Why Rural Maternal Mental Health Matters: And Why Telehealth Isn't a Luxury

The small town in rural Texas where I grew up didn't have a psychiatrist. It didn't have a therapist you could see without driving an hour. And it definitely didn't have anyone who specialized in perinatal mental health—a term I wouldn't even learn until years later, living in a city where these things existed.

So when I read that the Policy Center for Maternal Mental Health is launching a Rural Health Transformation Learning Collaborative—specifically focused on helping states implement maternal mental health strategies in rural areas—I think about what that would have meant for the mothers in my hometown. The ones who struggled silently. The ones who didn't have the language for postpartum depression or postpartum anxiety. The ones who were told it was "just the baby blues" and sent home to white-knuckle it.

The Numbers Don't Lie About Rural Risk

Maternal mental health conditions, including substance use disorders, are now the leading cause of pregnancy-related deaths in the United States. They account for nearly 20% of maternal deaths.

And if you're a mother living in a rural "maternity care desert"—a place where obstetric care is scarce or nonexistent—you're facing a dual crisis. You have a higher risk for these conditions and fewer places to turn for help.

That combination is lethal.

The Policy Center's announcement comes at a critical moment. States have received the first $10 billion in Rural Health Transformation funding from the Centers for Medicare & Medicaid Services, and they have nine months to demonstrate measurable outcomes. Nine months to build infrastructure. Nine months to prove that investing in rural maternal mental health actually works.

That timeline is absurd. But it's also what we have.

Telehealth Isn't a Band-Aid—It's Infrastructure

I've heard the argument that telehealth is a "second-best" solution. That it's what you settle for when you can't get in-person care. That it's inherently less effective, less personal, less real.

That's not what the research shows. And it's not what mothers in rural areas need to hear.

Telehealth isn't a workaround. It's infrastructure. It's the difference between driving two hours to see a therapist—if you can find childcare, if you have a car, if you can take time off work—and logging on from your kitchen table during naptime.

For mothers experiencing postpartum depression or anxiety, those logistical barriers aren't minor inconveniences. They're reasons people don't get help at all.

The Policy Center's collaborative is focusing on key strategies that include "leveraging telehealth consultation and technology." That language might sound bureaucratic, but what it means in practice is this: a mother in rural Montana should be able to access a perinatal mental health specialist without leaving her county. A mother in West Texas should be able to get screened, diagnosed, and connected to treatment without a six-week wait and a three-hour drive.

That's not lowering the bar. That's raising it.

The Workforce Problem Isn't Going Away

One of the hardest truths about rural mental health is that we cannot recruit our way out of this crisis.

There aren't enough psychiatrists. There aren't enough therapists. There certainly aren't enough specialists in perinatal mental health. And even if we tripled training programs tomorrow, it would be years before those providers reached rural communities—if they ever did.

Most mental health professionals want to live in cities. They want access to supervision, peer consultation, professional development, and the kind of infrastructure that makes their work sustainable. Rural communities can't always offer that.

So the solution isn't just about recruiting more providers to move to small towns. It's about building systems that allow providers to reach those towns without living there. It's about using technology to extend expertise. It's about training primary care providers and OB/GYNs to screen, diagnose, and manage mild to moderate cases—and connecting them to specialists via telehealth for consultation on complex cases.

This is the "expanding home-based and mobile care infrastructure" piece of the collaborative. It's also the "advancing rural workforce policy and financing" piece. Because if we don't pay providers adequately for telehealth services, if we don't reimburse for consultations between specialists and primary care, if we don't fund the technology rural health centers need—none of this works.

Payer Alignment Is Unsexy But Essential

One of the strategies the collaborative will focus on is "using health plan contracts and oversight as a lever for quality improvement."

This is the least flashy part of maternal mental health policy. It doesn't make for inspiring headlines. But it's where implementation lives or dies.

Health plans control access. They decide what gets covered, what gets reimbursed, how much providers get paid, and how hard it is to get authorization for treatment. If a health plan doesn't cover telehealth therapy, mothers in rural areas don't get telehealth therapy. If a plan requires prior authorization for every single session, mothers drop out before they finish treatment.

State leaders can write beautiful maternal mental health policies. They can fund pilot programs and launch awareness campaigns. But if health plans aren't aligned with those goals—if the financial incentives don't support the care model—it doesn't matter.

That's why this collaborative is focusing on state teams "with program design and implementation authority." They're not looking for people who can write white papers. They're looking for people who can actually change contracts, shift payment models, and hold health plans accountable.

What "Building Integrated Care Models" Actually Means

I'm wary of the phrase "integrated care" because it gets used to describe so many different things. Sometimes it means co-locating a therapist in an OB/GYN clinic. Sometimes it means warm handoffs. Sometimes it just means everyone uses the same electronic health record.

But in rural maternity care deserts, integrated care has to mean something more fundamental. It means obstetric care, mental health care, and substance use treatment aren't siloed. It means a pregnant woman doesn't have to see four different providers in four different locations with four different billing systems to get the care she needs.

It means her OB screens her for depression. The screen flags risk. A telehealth consult happens that week—not in six weeks. If medication is appropriate, someone prescribes it. If therapy is needed, someone connects her. If substance use is involved, treatment is coordinated, not punitive.

And all of this happens without the mother having to navigate a bureaucratic maze while experiencing a mental health crisis.

That's the ideal. The reality is messier. But it's what states need to be working toward if Rural Health Transformation funding is going to make any difference.

The Clock Is Ticking

Nine months to show measurable outcomes is not enough time. But it's what states have.

The collaborative is launching in June, and applications are open through March 31. That gives state leaders a few months to assemble teams, clarify priorities, and decide whether they're serious about addressing rural maternal mental health or just checking a box.

I hope they're serious. Because the alternative—continuing to tell mothers in rural areas that help exists somewhere else, that they just need to drive farther or wait longer or be more patient—is untenable.

Maternal mental health conditions are the leading cause of pregnancy-related death in this country. Mothers in rural areas face higher risk and fewer resources. Telehealth isn't a perfect solution, but it's an essential one. And if we don't build the infrastructure, fund the workforce, and align the payment systems to make it work, we're just going to keep losing people.

I think about the mothers in my hometown. The ones who didn't have language for what they were experiencing. The ones who were told to pray harder, sleep more, try to enjoy this precious time.

They deserved better. And so do the mothers living in rural America right now.

This collaborative is a start. It's not enough. But it's something.

And sometimes, in rural health, something is the difference between survival and loss.