Stressors Challenge Teen Mental Health but Solutions Exist

Growing Pains

Kristin Ward (back) has made mental health care a priority for her two teens, Kasey and Jack. (Joel Reichenberger)

Kristin Ward is making both a financial and a time investment in the mental health of her teens. When she moved her son, Jack, and daughter, Kasey, from Montana to rural Palisade, Nebraska, in late August 2023, both teens needed post-trauma therapy.

The single mom has been loading them up in the car and traveling 32 miles to the regional hub of McCook once a week to meet with their therapists. "We spend an hour on the road, an hour in the therapist's office and then usually need to stop for a meal in town. By the time we get home, half of the school day is gone," she explains. Besides the time commitment, fuel, meals and the cost of the sessions put a financial burden on her family.

"It's a good thing I believe in the power of mental health," Ward says, mentioning that her own past struggles keep her focused on providing the option for her kids.

Ward is just one of the thousands of parents across rural America doing everything in their power to help their kids survive the growing pains of adolescence and young adulthood. It can sometimes be a daunting task with the many unique challenges and stressors facing rural youth.


The statistics on rural teen mental health are somewhat staggering. According to a five-year study financed by the National Children's Center for Rural and Agricultural Health and Safety, about 60% of farmers and their adolescent children met the criteria for at least mild depression, while 55% of the adults and 45% of the adolescents surveyed met the criteria for generalized anxiety disorder. To contrast, the prevalence of depression in the general population is typically 17 to 18%, showing an alarming mental health issue in rural Americans.

Ward's regular trips down the highway are a choice she's made with those statistics in mind and because her kids prefer to meet with their therapists in person rather than through other options such as telehealth. Video conferencing has made mental health care more accessible for rural Americans than ever before -- opening pathways to mental health care that didn't exist before the pandemic altered the way people communicate.

Just 45 miles down the highway in Benkelman -- a farm community of just over 800 population, situated in the pocket where the Nebraska prairie connects to both Kansas and Colorado -- Dundy County Hospital (DCH) scored a big win recently by bringing in its second mental health practitioner.

Having two mental health therapists on staff is a rarity for a town its size, and this reality isn't lost on the hospital's CEO, Kris Mathews. "We got lucky when the first one moved to town because she married a local, and we lucked out again here recently," Mathews says, emphasizing that having just one therapist on staff is more than most hospitals Dundy County's size can boast.

Renee Ruhlman, who was the first therapist on staff at the hospital system, says the advent of telehealth has allowed more rural families access to therapy than ever before. She and Christy Freehling, a therapist who just moved to town from the state's capital city of Lincoln, see so many factors at play in the mental health of teens across the United States -- social media, addiction, current events, poverty and family issues such as divorce -- but also pointed out challenges exclusive to rural teens.

"What I've seen with my teen clients is that their anxiety is because sometimes they're pressured into doing more activities because there's not as many kids. Their involvement, sometimes overinvolvement, is crucial," Ruhlman explains. "On top of that, they're working long hours on the farm after practices and then finishing up homework late at night."

Freehling agrees. "There are high expectations in a small community to be involved in everything," she adds. "With all the demands on their time, it's like kids don't have time for themselves to just breathe."

Jenna Gibbs sees the same issues in her work with youth ages 16 to 25 across the Midwest through the Ag Health and Safety Alliance, in Iowa City, Iowa. She says students are often surprised when they meet with her for an agricultural safety discussion, and she begins a section on mental health. She says most data on mental health in rural areas focuses on older farmers.

The largest stressor in the older set is financial, but Gibbs says rural youth seem to be sheltered from most discussions about farm finances.

"Their biggest source of stress has nothing to do with finances. It's mostly time management that they struggle with," she explains. Gibbs spends a large portion of her time on college campuses with ag students. In Speed vs. Safety assessments she administers to the students, she sees many of them making the decision to cut corners on safety because of the burdensome demands on their time.

"These students are in college classes, working on the family farm and often also working on the school farm. There's pressure from all sides to make sure all the work gets done on time, and that causes anxiety," Gibbs says, explaining that on the assessments, students are averaging a dangerously low score of just 32 out of 100 points, where 100 points indicates total commitment to safety and zero points a complete lack of safety.

That average score shows Gibbs the students are often forced to prioritize speed as they complete their work, sacrificing safety in the process. "The great news is that they're interested in changing that culture, and they're also very open to discussions about their mental health," she emphasizes, noting that ag students are using the mental health services available at their colleges at a higher rate than before.

Gibbs also highlights the importance of sleep and explains that many of the students she works with aren't getting the sleep required for their development. "They're working long hours, trying to have social lives, and that doesn't allow them the 10 hours of sleep they need every night," she says.

Roz Sheldon, a therapist at Elevate Counseling, in Kearney, Nebraska, agrees. With a population of some 34,000, Kearney isn't necessarily considered rural. However, Sheldon works with youth from the smaller communities in the area. She views their constant mobile phone access as a concern.

"Kids have access to information that exceeds developmental capacity and understanding," she explains. "Now, they go home and have equal exposure to peers and outside influences as they do in the school setting. There is no reprieve unless parents enforce a distance from distraction and outside influences."

Her biggest concern, however, is that the need for mental health care exceeds the number of practitioners available to provide it. According to Health Resources and Services Administration data from late 2021, there were 3,426 rural areas in the United States designated with shortages of mental health practitioners, and it would take approximately 1,597 practitioners nationwide to remedy the shortage.

"Personally, the biggest concern is providing the services for the number of individuals seeking help," Sheldon says. "At our clinic, we're unable to accommodate the numbers. And, I have individuals who have driven from other time zones and for several hours to receive services. But, our biggest obstacle is overcoming stigma and helping people understand that mental health care is a component of overall wellness."

Stigma can be a factor surrounding mental health in small communities, but Gibbs doesn't worry about that as much when the next generation of farmers begins ag careers. "Sure, there might be some people asking why your truck is parked in front of the therapist's office in town. We know how small towns can be," she says. "But, telehealth offers privacy in seeking mental health. If you have a Wi-Fi connection, you can seek treatment privately."

Gibbs also sees that stigma breaking down. "The time is now to change that, and the students I work with are ready for a change. There's a shifting dynamic," she adds.

Tracy Lungrin, at Wayne State College in Nebraska, also sees residual stigma as repairable. "There's a lack of awareness and exposure to folks talking about and normalizing mental health care," she says. "Intervention to youth who are showing symptoms of mental health concerns and one-on-one and group support would help. And, educating the family and teaching them how to provide a more supportive environment to discuss mental health needs to happen."

For Ward, she'll continue to make the trips to McCook with her kids. "It's important to us," she says. "So, we prioritize it."


Knowing what to look for in teenagers is key to providing them with the help they need. The following are common signs that your teen may be having mental health issues:

-- Mood swings

-- Irritability and anger

-- Tearfulness

-- Changes in sleep, weight or eating habits

-- Loss of interest in things they love

-- Withdrawing from friends, family and community

-- Canceling plans with close friends

-- Abnormal academic struggles

-- Running thoughts or worries that won't subside

-- Signs of drug, alcohol or other substance abuse

-- Signs of self-harm

-- Refusing to discuss what's bothering them

-- Obsessive behaviors


-- If your teen, you, or anyone you know is in crisis, please contact the 988 Suicide and Crisis Lifeline. Call or text 988. Chat at…


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