Effect of Social Distancing in Collectivist Rural America

In this guest piece, Joy Beth Curtis offers suggestions for mental health care.

Posted Jan 18, 2021

This guest piece is written by Joy Beth Curtis.

Dave Hoefler/Unsplash
Source: Dave Hoefler/Unsplash

Though the United States at large is considered an individualistic society, Appalachia and other areas of rural America remain more collectivist in nature, with both individual and social identity tied to family standing and reputation. It is not uncommon for several generations of a family to live within a few miles of each other, often on the same road or in the same hollow. Extended family members are often fully interconnected; they attend the same schools and churches, rely on one another for child care, and often work for the same employer. Cousins may have sibling-type relationships, and extended family get-togethers are often frequent and spontaneous. “Social distancing” from non-household members, therefore, may require a dramatic shift in daily functioning and division of responsibilities.

Of additional significance is the fact that social distancing has, in large part, been a requirement put forth by local and/or state governments. Generally, mistrust of government remains high in the Appalachian region due to a historical sense of mistreatment, exploitation, and neglect. Further contributing to this sense of mistrust in the current pandemic are preliminary news reports that difficulty in transportation and storage may lead to a delay in vaccination in rural areas. All these factors taken together may lead to significant mental health concerns, such as depression and anxiety, in areas already traditionally underserved with respect to mental health care.

In spite of these challenges, Appalachia and rural America in general are resilient areas, and the collectivist nature of the region also means that individuals take their responsibility to protect the health and well-being of their neighbors seriously. So then, what are some steps that can be taken to address mental health concerns in these regions during the COVID-19 pandemic?

1. Increase Telehealth Awareness and Accessibility

As the pandemic closed many mental health offices to in-person counseling, telehealth has experienced a surge in popularity, and there has been a push among professional organizations and insurance companies to expand available providers and coverage for this type of service. Telehealth can also be accessed in the privacy of one’s own home, which, in addition to requiring no travel and a broader network of providers, can also reduce stigma for those who might feel ashamed or embarrassed to be seen in a therapist’s office.

Telehealth is not without its challenges in rural areas, however. Most significantly, high-speed Internet is not available in all areas, is cost-prohibitive, and/or may be unreliable. Additionally, with many school systems moving to an online format, parents may not have additional devices on which to connect with a provider. While these are larger infrastructure problems that continue to require attention, providers may consider expanding their services to include telephone contact as well. 

2. Collaborate With Primary Care Providers and Home Health Workers

Primary care providers (PCPs) and home health workers provide the majority of medical care in rural areas, and these medical professionals do not hold the same stigma as mental health care providers. While PCPs and home health workers may not be able to provide full counseling services, engaging in brief mental health checks may help identify those who are most at risk for serious mental health concerns. Additionally, these professionals may be able to leverage their existing relationships with patients to encourage mental health services and refer to appropriate mental health providers.

3. Involve School Systems in Mental Health Awareness

Though many school systems have canceled in-person classes in Appalachia and rural America, public school systems remain involved in the lives of students and their families. Beyond contact regarding school assignments, many school systems provide aid in the form of breakfasts/lunches, mobile hotspots, and other needs. These frequent engagements with students and their families provide school personnel the unique opportunity to learn about individual family situations and needs. In addition to providing resources about mental health care, school personnel can be trained to recognize mental health warning signs.

4. Utilize Faith Leaders as Mental Health Care Resources

In traditionally underserved areas, faith leaders often fill the roles of mental health care providers and can serve as gatekeepers for higher levels of care. With the closure of many places of worship due to COVID-19 guidelines, faith leaders may require a higher level of intentionality to connect with congregants in such a way as to recognize when mental health is an area of concern, but they also have the advantage of pre-established relationships with congregants. Additionally, their respected role as religious leaders may grant them additional leverage in being able to ask difficult questions about well-being which might be considered offensive or prying from others. In addition to pastoral training and awareness of referral options, faith leaders may consider training in areas such as psychological first aid and suicide prevention.

5. Embrace Alternative Methods of “Togetherness”

While family “togetherness” looks different than it did a year ago, there are still ways for extended families to provide emotional support while practicing social distancing, such as using virtual meeting platforms. For those who are unable or unwilling to utilize these resources, some creativity can keep families connected through porch visits, drive-by parties, etc.


Social distancing can create significant depression, anxiety, and other mental health concerns in Appalachia and other areas of rural America where extended family interconnectedness and collectivist views make physical separation especially challenging. However, these geographic areas are resilient, and through collaboration with community resources and innovative ways of emotional connectedness, mental health care can be provided and family ties maintained.

Joy Beth Curtis, used with permission
Source: Joy Beth Curtis, used with permission

About the Author: Joy Beth Curtis, Psy.D., is an online adjunct professor at Liberty University in the Department of Community Care and Counseling. She is a licensed clinical psychologist in Kentucky and Virginia with clinical interests in trauma/PTSD and the integration of faith and psychology. Originally from southeastern Kentucky, she also has an interest in rural psychology and has published in the area of clergy as mental health first responders following a coal mining disaster.


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Elam, C. (2002). Culture, poverty, and education in Appalachian Kentucky. Education and Culture, 18, 10-13.

Santora, T. (2020). Rural America may miss out on early COVID-19 vaccines. Popular Science.