This report presents findings from the Libraries for Health (L4H) initiative, which embedded nonclinical adult mental health supports into rural libraries. The findings derive from a three-year implementation evaluation of L4H. The authors summarize libraries’ implementation of L4H, libraries’ primary barriers and facilitators of implementation, and the efforts and adaptations they made to build and sustain L4H.

Integrating Mental Health Support into Rural Libraries

Evaluation of the Libraries for Health (L4H) Initiative

Lynsay Ayer, Karen Christianson, Ivy Todd, Logan Dick, Amy L. Shearer, Yoselín Mayoral, Abigail Kessler, Rajeev Ramchand

ResearchPublished Jun 20, 2025

Residents in rural communities across the United States face significant barriers to accessing mental health care. In the rural areas of Texas, this need is critical: In 2022, the suicide rate among rural Texans was 20.88 per 100,000, nearly double the rate among residents in Texas’ metropolitan communities. Although these communities may lack access to mental health providers, they do have robust community libraries: Trusted hubs that could be transformed, with the necessary resources and supports, into a new access point for care.

This report presents findings from an initiative focused on embedding nonclinical adult mental health supports into rural libraries. The findings derive from RAND researchers’ three-year implementation evaluation of Libraries for Health (L4H), a pilot program funded by St. David’s Foundation (SDF) in which ten libraries in rural Central Texas worked to integrate mental health supports. This report summarizes how libraries implemented L4H, libraries’ primary barriers and facilitators of implementation, and the efforts and adaptations they made to build and sustain L4H. The report should be especially relevant to community members and leaders who are interested in incorporating nonclinical mental health supports within libraries or other community spaces with a goal of expanding the mental health workforce. A companion toolkit is designed to help librarians identify and implement mental health supports within libraries to support their patrons’ mental well-being. An annex to that toolkit includes its worksheets.

Key Findings

Staff and patrons attributed a variety of positive outcomes to L4H

  • Staff at most libraries reported that L4H helped bring in more patrons, including those who had not previously used the library.
  • Interviewees from nearly all libraries described increased social connection among patrons who participated in L4H programming or who received support from a peer specialist and described patrons as feeling and doing better.
  • Staff at most libraries reported feeling more empathetic and confident in supporting patrons’ mental health.

Successful L4H implementation was strengthened by support from staff, external community partners, and fellow libraries

  • Peer specialists highlighted the importance of supportive staff who were receptive to their ideas and helped them feel like part of the library team.
  • Staff noted the value of engaging external partners to expand programming and having multiple staff members involved in planning and oversight.
  • The opportunity to exchange ideas through the learning cohort was helpful for libraries in deciding how to use peer support and grant funds wisely.

However, barriers slowed full implementation, and staff were unsure whether they could sustain all components

  • After initial challenges with recruitment, each library eventually incorporated a peer specialist who supported patrons’ mental health.
  • It took time for staff to create new mental health–focused programming tailored to patrons’ needs and to spread the word about their offerings.
  • Staff at most libraries thought that it would be challenging to secure enough funds to sustain the peer specialist role after the pilot.

Recommendations

Libraries looking to create a program like L4H should start with a good understanding of the community’s needs and resources

  • Libraries should engage staff members and potential community partners early in the process.
  • Libraries should establish a vision and identify what and who will help make it a reality.
  • Libraries should learn from organizations (including other libraries) also working on mental health topics.
  • Libraries should start small to sustainably build mental health programs.
  • Libraries should consider hiring a peer specialist who is a community member already engaged in the library.

Policymakers, community leaders, and funders should establish clearly defined roles and responsibilities for all partners when looking to create a program like L4H in their communities

  • Leaders should consider funding multiple organizations simultaneously and building a learning cohort that can grow together and learn from each other’s members.
  • Leaders should have clear guidelines, but be flexible, on how funding should be used.
  • Leaders should begin discussions about sustainability early in the process.
  • Leaders should collect data to monitor program implementation and quality.

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Citation

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Ayer, Lynsay, Karen Christianson, Ivy Todd, Logan Dick, Amy L. Shearer, Yoselín Mayoral, Abigail Kessler, and Rajeev Ramchand, Integrating Mental Health Support into Rural Libraries: Evaluation of the Libraries for Health (L4H) Initiative. Santa Monica, CA: RAND Corporation, 2025. https://www.rand.org/pubs/research_reports/RRA3597-1.html.
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This research was conducted in the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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