Rural-Urban Differences in Child and Adolescent Access to and Receipt of Mental Health Services Prior to and During the COVID-19 Pandemic: Results From the National Survey of Children's Health


This study fills a critical gap by comparing rural-urban differences in access to and receipt of mental health services to evaluate the impact of the COVID-19 pandemic on service accessibility and utilization in different geographic settings. This policy brief analyzes data from a large, national sample of children and adolescents to examine gross inter-group similarities and differences and offer timely considerations for alleviating the youth mental health crisis.

Key Findings

  • Both urban and rural children had greater difficulty accessing mental health services during the pandemic (July 2020 – January 2021) than they did prior to the pandemic (2018-2019).
  • Access to insurance coverage for mental health services improved during the first year of the COVID-19 pandemic for both urban and rural children, but greater than a third of all caregivers continue to report insufficient coverage.
  • Rural and urban children were equally likely to receive mental health services prior to and during the COVID-19 pandemic.
  • Amongst children with mental health conditions, rural children were less likely to take psychiatric medication than urban children, and this remained unchanged during the first year of the pandemic.
Rural and Minority Health Research Center
Kristen Figas, Theodoros Giannouchos, Elizabeth Crouch