Behavioral health in a rural setting: Understanding access, availability and acceptability of care and services

Behavioral health outcomes are often worse in rural areas than in urban areas. Unfortunately, there is also a shortage of behavioral health professionals across the nation. Rural areas especially suffer from this shortage, coupled with their already scarce resources. Of the behavioral health services that do exist, they are often ridiculed as being low-quality and unavailable to residents. Furthermore, there is a negative stigma that surrounds behavioral health care that is only amplified in rural areas. This dissertation focuses on behavioral health and behavioral health care in rural California, as 13%of the state’s population live in rural areas. First, I examine Emergency Department (ED) utilization by adolescents seeking behavioral health care. Quantitative methods are used to compared ED utilization in both urban and rural areas of California. Second, I qualitatively observe a specific behavioral health program, Behavioral Health Court, which serves incarcerated individuals in a rural Sierra Nevada county. The written program guidelines are compared to client and staff perceptions of these program guidelines. Finally, using both quantitative and qualitative methods, I survey and observe residents of a rural community to understand their perceptions of behavioral health and behavioral health care. Results indicate that access to quality behavioral health care, availability of trusted behavioral health care and acceptance of receiving behavioral health care are all of concern to rural California and its residents. Implications of improving access and availability through modern technologies (such as telemedicine), forming networks of care to address lack of funding, and the development of educative social marketing campaigns from a public health perspective are discussed. Future research should consider further assessing behavioral health care in rural areas to gain a more comprehensive understanding of such care with respect to access, availability and acceptability