Behavioral Health in Rural America: Challenges and Opportunities

John Gale MS, University of Southern Maine, Muskie School, Maine Rural Health Research Center
Jaclyn Janis BSN, RN, MPH, University of Southern Maine, Muskie School
Andrew F. Coburn PhD, University of Southern Maine
Hanna Rochford MPH

This report was prepared by the RUPRI Health Panel: Keith J. Mueller, PhD; Alana Knudson, PhD; Jennifer P. Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; and Timorthy D. McBride, PhD. Support was provided by the Leona M. and Harry B. Helmsley Charitable Trust grant number 2017PG-RHC006. We would like to thank Paula Weigel, PhD, and Karen Pearson, MLIS, MA, for their research and contributions to this document. We also thank Sue Nardie for helpful editing of this document.

For more information, please contact John Gale (


This paper provides an overview of behavioral health (BH) in rural America. The goal is to help rural leaders and providers understand the issues related to rural mental health (MH) and substance use (SU) and give them resources and tools to develop targeted strategies to address the unique needs of their communities. In the first section, we discuss the prevalence of behavioral health disorders (BHDs) in rural populations generally and among certain high-risk population groups (e.g., veterans, children). We then review what is known about rural access to BH services, focusing on the challenges of providing prevention, treatment, and recovery services in rural areas. The third section focuses on promising program and policy strategies that have been tested in rural communities targeting improvements in rural BH systems. We conclude with a discussion of opportunities for policy and system changes to improve rural BH systems and outcomes.

Executive Summary available as a separate document: