Rural-Urban Disparities in Mental Health Access and Quality in the United States

This project addressed the following questions:

• Does access to inpatient, outpatient, and telehealth care for mental health services, and access to facilities offering substance use treatments, vary in urban and rural communities? How are inpatient psychiatric supply, outpatient mental health care settings, and telehealth supply for mental/behavioral health services distributed across rural/urban communities?
• Does inpatient psychiatric care quality differ between urban and rural facilities? Which facility characteristics and community characteristics are associated with quality of psychiatric care?
• Does outpatient care quality differ by residence rurality? What factors, such as proximity to a nearest outpatient mental health care unit, provider, and individual sociodemographic characteristics, are associated with variation in outpatient care quality?

This project employed two different knowledge generation approaches. First, using a systematic literature review, researchers summarized rural-urban disparities in mental health services across the following domains: spatial accessibility in driving distances (miles and minutes) to inpatient and outpatient mental health care and access to mental health facilities with telehealth capacities. Studies were included if they provided estimates and variation (e.g., confidence interval, standard error, standard deviation) on the distribution of any mental health domain among rural and urban residents or communities in the United States. Researchers identified the top three domain measures based on the calculated effect sizes of residence rurality.

Second, using multiple publicly available nationwide datasets, researchers profiled the extent of disparities in mental health access and care quality by residence rurality. Descriptive and multivariable regression analyses were employed to identify differential associations between rural/urban communities. Variance inflation factor was calculated to identify potential multicollinearity between independent variables.

Publications

• Access and Quality of Mental Health Services in Rural and Urban America
  Policy Brief
  University of South Carolina Rural Health Research Center
  Date: 07/2025
  Access to and quality of mental health facilities is a significant concern in the United States. This research identified disparities in mental health access and care quality by residence rurality.
• Geographic Variations in Driving Time to U.S. Mental Health Care, Digital Access to Technology, & Household Crowdedness
  Journal Article
  University of South Carolina Rural Health Research Center
  Date: 12/2023
  This study compared travel time to mental health facilities in rural versus urban areas and potential barriers to digital devices for telemedicine access in those same rural/urban locations. In addition, the research examined private space within the home as it relates to household crowdedness.
• Rural-Urban Disparities in Quality of Inpatient Psychiatric Care
  Journal Article
  University of South Carolina Rural Health Research Center
  Date: 11/2022
  Using data from the Inpatient Psychiatric Facility Quality Reporting program 2015-2019, this study examined differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals.