Mental Health Accessibility for Rural Texas Students

Abstract

Rural Texas high school students continue to face a general lack of funding, which consistently correlates with the steady diminishing of mental health resource accessibility (Texas Association of School Boards). This study examines the quality, efficacy, and accessibility of these mental health resources using the experiences of 300 high school students through surveys and individual emails in order to better understand the faults within the district system and better allocate funding to help those in need. The survey measured students’ awareness, usage, perceived service quality (1 = poor to 5 = excellent), and ease of utilization (1 = very difficult to 5 = very easy). Stratified follow-up email correspondence provided qualitative insights.

Results: Only 24% of students had utilized school-based mental health support, though 87% were aware such services existed. Perceived service quality was moderate-to-high (mean rating 3.3/5), whereas perceived ease of utilization was lower (mean 2.9/5); this difference was statistically significant (p < .001). Quantitative analyses showed that 45% of students rated service quality as “good” or “excellent,” but only 30% found services “easy” or “very easy” to access. A moderate positive correlation (r ≈ 0.45, p < .001) was observed between quality and ease ratings. Qualitative themes included limited counselor availability or delayed scheduling, lack of awareness on accessing services, and cultural stigma or privacy concerns affecting their tendency to seek appropriate help. Despite access hurdles, students who received support reported high satisfaction with the care’s quality and outcomes.

Adolescent mental health challenges are an urgent concern in rural communities, where disparities in care are fueled by provider shortages, fundamental lack of funding, and social isolation (Frontiers in Psychology; Evidence-Based Mentoring). National data indicate that nearly 30% of rural high school students report persistent feelings of sadness or hopelessness, and youth suicide rates in rural areas (approximately 16 per 100,000) are about 70% higher than those of their urban peers (Frontiers in Psychology). These contrasting figures reflect the inadequacy of traditional mental health care models for rural youth and demonstrate a critical need for further support.

Research shows that up to 20% of youths—depending on multiple factors across regions—have diagnosable mental disorders or symptoms. However, more than 70% do not receive the services they need (ERIC). Such a gap is even further extrapolated in rural regions where providers are scarce; many rural and frontier counties have only one or no mental health professionals available (Texas Tribune), leaving students to wait weeks or months for urgently needed care (Frontiers in Psychology).

It is not only logistical and availability errors that permeate the rural landscape. Lingering stigma remains another obstacle to mental health accessibility in these communities. It is well known by many accredited psychologists that families and students may avoid seeking mental help in fear of being ostracized or judged by their peers (Frontiers in Psychology). Misconceptions of mental health and lack of awareness of supportive resources only serve to further widen the gap in access. Transportation difficulties also contribute to the lack of accessibility students have to mental health services, especially in rural settings (Evidence-Based Mentoring).

A recent analysis of Texas schools found that most districts fall short of the recommended 250:1 student-to-counselor ratio, and some rural districts have no counselor at all on staff (Texas Appleseed). In 2017–2018, 13% of Texas school districts reported having zero counselors or mental health personnel, the majority of which were small, rural districts (Texas Appleseed).

This absence of social workers leaves students at a disadvantage and highlights the need for both equity and equality across the state.

In summary, the research accumulated here does not hold any unusual qualities but is instead backed by prior accredited observations. The present study seeks to fill the gaps between established research and find effective, student-centered solutions according to the reported data. To examine the existing issues, this study focuses on two key questions:

1.How do rural high school students perceive the quality of the mental health services provided at school?

2. How do they view the ease of utilization of these services (including awareness, accessibility, and comfort with use)?

Through the use of surveys and personal contact, the data aim to create a clear solution to the lack of access to mental health resources and advocate for communities that do not stigmatize mental health care.

This study employed a cross-sectional survey design with a mixed-methods component. The target population was high school students (grades 9–12) residing within a 50-mile radius of Aubrey, Texas—a largely rural area in North Texas. Using school enrollment lists obtained with district permission, students from four public high schools in the region were invited to participate. A total of 300 students (approximately 75 from each school) were recruited in Spring 2025. Participant ages ranged from 14 to 18 (mean 16.1 years, SD = 1.2); 53% identified as female, 45% male, and 2% non-binary or other. The sample was ethnically diverse for the region (62% White, 24% Hispanic, 8% Black, 6% other/mixed). The survey was administered anonymously online via Google Forms.

We used a survey form to quantitatively assess students’ experiences with school-based mental health services, with the option to send anonymous emails to us personally for further elaboration. The survey instrument covered the following key areas:

Awareness of Services: Items asking whether students knew what mental health services (e.g., school counselor, school psychologist, social worker, or special programs) were available at their school, and whether they had received any information about these services (for example, through counselor emails, school-wide presentations, and newsletters).

Utilization History: Questions about whether the student had ever used any school-based mental health support (yes/no), and if yes, how frequently (e.g., number of meetings with counselors or attendance in programs over the past year). Those who answered “no” were prompted to select reasons (multiple choice and open-ended options, e.g., “I have not needed mental health support,” “Did not know how to access,” “Did not feel comfortable,” or “Service not available at my school”). Those who had not accessed mental health services were also asked about their overall impression of them and what they had heard.

Quality was rated on a 5-point Likert scale (1 = Poor, 2 = Fair, 3 = Good, 4 = Very Good, 5 = Excellent). Other questions included competency level, perception of comfortability, and accessibility to determine an overall quality score (Cronbach’s α = 0.88 for the quality scale, indicating good internal consistency).

Regarding follow-up on the survey results, 20 individuals volunteered to participate anonymously to provide more in-depth perspectives. Quotes from these responses were consented to be published throughout the study to ensure adequacy. Responses with missing data on key variables were excluded pairwise in analyses to maximize available information.

Ethical Considerations

Several precautionary measures were taken to reassure students emotionally and ensure confidentiality and informed participation. This was done through checking the first box presented on the Google Form:

“I understand that my participation will be anonymous and that my responses will be published both in a quantitative and qualitative manner. I understand that if I choose to email the publisher for a more in-depth analysis, this too will remain anonymous and be used for qualitative research designed for publication.”

All surveys were anonymous, and students were reassured they could skip any questions they didn’t feel comfortable answering. The end of the survey also included a list of mental health resources in case the survey raised personal concerns. Emphasis on comfortability, consent, and confidentiality led to a safe and informative participation experience for the students.

Participants’ Utilization of Mental Health Services

Eighty-seven percent of the 300 surveyed reported that their school had some form of mental health support (most often being a counselor or something similar). However, only 24% reported that they had personally utilized those services during high school, leaving 76% without mental health resource support. Over 50% of the students who did not access mental health services reported feeling stressed at school and identified academic pressures as one of the predominant factors for mental health decline. This relatively low use of mental health services, regardless of actual mental health state, is not only found in rural areas but reflects national trends showing about one in five students using mental health services (KFF).

Quality of Mental Health Services

Students’ ratings of mental health resource quality were generally positive. On the 5-point scale (1 = Poor, 5 = Excellent), the mean perceived quality rating was 3.3 (SD = 1.2), corresponding roughly to a “good” rating. Over 45% of students rated the quality of their school’s mental health services as “Very Good” (4) or “Excellent” (5). About 30% gave a middling rating of “Good” (3), while approximately 25% expressed a negative view of quality, rating it “Fair” (2) or “Poor” (1). Among service users, 82% agreed that “the counselor listens to students and understands their problems,” and 77% agreed that “I felt comfortable talking to the mental health staff.” These satisfaction indicators align with prior research showing strong comfort and trust in school-based counseling relationships.

Accessibility

Students’ ratings of accessibility were lower than the mean quality ratings (paired t(299) = 6.45, p < .001). Only 30% of the students considered the services easy or very easy to utilize and access, while 40% found it difficult or very difficult. The remaining 30% were neutral, indicating that many students face systematic obstacles to accessing mental health support even when quality is high.

From the survey items, only 55% of students agreed with the statement “I know how to contact or meet with the school counselor if I need to,” highlighting an information gap. Additionally, just 48% agreed that “It is easy to find time during the school day to get counseling without falling behind,” reflecting scheduling and academic pressures as obstacles.

In qualitative responses, one junior wrote:

“I honestly wouldn’t know what to do if I were ever in a crisis. I know I should go to my counselor, but what does that even really mean?”

Another student wrote:

“I know how to access support, it’s just that due to delayed scheduling I feel discarded and unimportant as I often go weeks without meeting them.”

Interestingly, almost none of the students who had not utilized services selected “I was not comfortable talking about personal problems at school” as a reason for not seeking help. This is notable since many of the same districts report showing videos in class about mental health awareness—though these appear to have limited impact.

Accessibility Barriers

One of the prominent problems that emerged throughout the survey was late scheduling and difficult accessibility. Some students reported that their schools had no on-site mental health professional full-time. Students often wrote in qualitative emails things like:

“I don’t know where to go, whether I have to ask online or in person for a pass, or who will even greet me when I finally walk into the room.”

This highlights the need for teachers and districts to provide a clear, step-by-step guide for students on how to access mental health support.

 Table 1. Summary of Student Survey Results and Sample Qualitative Comments |

 | ------------------------------------------- | -------------------------------------------- |

 | Metric / Finding | Quantitative Result (N=300) |

 | Students aware of any school MH services | 87% aware their school offers support |

 | Students who have utilized services | 24% (n=72) have used at least once |

 | Mean quality rating (1–5 scale) | 3.3 (SD 1.2) – “Good” on average |

 | Mean ease-of-use rating (1–5 scale) | 2.9 (SD 1.1) – below “OK” |

 | Rated quality “Very Good” or “Excellent” | 45% of students |

 | Rated access “Easy” or “Very Easy” | 30% of students |

 | Top barrier for non-use (multiple allowed) | 58% prefer to self-manage; 45% unsure how; 32% stigma/embarrassment |

 | Quality vs Ease correlation | r = 0.46, p < .001 (moderate positive) |

Discussion

The findings presented in this study reveal a consistent trend: the quality of support is usually sufficient when accessed. However, repetitive barriers of stigma, scheduling, and ease of use frequently prevent students from gaining access to these services. This is encouraging yet concerning—quality services exist, but access barriers render them underutilized.

These obstacles are not insurmountable. Through the potential use of school-wide announcements, district-wide videos, and the creation of an online system allowing students to easily schedule mental health support, these barriers can be reduced.

To measure the effectiveness of these proposed solutions, further experiments and evaluations should be conducted.

Recommended steps:

• Increase school-based mental health staff and services in rural areas.

• Expand awareness programs district-wide to disarm stigma and clarify how students can seek help.

• Implement confidential digital systems for scheduling appointments.

• Conduct routine student check-ins to measure progress and gather feedback.

Limitations

This study was confined to a 50-mile radius around Aubrey, Texas, with a modest sample size of 300 students. Findings, although consistent with previous data, may have been influenced by demographic and district policy differences. As data were self-reported, potential biases such as fear of judgment, overgeneralization, and selective positivity or negativity may be present.

Conclusion

This study showcases a hopeful yet challenging paradigm. Rural schools have the potential to deliver effective mental health care to youth; however, this potential is yet to be realized due to the lack of service, awareness, and ease of access. By bridging these gaps, we can ensure that no individual—no matter where they live—lacks access to the mental health resources they deserve.

Sources:

Texas Association of School Boards – Advocating for Rural Schools

Frontiers in Psychology – Stigma and Mental Health

Evidence-Based Mentoring – Rural Mental Health Accessibility

ERIC – Access to Mental Health Services

Texas Tribune – Rural Mental Health Professional Shortages

Texas Appleseed – School Counselor Ratios in Texas

KFF – The Landscape of School-Based Mental Health Services

PMC – School-Based Counseling Relationships