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Substance Abuse, Mental Illness, and Access to Care in Rural America

by Colleen O'Day ❘  

The Downside of Rural America

It may be peaceful. There may be less traffic. However, getting adequate health care can be quite a challenge in rural America — particularly when addiction treatment and rehabilitation services are needed. Trying to get help for substance abuse or mental illness is a very different experience in these communities than it is in urban America. Here, we’ll examine why that’s the case.

Health Care in Rural America

It’s been well-documented that people in America’s rural areas face significant barriers accessing effective health care. That may partly explain why they’re more likely to suffer from chronic health conditions such as diabetes, cardiac issues, and cancer. A variety of factors influence this difficult dynamic, including:

  • a shortage of health care providers
  • decreased quality of care within available health care systems
  • transportation issues — either it’s too far to drive or transportation isn’t available
  • lack of financial resources to obtain care
  • social dynamics of small communities, such as lack of privacy

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Access to Behavioral Health

For those living in rural America who are also struggling with substance abuse or mental health issues, the challenge is even greater. According to a 2016 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), people in these communities have a similar — and often higher — need for these services as those in urban communities but “have less access to the behavioral health continuum of care than do people in urban areas.” SAMHSA says there are three key issues that play a role:


If patients don’t consider treatment to be “relevant, beneficial, and worthwhile,” they won’t seek treatment. In some communities, there may be a normalization of substance abuse and certain types of mental illness, such as depression. Lack of privacy and lack of culturally appropriate treatment both have a major influence on whether an individual will seek help.


Specialized services are usually lacking in hospitals and clinics, and qualified practitioners trained in using evidence-based practices (EBPs) often aren’t available.


Issues such as lengthy travel requirements, lack of transportation, and poverty make it difficult for individuals to access the needed services.

These factors contribute to a dangerous scenario for rural Americans who need behavioral health services, but can’t reach them. A recent infographic from the University of Southern California’s online MSW program highlights how prevalent the worst-case scenario of suicide has become:

  • Suicide now ranks as the 10th-leading cause of death in the United States.
  • Rates of suicide for rural populations are higher than in urban areas.
  • Rates of suicide in rural areas are increasing faster than rates in metropolitan areas.

The Impact of the Opioid Epidemic

Across America, the opioid epidemic is taking an incredible toll, especially in rural communities.

In these communities, the labor intensity of the workforce — many are employed in industries like agriculture and mining — contributes to increased work-related injuries. With the lack of complementary therapies, such as physical therapy, small-town providers have traditionally used opioids as a significant component of pain management.

However, if a patient begins to abuse these substances — a dynamic that is enhanced by the social networks within small communities — there is limited treatment available.

The Role of Telehealth

The good news is that technology is providing new ways to improve care in rural communities. The increased use of telehealth in rural areas has expanded the availability of all types of health care, especially treatment for substance abuse and mental health.

Using information and communication technologies (ICTs), such as videoconferencing, email, and text messaging, telehealth is helping to overcome the barriers to acceptability, availability, and accessibility that rural Americans face.

“Telehealth may be part of the solution to improving access to behavioral health services in rural areas and increasing the likelihood that individuals living in rural locations will engage with the behavioral health system,” notes SAMHSA in its report, “Rural Behavioral Health: Telehealth Challenges and Opportunities:”

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