Rural Psychology and Integrated Care

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Rural Psychology and Integrated Care


As anyone living in rural North Dakota can attest to, stress is not an attribute unique to urban areas. The day-to-day struggles that cause anxiety--paying bills, taking care of a family, maintaining relationships--all of these situations are just as challenging in a rural place, often more so due to a lack of rural mental health supports.

In 2010 the UND Rural Psychology in Integrated Care (RPIC) program, led by Cindy Juntunen, has secured a three-year grant worth more than $500,000 that will be used to prepare new psychologists, substance abuse counselors, and nurses to address rural mental and behavioral health needs. The grant funding, from the Graduate Psychology Education Program: Workforce Training to Improve Access to Mental Health Services program, will be used to train UND students to serve as a part of integrated health care teams in rural communities.

More than 3,480 U.S. communities have mental health care shortages, impacting about 84 million people nationwide, according to recent statistics. In North Dakota, nearly 90 percent of counties — home to 40 percent of state citizens — have shortages in mental health services. Responding to this need, the Counseling Department in the College of Education and Human Development at UND has worked to provide services for clients for whom the drive to Grand Forks might otherwise preclude them.

Some Accomplishments Over the First Year

The RPIC group has started a research team whose members are focusing on the stigma related to mental health in rural areas, and the barriers that individuals in rural areas feel in regard to seeking mental health services.

The RPIC group is also sponsoring an outreach program in collaboration with several mental health care providers to promote mental health awareness. This project includes advertising and public service announcement opportunities for the mental health care providers at the local auto races.

The team provides knowledge, skill, and ability experiences to the trainees in the program in order to better prepare them for clinical work in rural areas. The RPIC trainees will complete practicum placements at rural healthcare sites in order to experience what it is like to be a therapist working in a rural location in integrated healthcare settings. There is currently one trainee who has been providing mental health services in a rural community in North Dakota over the past year. The outreach work of this trainee has been featured in the Grand Forks Herald and the Walsh County Press.

Factors that Influence Mental Health Service Utilization in Rural Areas

  • Acceptability, accessibility, and availability, and an understanding of mental health issues are four considerations that influence mental health service utilization in rural areas.
  • In rural America, self-sufficiency and self-reliance, including solving one’s own problems, is valued (Human & Wasem, 1991).
  • Murray and Keller (1991) report that one of the most significant barriers to the delivery of all forms of social service in rural settings is geography.
  • Although concerns with service utilization and factors that influence it are not unique to rural settings, psychologists working in rural communities must be willing to address the negative stereotypes about psychology that hinder service utilization (Thorngren, 2003) and work to gain knowledge of and acceptance of unique rural issues.

Why Does Mental Healthcare in Rural Areas Matter?

Rural communities are complex, interrelated systems of informal and formal political and social units. Relationships among community members are interdependent, complex, and have deep historical, social, political, and familial roots (Helbok, 2003).

Compared with urban areas, people from rural areas have traditionally lower educational attainment, less access to higher formal education, lower family income, and smaller percentages of people in the labor force (Murray & Keller, 1991).

Rural communities tend to have more scarce resources, elevated rates of poverty, less access to employment, higher illiteracy rates, inadequate health services, limited insurance coverage, and higher rates of disabilities as compared to urban residents and areas (Harowski et al., 2006).

Beyond issues such as high rates of alcohol abuse, chronic illnesses, disabilities, poverty and financial strain, and lack of access to insurance, people residing in rural communities are exposed to a wide array of stressful life events, different from that of their urban counterparts, many of which are unpredictable and out of their control (Helbok, 2003; Cellucci & Vik, 2001).

Rural residents deal with things such as weather that is not conducive to crop production, natural disasters, and farm crises (Helbok, 2003; Cellucci & Vik, 2001).

Community members in rural areas often have multiple roles and have been found to possess unique attitudes and beliefs, characterized by more prejudice, less acceptance of deviance, more isolation and ethnocentrism, and a stronger work ethic (Wagenfield, 2001; McSparron, 2002).

Differences on the whole are found in attitudes, beliefs, ways of communicating, and work ethic; these differences in characteristics differentially impact the mental health of people residing in rural areas. Thus, it is important for psychologists who plan to or do practice in rural communities to understand how these cultural differences may play out in a therapeutic setting in rural areas.

Ways to Learn More

Prospective Students

  • Students who want to learn more about rural psychology and integrated care or who are interested in applying to the Rural Psychology and Integrated Care program can contact Cindy Juntunen at (701) 777-3740

Healthcare Providers

  • Healthcare providers who want to be involved in the River City Speedway sponsorship opportunity can contact Erin Martin.
  • Healthcare providers who want more information on our Rural Psychology and Integrated Care or who want to get involved in the training process can contact Cindy Juntunen at (701) 777-3740


The Department of Counseling Psychology and Community Services has developed an emphasis in Rural Psychology and Integrated Care (RPIC). The Rural Psychology and Integrated Care program seeks to offer courses and training specifically tailored to rural psychology and integrated health care settings. Specifically our objectives are to:

  • Prepare new psychologists, substance abuse counselors, and nurses to address rural mental and behavioral health needs as part of Integrated Health Care (IHC) teams.
  • Prepare new psychologists, substance abuse counselors, and nurses to work effectively as mental and behavioral health care providers in the context of rural culture.
  • Maximize the impact of RPIC in a rural service area by providing continuing education workshops to practicing professionals and other participants.
  • Develop and disseminate public education materials to decrease the stigma associated with mental health care in rural communities.
  • Demonstrate effectiveness of RPIC training through programmatic evaluation activities, including multiple raters and rating tools.
  • Increase awareness of rural mental and behavioral health concerns, as well as strategies for addressing these concerns, through disseminating project outcomes and related research.

Course Offering Opportunities

• The RPIC group is offering a course this summer called Integrated Healthcare for Underserved Populations (COUN 565A) which would be beneficial for all professionals in training who could be working in a mental health care role in integrated health care settings. For more information contact Christine Boulton-Olson

• The RPIC group will be offering a course in the fall of 2011 called Behavioral Health in a Rural Context. Some topics that will be covered in the course are rural culture, help-seeking attitudes, and critical care in isolated settings.

Rural Psychology in Integrated Care Personnel

Grant Personnel

Cindy Juntunen, PhD, Primary InvestigatorChristine Boulton-Olson, PhD, Co-Primary Investigator, Project Director o Rachel L. Navarro, PhD, Coordinating Faculty

Trainees Thomas Roskos, M.A. Erin Martin, M.A. Kipp Pietrantonio, M.A. Sinead Unsworth, B.A.

Program Consultants Michael Tilus, PhDJacqueline Gray, PhD

Graduate Research Assistants Shawn WhitingCrystal Rofkahr Stigma Reduction Research Group Led by Rachel L. NavarroAstrid DcunhaLauren FullerLindsay KujawaErin MartinTheresa TomsyckErlend WeiseShawn Whiting Collaborative Partners Park River First Care Health CareNorthwood Deaconess Health CenterLarimore Valley Community Health Centers Osnabrock and Park River Good Samaritan Centers


Cellucci, T., & Vik, P. (2001). Training for substance abuse treatment among psychologists in a rural state. Professional Psychology: Research and Practice, 32, 248-252.

Harowski, K., Turner, A.L., LeVine, E., Schank, J., & Leichter, J. (2006). From our community to yours: Rural best perspectives of psychology practice, training, and advocacy. Professional Psychology: Research and Practice, 37, 158-164.

Helbok, C.M. (2003). The practice of psychology in rural communities: Potential ethical dilemmas. Ethics and Behavior, 13, 367-384.

Human, J., & Wasem C. (1991). Rural mental health in America. American Psychologist, 46, 232-239.

McSparron, W.J. (2002). Depression and help-seeking behavior or North Dakota farmers: The impact of the farm crisis. Unpublished doctoral dissertation, University of North Dakota, North Dakota.

Murray, J.D., & Keller, P.A. (1991). Psychology and rural America: current status and furture directions. The American Pychologist, 46, 220-230.

Thorngren, J.M. (2003). Rural mental health: A qualitative inquiry. Journal of Rural Community Psychology, E6(2).

Wagenfield, M.O. (2001). A snapshot of rural and frontier America. In Stamm, B.H. (Ed.) Rural Behavioral health care: An interdisciplinary guide. (pp. 33-40) Washington, D.C.: American Psychological Association.

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