Libraries as Community Hubs for Expanding Mental Health Supports

Photo by RyanJLane/Getty Images

There Is a Significant Need for Enhanced Mental Health Services in Rural Texas

Like residents in rural communities across the United States, those in the rural areas of Texas face significant barriers to mental health care. Yet the need in rural Texas is particularly urgent: In 2022, the suicide rate in those areas was 20.88 suicides per 100,000 residents, nearly double the rate of 13.83 suicides in the metropolitan communities of Texas. Although rural communities may lack access to mental health providers, they have robust community libraries: trusted hubs that could be transformed, with adequate resources and supports, as a new access point for care. Using lay mental health workers, such as peer specialists, can be an innovative solution to tackle the well-documented shortage of mental health providers both regionally and nationally.

Libraries May Be Part of the Solution

In January 2022, St. David’s Foundation, an organization focused on advancing health equity in Central Texas, launched the Libraries for Health pilot to address the shortage of mental health care in rural Central Texas. RAND served as the pilot’s design and evaluation partner and worked alongside Via Hope, the pilot implementation partner that hired, trained, and supervised the peer specialists (described below).

What Is Libraries for Health?

Libraries for Health is a pilot initiative to bolster community mental wellness in Central Texas. It integratedmental health supports (i.e., mental health–focused resources, practices, relationships, and services) into ten rural libraries. The pilot began in 2022 and continued through 2025, while the formal evaluation concluded in 2024. Libraries for Health consisted of three primary components:

• Peer specialists: Libraries were assigned a trained peer specialist who, when possible, represented the communities they served. Peer specialists are individuals with lived experience of mental health challenges who use their training and experience to support others. Since 2019, Texas has been certifying peer specialists. Certification requires at least 40 hours of training and 250 hours of supervised work experience. Peer specialists supported the mental health needs of community members in the library through one-on-one and group interactions (see Figure 1).
• Library learning cohort: Libraries participated in a professional learning cohort that included quarterly meetings, professional learning, and other collaborative opportunities.
• Flexible grant funding: St. David’s Foundation awarded multi-year grants to libraries to support the implementation of pilot activities and the integration of mental health supports.

This figure is donut chart that segments peer specialist activities into four categories.:

• Individual patron support: The largest segment, highlighted in dark red.
• Leading, planning, or attending events: The second largest segment, shown in light pink.
• Other library duties: The third largest segment, represented in pale beige.
• Staff support and coaching: The smallest segment, depicted in dark gray.

The circular diagram emphasizes that individual patron support is the predominant duty among those represented.

SOURCE: Features information from Libraries for Health peer specialist activity logs.

Did Libraries for Health Work?

RAND researchers conducted an implementation study of Libraries for Health that examined the pilot’sfeasibility, barriers, facilitators, and sustainability. Several key findings emerged, including the following:

• The pilot successfully increased mental health supports in rural Central Texas, with libraries expanding programming over time. Peer specialists enhanced patron engagement and library staff wellness, while grant funding supported diverse programming, from mental health seminars to food pantry access, in response to each community’s needs.
• Implementation of the pilot benefited from libraries’ community partnerships, which helped expand access to library resources. Libraries that proactively integrated peer specialists into their existing programming helped familiarize patrons with peer specialists and open them up to the concept of peer support.
• Library patrons and staff viewed the pilot favorably. Patrons described libraries as “the perfect setting” for mental health programming, calling it a “safe space” and a “great, great option.”
• Library staff felt that they had become more empathetic to patrons’ needs and more confident in engaging with patrons experiencing mental health challenges. Participating in the pilot helped them manage their own mental health challenges and foster more open conversations about mental health.

Staff Encountered Some Challenges Implementing Libraries for Health

The evaluation also documented logistical, structural, and cultural implementation barriers that librariesexperienced. At least two libraries encountered each of the barriers listed in Table 1. Most libraries were able to address many of these barriers effectively.

Libraries Want to Sustain Program Elements Beyond the Pilot and Are Looking to Secure Funding

Another indicator of the model’s success is that most libraries want to continue at least some of the elements of Libraries for Health after the pilot’s conclusion. Staff from most libraries reported that they could sustain most of the programming they created under the pilot with their existing staff and budget. However, budget constraints and fundraising limitations may prove challenging, especially in regard to supporting peer specialist positions. Library staff and peer specialists planned to further develop and deepen their partnerships with community organizations, hoping these efforts will help them strengthen and sustain their programs.

Recommendations

This pilot demonstrated an innovative approach to how philanthropy can partner with trusted libraries to support community mental health. We developed two sets of recommendations: one for those thinking of implementing this or a similar program (e.g., libraries or other trusted community organizations), and one for policymakers, community leaders, or funders interested in supporting a future similar effort.

We encourage the following for prospective implementers of Library for Health:

• Understand the community’s needs and resources.
• Engage staff members and potential community partners early on.
• Learn from other organizations (including libraries) working to embed mental health supports.
• Establish a vision and identify what and who will help make it a reality.
• Start small to sustainably build mental health supports.
• Consider hiring a community member already engaged in the library or organization to ensure a strong fit with a peer specialist.
• Be flexible; when challenges arise, adjust as needed.

We recommend the following for policymakers, community leaders, and funders who are interested in supporting future implementation:

• Consider funding multiple organizations simultaneously and building a learning cohort that can grow together and learn from each other.
• Establish clearly defined roles and responsibilities for all partners.
• Have clear guidelines, but be flexible, on how funding should be used.
• Begin discussions about sustainability early.
• Collect data to monitor program implementation and quality.

Topics

• Community Organizations
• Community Resilience
• Community-Based Health Care
• Mental Health Treatment
• Program Evaluation