioral Health is responsible for ensuring all people in Colorado have access to quality mental health and substance use disorder services, regardless of where they live or their ability to pay. The Behavioral Health Office states that it aims to continuously improve access to, and quality of, affordable care and reduce stigma “so that the people of Colorado feel confident and comfortable seeking support and/or treatment for their mental health and substance use disorder.” BHA also strives to provide ways to find care that are free and confidential and to recruit and retain the workforce to support the people of Colorado.BHA defines behavioral health issues to include substance use disorders, mental health disorders, serious psychological distress, serious mental disturbance, and suicide. Issues can range from unhealthy stress or subclinical conditions to diagnosable and treatable diseases. Learn more about BHA and how to access its services here.
(Footnote: In the 2024 Colorado legislative session, Senate Bill 55 created a specific agricultural and rural community behavioral health program in the BHA. The bill directs the BHA to identify a specific staff person to serve as a liaison between the BHA, the Department of Agriculture, behavioral health-care providers, rural community leaders, agricultural communities, and nonprofit organizations that serve agricultural communities. The Senate bill states this new program shall do statewide community outreach to educate communities on behavioral health issues facing farmers, ranchers, other agricultural industry workers, their families, and rural communities and develop an understanding of and address the root causes of behavioral health issues in the agricultural industry and in rural communities. A practice work group will bring together leaders and experts in agriculture and behavioral health care “to improve access to behavioral health care for those involved in agriculture and their families.” The group is expected to begin its work by the end of the year.)
Information on Additional Support Services. You can read additional information on mental health support services for older Coloradans in our AgeWise Colorado article here.
