A study by researchers at the Wake Forest School of Medicine shed some light on why rural seniors often forego treatment. They questioned 478 adults aged 60 or older in rural North Carolina, and found that the most common answer was "I should not need help." Other frequently cited reasons were not knowing where to go, distance to access treatment, mistrust of counselors or therapists, not wanting to talk about private matters with a stranger, and stigma.
The relative lack of anonymity in rural areas and small towns could contribute to a rural senior's refusal to seek treatment for mental health issues. Dennis Mohatt, vice president of the behavioral mental health program at the Western Interstate Commission for Higher Education and director of its Center for Rural Mental Health Research, told Gurnon, "Your neighbors don’t have a clue in a city if you’re going to go get some help. But everybody [in a small town] will know if your pickup truck is parked outside of the mental health provider’s office."
Some seniors may believe that seeking help for mental illness may signal to others that they are weak or unable to be self-reliant. A study of rural veterans, half of whom were seniors, found this to be a potent barrier to seeking mental health treatment. The veterans rated independence and self-reliance very highly, and cited an emphasis on stoicism and concern about stigma as reasons that would make them less likely to seek help.