To the Editor
The coronavirus disease 2019 (COVID-19) pandemic will have major implications on the mental health of children and adolescents. To address gaps in mental health care associated with COVID-19, Golberstein et al1 propose technology-enabled modalities, such as telehealth (ie, telemental health), as a potential solution.1 While acknowledging that some schools and families may lack access to technology to support telehealth and remarking that existing inequities must not be worsened,1 the authors missed an opportunity to note that in rural areas, where youth mental health needs are arguably most profound, limited broadband accessibility may preclude use of telehealth services entirely.
In rural areas, increases in suicides among children aged 10 to 19 years outpaced those of urban youths by 1.5 times between 2010 and 2018, exacerbating an existing disparity for youths with limited access to mental health clinicians. Ergo, the potential consequences social distancing may have on rural youths, particularly those with preexisting mental health difficulties, have generated concern. Rural youths have less access to technologies that many hope will temper the effects of isolation from friends and social networks. What if technology is not a viable option for mitigating youth mental health challenges posed by COVID-19?
Schools recognize that internet accessibility is critical to provide education continuity amidst school closures during the COVID-19 pandemic.2 However, short of providing tablets and devices to families, there is little schools can do. Internet providers in some areas have reduced service fees, but costs may remain a barrier in a time of economic crisis. Moreover, in many rural areas, broadband speed necessary for telehealth is simply not available. Rural broadband infrastructure is sorely needed.3 The health care/mental health community must be aware of disparities in mental health clinician access for rural youths, higher rates of suicide in rural areas, and the reality that telehealth may not be a realistic option for rural communities.
Technology-enabled modalities, such as telehealth, have often been cited as the sole tool to circumvent COVID-19–related restrictions to accessing mental health clinicians, without acknowledgment of the inadvertent ways that such interventions may actually exacerbate existing inequalities. Galea et al4 suggested communities train nontraditional groups to offer psychological first aid and build community connectivity while maintaining social distancing. Others have provided considerations for suicide prevention tailored to rural communities during the COVID-19 pandemic.5 To reach youths in rural communities, creative approaches must be used until state and federal policies address the need for improved broadband infrastructure necessary to make telehealth a reality.3
Footnotes
Conflict of Interest Disclosures: Dr Graves reported support received from the Health Equity Research Center, a strategic research initiative of Washington State University. Dr Abshire reported grants from National Institute on Minority Health and Health Disparities. No other disclosures were reported.
Contributor Information
Janessa M. Graves, College of Nursing, Washington State University, Spokane.
Jessica L. Mackelprang, Swinburne University of Technology, School of Health Sciences, Melbourne, Victoria, Australia.
Demetrius A. Abshire, College of Nursing, University of South Carolina, Columbia.
References
- 1.Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents. JAMA Pediatr. 2020;174(9):819–820. doi: 10.1001/jamapediatrics.2020.1456 [DOI] [PubMed] [Google Scholar]
- 2.Sen A, Tucker CE. Social distancing and school closures: documenting disparity in internet access among school children. Published April 26, 2020. Accessed October 21, 2020. https://ssrn.com/abstract=3572922
- 3.Ford S, Buscemi J, Hirko K, et al. Society of Behavioral Medicine (SBM) urges Congress to ensure efforts to increase and enhance broadband internet access in rural areas. Transl Behav Med. 2020;10(2):489–491. doi: 10.1093/tbm/ibz035 [DOI] [PubMed] [Google Scholar]
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