Lawmakers and advocates think outside the box on rural mental health

(The Center Square) – With limited access to clinicians and deeply entrenched stigmas, the question of how to best provide mental health care for rural Pennsylvanians is a thorny one.

One organization, Rural Minds, has set out to make an impact in the space by supporting a bill in the U.S. House they say would level the playing field for the most effective psychiatric drugs, increasing access for the most vulnerable.

“I’ve always said about drugs, it doesn’t matter how innovative they are,” said Don Hannaford, vice president for public policy at Rural Minds. “If you can’t get them, they’re not worth anything.”

Rural Minds oversaw a survey in Pennsylvania, Florida and North Carolina examining the barriers rural Americans face in accessing adequate mental health care. Just over half of respondents cited cost as a major obstacle. Within cost are a variety of different factors including copays, deductibles, and coinsurance as well as health insurance premiums.

The EPIC Act is one strategy toward making essential treatments more available, if not immediately more affordable. The legislation introduced in the House in February would lengthen the period of time required for “small molecule” drugs to be on the market before entering price negotiations from seven to 11 years.

Small molecule drugs represent a huge number of prescription and generic drugs on the market and are contrasted with biologic drugs, which come from living organisms. Small molecule drugs are capable of crossing the blood-brain barrier and therefore essential to psychiatric treatment.

Lawmakers say the change would put small molecule drugs on equal footing with biologics, which have an 11-year waiting period. By giving drug companies more time to make money off of new formulas, Hannaford and legislators hope that innovation will be incentivized. The benefits, they say, would be worth the trade-off for a few more years at higher prices.

“We don’t have perfect solutions in pill form,” said Hannaford. “This is an area that needs a great deal more research and development.”

The use of small molecule drugs isn’t exclusive to psychiatry. They’re essential tools across virtually all areas of medicine, including cancer treatment.

“Small-molecule medicines, often pill-based treatments, are some of the most practical therapies for patients battling cancer and other serious illnesses,” one of the bill’s co-sponsors, Rep. Brian Fitzpatrick, R-Langhorne, told The Center Square. “Without the EPIC Act, we risk losing future cures as research dries up. For families in rural and underserved communities, this change means more options close to home and fewer barriers to lifesaving care. As Co-Chair of the Bipartisan Cancer Caucus, I’m fighting to make sure innovation leads to new treatments that reach every patient who needs them.”

Biotechnology, including innovating drugs and new health care treatments, are a major area of focus in the commonwealth as the Shapiro administration, Pennsylvania congressional representatives, and local legislators all work to draw research investments to the commonwealth. Leveraging the state’s prestigious research institutions has paid off so far in competing for large-scale artificial intelligence development.

But experts say new science alone won’t be enough to combat the rural health care crisis. People in rural America have a higher “foundation of stress” due to huge fluctuations in the limited number of industries available for employment. Hannaford cited the impact of tariffs on grain producers.

“You add on to that other things that are endemic to rural America — simple loneliness, lack of connectivity to bigger communities,” said Hannaford. “I would argue that the groundwork for mental illness is much higher in rural America.”

One of the goals of Rural Minds is to put resources in the hands of the people who need it, including innovative new approaches to therapy. Hannaford praised research at Northwestern into single-session interventions, a talk therapy strategy that only requires a single meeting to help put someone struggling back on track.

Hannaford said that in rural America, “There is a pull yourself up by your bootstraps attitude, although that’s changing. That’s evolving.”