How Rural Libraries Are Reimagining Mental Health Support

“I’ve really seen a difference in the people coming in — not just more people, but happier people. They come in, give you hugs… it’s gone back to feeling like the small town I love.”
— Library Staff, Libraries for Health Initiative

Introduction

In many small towns, the local library is more than just a place to borrow books — it’s the heart of the community. It’s where parents bring their children for story time, where older adults seek connection, and where individuals facing life’s challenges often find a safe, welcoming space.

But what if libraries could do even more? What if they could help bridge one of the most persistent gaps in rural communities — access to mental health support within familiar and trusted spaces?

The Libraries for Health Initiative: A New Model for Rural Mental Health

In January 2022, St. David’s Foundation set out to explore that very question by launching the Libraries for Health pilot. Its design was guided and informed by data from the Foundation’s Community Health Needs Assessments (CHNAs), regional behavioral health studies, and over 100 interviews and community conversations with rural leaders, residents, and library staff. Partnering with libraries across Central Texas, this initiative reimagined mental health support in rural communities — leveraging one of the most trusted, accessible, and beloved public spaces and combining it with mental health supports.  

This approach enabled trained peer support specialists to deliver evidence-based mental health supports that might otherwise only be accessible through clinical providers. In this model, peer support specialists — individuals with lived experience in mental health, substance use, incarceration, and/or homelessness — are equipped with the skills to identify the mental health concerns of adult library patrons and provide support. 

Over three years, the Foundation collaborated with national research partner RAND, who served as the evaluation and pilot design partner, and Via Hope, who served as the implementation partner.  

Together, we set out to answer: Can libraries play a bigger role in supporting mental health in resource-limited rural communities? 

The answer, it turns out, is a resounding yes. 

Why Libraries?

In many rural areas, the library may be one of the few — or only — community gathering places. They serve people from every walk of life, including those who often face the greatest barriers to mental health care: 

• Older adults, isolated and eager for connection. 

• Parents of young children, looking for free activities and adult interaction. 

• People experiencing homelessness, seeking shelter from the elements. 

• Community members navigating everyday life challenges, such as stress, loneliness, or uncertainty. 

Library staff often noticed signs of mental health struggles among adult patrons but didn’t always feel equipped to help. Through community conversations and planning, it became clear that any new model needed to ease the burden on already stretched staff while providing meaningful, approachable, and effective mental health support. 

The Power of Peer Specialists

The heart of the Libraries for Health model lies in the use of peer specialists —individuals with lived experience who have been successful in managing their mental health challenges and are trained to support others on their journeys.  

While peer specialists have been used in clinical and nonprofit settings, bringing them into public libraries was a new and bold idea. Through a partnership with Via Hope, the initiative provided training, supervision, and certification for peer specialists, ideally hired from the local community, who were placed in participating libraries.  In addition, Via Hope, through a partnership with Austin Mental Health Community, handled administrative tasks such as peer specialist supervision and payroll, ensuring library staff could focus on their core library work and the integration of mental health supports within the library setting. Moving forward, Austin Mental Health Community will serve as the peer support specialist and implementation partner for libraries that are continuing this initiative. Via Hope served in this role during the pilot phase of the initiative.  

Peer support has been proven effective in global health and offers promise in rural areas where mental health clinicians are in short supply. 

What We’ve Learned

Three and a half years later, the results are clear: 

• Libraries are viable mental health access points. Integrating peer specialists into libraries is not only feasible but also perceived as beneficial additions by both staff and patrons. Patrons described the libraries as “the perfect setting” and a “safe space” to receive support free from stigma and judgement. 

• Challenges are real — but manageable. Issues like funding, staff turnover, and space constraints emerged, but most libraries overcame them through creativity, community partnerships, and persistence. 

• Community matters. The Libraries for Health initiative’s learning cohort provided space for library staff to participate in specialized trainings, share ideas, support each other, and build lasting relationships — a key factor in the program’s success. 

• Flexibility is essential. Libraries used multi-year flexible funding from St David’s Foundation to tailor programs for their communities (e.g., mindfulness classes, grief support groups) and also used funds to enhance their mental health-related library collections. 

As one patron shared:

“I’d say my mental health has improved since I started attending classes here… I even decided to use my benefits and start going to therapy again.” 

Even when hiring a peer specialist isn’t possible, libraries have incorporated mental health into everyday operations — from programming to staff culture — creating safe, supportive spaces for all. All participating libraries have increased their focus on mental health support across their program offerings, from dedicated support groups to exploring self-expression through arts and crafts. We learned from several library directors that mental health support has become more central to the libraries’ mission and strategic planning, even beyond the components of the Libraries for Health model. Another unexpected finding is that not only do library staff report increased confidence in supporting patrons and connecting them with resources, but the staff are also more observant and mindful of each other, supporting their own mental wellness. 

Bringing the Model to More Communities

Rural areas across the country face a shortage of mental health professionals. But models such as Libraries for Health demonstrate how non-clinical mental health workers, including peer specialists, community health workers, and behavioral health aides, can help close the gap. We encourage you to read the full research findings to learn more about the impact of the three-and-a-half-year Libraries for Health initiative. For other libraries interested in incorporating aspects of the model, and public and private funders wanting to support their local libraries, RAND has developed a toolkit with tips, considerations, and worksheets to support future implementation and extend the model to other communities.   

Looking Ahead

One of the most powerful signs of success? Even as this pilot initiative winds down, participating libraries are working to sustain mental health programming — seeking new, ongoing funding, building peer specialist roles into their budgets, and making mental health and wellness a permanent part of their mission. 

The Libraries for Health initiative reminds us that mental health support doesn’t have to only come in traditional clinical settings. Sometimes, it starts with a familiar face and/or familiar settings — at your local library. A listening ear. A welcoming space. A conversation that sparks hope. 

As one library staff member put it:

“Patrons having a peer to talk to, honestly, is magical.”

We couldn’t agree more.