Mental health care at the margins: bridging persistent access gaps in rural and underserved U. S. communities

Farhana Faruque Zerin; Hadeer Hegazy; Suhail Channar

doi:10.18203/2394-6040.ijcmph20262775

Authors

Farhana Faruque Zerin Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
Hadeer Hegazy Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
Suhail Channar Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20262775

Keywords:

Mental health care, U. S. communities, Persistent access gaps

Abstract

Mental health is a key component of public health, and access to behavioral health services remains uneven across the United States. Rural populations have higher rates of depression, anxiety, substance use disorders, and suicide, while they face limited access to mental health providers and services. These inequities are affected by structural, socioeconomic, and geographic factors, including economic instability, transportation barriers, and limited access to care, rather than differences in clinical need. Rural communities face ongoing difficulties due to provider shortages, inadequate mental health infrastructure, broadband inequities, and social stigma, which can hinder care-seeking behavior and exacerbate mental health outcomes. These barriers contribute to fragmented service delivery and diminished continuity of care for underserved populations.

Metrics

Metrics Loading ...

References

Stanley BJ. Trends in mental health care utilization in rural and nonrural areas, 2019-2023. J Rural Health. 2025;41(3):e70074. DOI: https://doi.org/10.1111/jrh.70074

Hoffmann JA, Attridge MM, Carroll MS, Simon NJ, Beck AF, Alpern ER. Association of youth suicides and county-level mental health professional shortage areas in the US. JAMA Pediatr. 2023;177(1):71-80. DOI: https://doi.org/10.1001/jamapediatrics.2022.4419

Hirsch JK, Cukrowicz KC. Suicide in rural areas: An updated review of the literature. J Rural Ment Health. 2014;38(2):65-78. DOI: https://doi.org/10.1037/rmh0000018

Fontanella CA, Hiance-Steelesmith DL, Phillips GS, Bridge JA, Lester N, Sweeney HA, et al. Widening rural-urban disparities in youth suicides, United States, 1996-2010. JAMA Pediatr. 2015;169(5):466-73. DOI: https://doi.org/10.1001/jamapediatrics.2014.3561

Shiner B, Gottlieb D, Rice K, Forehand JA, Snitkin M, Watts BV. Evaluating policies to improve access to mental health services in rural areas. J Rural Health. 2022;38(4):805-16. DOI: https://doi.org/10.1111/jrh.12674

Faruque F, Shah GH, Bohler RM. The association between social determinants of health and mental health status in the United States. Eur J Investig Health Psychol Educ. 2025;15(5):87. DOI: https://doi.org/10.3390/ejihpe15050087

Morales DA, Barksdale CL, Beckel-Mitchener AC. A call to action to address rural mental health disparities. J Clin Transl Sci. 2020;4(5):463-7. DOI: https://doi.org/10.1017/cts.2020.42

Stewart H, Jameson JP, Curtin L. The relationship between stigma and self-reported willingness to use mental health services among rural and urban older adults. Psychol Serv. 2015;12(2):141-8. DOI: https://doi.org/10.1037/a0038651

Cummins MR, Wong B, Wan N, Han J, Shishupal SD, Gouripeddi R, et al. Social vulnerability, lower broadband internet access, and rurality associated with lower telemedicine use in US Counties. JAMIA Open. 2025;8(4):ooaf056. DOI: https://doi.org/10.1093/jamiaopen/ooaf056

Ramesh T, McBain RK, Cantor JH, Stein BD, Yu H. Mental health outcomes among patients living in US counties lacking broadband access and psychiatrists. JAMA Netw Open. 2023;6(9):e2333781. DOI: https://doi.org/10.1001/jamanetworkopen.2023.33781

Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry. 2018;30(6):292-309. DOI: https://doi.org/10.1080/09540261.2019.1571483

Andrilla CHA, Patterson DG, Garberson LA, Coulthard C, Larson EH. Geographic variation in the supply of selected behavioral health providers. Am J Prev Med. 2018;54(6 Suppl 3):S199-207. DOI: https://doi.org/10.1016/j.amepre.2018.01.004

Garfan S, Alamoodi AH, Zaidan BB. Telehealth utilization during the Covid-19 pandemic: a systematic review. Comput Biol Med. 2021;138:104878. DOI: https://doi.org/10.1016/j.compbiomed.2021.104878

Counts N. Understanding the U.S. behavioral health workforce shortage. The Commonwealth Fund. Available at: https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage. Accessed on 18 May 2023.

Hung P, Negaro SN, Hantman RM, Boswell EK, Andrews CM, Odahowski CL. Access and quality of mental health services in rural and urban America. Rural Health Research Center. 2025. Available at: https://www.ruralhealthresearch.org/mirror/17/1722/access-quality-mental-health-services.pdf. Accessed on 18 May 2026.

Negaro SN, Hantman RM, Probst JC, Crouch EL, Odahowski CL, Andrews CM, et al. Geographic variations in driving time to US mental health care, digital access to technology, and household crowdedness. Health Aff Sch. 2023;1(6):qxad070. DOI: https://doi.org/10.1093/haschl/qxad070

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality. 2022. Available at: https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report. Accessed on 18 May 2026.

Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-57. DOI: https://doi.org/10.15585/mmwr.mm6932a1

Holmes S, Elliott T, Broman-Fulks J, Hutchinson C, Reagan K. Bridging the gap? Addressing mental health disparities in rural areas through telehealth implementation. J Rural Ment Health. 2026;50(1):3-11. DOI: https://doi.org/10.1037/rmh0000325

Curtis ME, Clingan SE, Guo H, Zhu Y, Mooney LJ, Hser YI. Disparities in digital access among American rural and urban households and implications for telemedicine-based services. J Rural Health. 2022;38(3):512-8. DOI: https://doi.org/10.1111/jrh.12614

Grenon S, Hoang KN, Luo S, Koch A. Adolescent mental health in rural settings: the role of artificial intelligence and community engagement. Front Public Health. 2025;13:1643466. DOI: https://doi.org/10.3389/fpubh.2025.1643466

Panchal N, Cox C, Rudowitz R. The landscape of school-based mental health services. KFF. Available at: https://www.kff.org/mental-health/the-landscape-of-school-based-mental-health-services/. Accessed on 11 September 2025.

Turi E, Courtwright SE, Dixon J, O'Neill I, Marchiano M, Poghosyan L. Primary care models and depression outcomes in rural adult populations: A systematic review. J Rural Ment Health. 2024;48(3):145-56. DOI: https://doi.org/10.1037/rmh0000261

Reist C, Petiwala I, Latimer J, Raffaelli SB, Chiang M, Eisenberg D, et al. Collaborative mental health care: A narrative review. Medicine (Baltimore). 2022;101(52):e32554. DOI: https://doi.org/10.1097/MD.0000000000032554

Cerimele JM, Blanchard BE, Johnson M, Russo J, Bauer AM, Veith RC, et al. Effectiveness of collaborative care and colocated specialty care for bipolar disorder in primary care: a secondary analysis of a randomized clinical trial. J Acad Consult Liaison Psychiatry. 2023;64(4):349-56. DOI: https://doi.org/10.1016/j.jaclp.2023.02.002

Weaver A, Lapidos A. Mental health interventions with community health workers in the United States: a systematic review. J Health Care Poor Underserved. 2018;29(1):159-80. DOI: https://doi.org/10.1353/hpu.2018.0011

Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3-e28. DOI: https://doi.org/10.2105/AJPH.2015.302987

Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: A conceptual model to address disparities in care. Annu Rev Clin Psychol. 2018;14(1):185-208. DOI: https://doi.org/10.1146/annurev-clinpsy-050817-084825

Mengell KA, Chikawa MM, Weinstein JN, Welch R, Smallwood SW, Hansen AR. A systematic review of rural community-based mental health interventions in the United States. J Ment Health. 2025;34(3):295-304. DOI: https://doi.org/10.1080/09638237.2024.2361229

Knowles M, Crowley AP, Vasan A, Kangovi S. Community health worker integration with and effectiveness in health care and public health in the United States. Annu Rev Public Health. 2023;44(1):363-81. DOI: https://doi.org/10.1146/annurev-publhealth-071521-031648

Langarizadeh M, Tabatabaei MS, Tavakol K, Naghipour M, Rostami A, Moghbeli F. Telemental health care, an effective alternative to conventional mental care: a systematic review. Acta Inform Med. 2017;25(4):240-6. DOI: https://doi.org/10.5455/aim.2017.25.240-246

Mack EA, Loveridge S, Keene T, Mann J. A review of the literature about broadband internet connections and rural development (1995-2022). Int Reg Sci Rev. 2024;47(3):231-92. DOI: https://doi.org/10.1177/01600176231202457

Rodriguez JA, Clark CR, Bates DW. Digital health equity as a necessity in the 21st century cures act era. JAMA. 2020;323(23):2381-2. DOI: https://doi.org/10.1001/jama.2020.7858

Huskamp HA, Busch AB, Souza J, Uscher-Pines L, Rose S, Wilcock A, et al. How is telemedicine being used in opioid and other substance use disorder treatment? Health Aff (Millwood). 2018;37(12):1940-7. DOI: https://doi.org/10.1377/hlthaff.2018.05134