Rural areas of the United States continue to struggle to provide residents with adequate access to quality mental health care. Problems with adequately defining rurality for research and policy purposes, a shortage of qualified personnel, a lack of integration between primary-care and specialty mental health services, and stigma associated with mental illness have contributed to the mental health service crisis in rural areas. The assertion is made that psychologists can help to alleviate these problems through specialized training for rural service, the utilization of technology for service delivery, the dissemination of empirically supported treatments, and grassroots advocacy. Furthermore, the advantages and disadvantages of prescription privileges for psychologists and the unclear status of subdoctoral providers are discussed in terms of potential impact on rural areas. Finally, psychologists are encouraged to direct research efforts toward the development and implementation of novel solutions to the service problems in rural areas.

For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.

The large number of rural older adults suffering from untreated psychiatric illnesses suggests that stigma may be a significant barrier to the utilization of mental health services in this population. The current study examines self-stigma, public stigma, and attitudes toward specialty mental health care in a community sample of older adults living in a geographically isolated rural area, a rural area adjacent to a metropolitan area, and an urban area. One hundred and 29 older adults age 60 and above from the 3 geographic areas completed self-report measures of these constructs, and differences on the measures were assessed among the groups. Results indicated that older adults living in isolated rural counties demonstrated higher levels of public and self-stigma and lower levels of psychological openness than older adults in urban areas even after accounting for education, employment, and income. However, no differences emerged in reported willingness to use specialized mental health care in the event of significant distress. Results are discussed in the context of rural values, beliefs, and community structural factors. We further suggest that conventional binary rural/urban distinctions are not sufficient to understand the relationship between rurality and stigma.

Polypharmacy patients are the most likely to have drug-related problems and require intervention. Of all the interventions performed in this study, 73% of the original problems were recognized only through a patient interview, suggesting that an interpersonal relationship remains critical to the provision of pharmaceutical care. Although patients and physicians see intuitive value in pharmaceutical care, pharmacists need to exert more energy in the direction of marketing the profession. Finally, there are numerous difficulties in measuring the benefits of these interventions, possibly making broad-based interventions in complicated patients too difficult to assess accurately. Future studies should focus on patients with limited, specific problems or on interventions with narrow goals.

Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted veterans with a new diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) (n = 410,923). Veterans were classified as rural (categories 6-9; n = 65,044) or urban (category 1; n = 149,747), using the US Department of Agriculture Rural-Urban Continuum Codes. Psychotherapy encounters were identified using Current Procedural Terminology codes for the 12 months following patients' initial diagnosis. Findings: Newly diagnosed rural veterans were significantly less likely (P < .0001) to receive psychotherapy (both individual and group). Urban veterans were roughly twice as likely as rural veterans to receive 4 or more (9.46% vs 5.08%) and 8 or more (5.59% vs 2.35%) psychotherapy sessions (P < .001). Conclusions: Rural veterans are significantly less likely to receive psychotherapy services, and the dose of the psychotherapy services provided for rural veterans is limited relative to their urban counterparts. Focused efforts are needed to increase access to psychotherapy services provided to rural veterans with depression, anxiety, and PTSD.