Mental Struggles in Appalachia

When I was in middle school, I began to notice that I was “not okay.” I was struggling with anxiety and depression; however, I did not know those names then, and it terrified me. How could my brain deceive me like this? Am I the only one feeling like this? Why do the people in my hometown belittle people like me?

How is mental health in Appalachia different than in other regions within the U.S? Eight percent of the U.S. (or 24.9 million people) lives in the Appalachian Region, but the average resident typically reports to be mentally unhealthy 14% more often than the average American. One cause of the higher percentage is that mental health has been taken less seriously due to the lack of education on it and because most Appalachians value being independent. This feeling or need to be independent stems from having fewer financial resources, so all too often, people lack access to quality medical care. This can be detrimental to some because it keeps some people from asking for help even when they desperately need it.

Mental health and therapy have always been a part of my life, whether it was noticeable or not. For instance, after my parent’s divorce, when I was in the 2nd grade, I had a court-appointed therapist. Unfortunately, this arrangement was not as beneficial as it was intended because I did not have a basic understanding of what was going on at the time. I have had a handful of therapists throughout my 21 years, and I have learned that not only do you have to want the therapy, but you also need to feel comfortable with your therapist. Not every therapist will work well with each client, and that is okay.

Other reasons for increased issues with mental health disorders in the region include financial stress. People in the Appalachian region’s economically distressed counties are 14% more likely to commit suicide than those in non-distressed counties. These distressed counties are mostly in central Appalachia, such as the Virginia county where I grew up that borders Kentucky and Tennessee. Also, as mentioned before, the lack of education about mental health along with having few resources to access quality care means that young Appalachians who have mental illnesses do not feel welcomed or like they belong. So they either think of leaving or find their way out by other means—sometimes by adding to the percentage of those who have taken their own lives.

I have known many people who share these thoughts. When I was in middle school, I would end up in situations where I would have to talk to friends going through this. This was not healthy for me as well because it would drain me emotionally. Eventually, they were able to get the help that they need.

As mentioned before, many Appalachians really hate asking for help because they seemingly find themselves having to do everything for themselves. For example, many people in my family or close friends to my family will try every at home remedy they can before even considering going to see a health-care professional. This self-dependence makes it hard to admit they might need professional help, so many of us end up relying on advice from our family and friends. The issue here is how the lack of knowledge in the area about current mental-health thinking means that uninformed people do not always know what they are talking about, which could potentially create tension for those wrestling with mental illness and their loved ones.

Growing up, I was always really aware of mental health. My mom has bipolar, and anytime I had questions she would answer as well as she could. But like many places throughout the Appalachian region, my hometown does not prioritize or understand mental health to the extent that they should—especially the medical professionals. I mentioned this because the ones that I have experience with typically medicate people before having full evaluations of what they might be struggling with. Doing so can make people they treat feel small, like they are failures, when in reality it is the system failing them.

What can we do to fix this problem? In the Appalachian region, we should advocate for more mental health resources that are accessible and affordable, and for professional who have at least a basic sense of the region’s culture and how that may affect health. We can start by continuing to spread awareness with the intent to make it normal for people to seek out help and to freely express how they feel. This awareness needs to start when we are young though, so schools should add this education into the curriculum. Finally, through this awareness and education, we can help lift each other up and create a space and understanding for the generations to come.

For an introduction to the health disparities and bright spots in Appalachia, interested readers can consult Creating a Culture of Health in Appalachia (

Article Written by Erika Wilson