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The National Institute of Mental Health reported in 2017 that approximately 50 million adults living in the United States (U.S.) had a mental illness and, only half received treatment (NIMH, 2020). According to the search and recruitment firm Merritt Hawkins & Assoc., Psychiatry has been one of the most requested specialties, occupying the second place on 2016, which has revealed a lack of these specialists to serve the population that has required it on various areas of the U.S. (Merritt Hawkins, 2017). Access needs to care, and treatment of people on issues related to mental illness have increased due to factors such as the crisis in the use of opioids, for which it is estimated that by 2025, the number of existing psychiatrists may only be a third of what will be required (NCBH, 2017).
In 2016, about 60 million individuals, or 19.3% percent, of the U.S. population lived in rural areas (USCB, 2016). According to the U.S. Census Bureau, a rural area, is any population, housing, or territory not defined as an urbanized area or urbanized cluster. An urbanized area contains 50,000 or more individuals, and an urban cluster has at least 2,500 but less than 50,000 people (USCB, 2016). Rural areas have experienced higher than average healthcare workforce shortages, which have limited access to healthcare services (RHIhub, 2014Less than 10 percent of physicians have practiced in rural areas, although 20 percent of the U.S. population is located in rural communities (Stanford School of Medicine, 2010). Also, geographic constraints have been a challenge. Residents have traveled considerably to access different and often limited services, and some patients reported a substantial burden on time and money (Smalley, Warren, & Rainer, 2012) Furthermore, lack of public transportation, distance, hazardous weather conditions, and environmental issues have been among other challenges exacerbated in this environment (Eberhardt, & Pamuk, 2004).
For urban and rural areas, the incidence and prevalence of most behavioral disorders have been comparable (van Hecke, 2012). A study conducted in 2014 found no significant difference in incidence or prevalence for major depression or severe mental illness (SMI) in large metropolitan and rural areas (Breslau, Marshall, Pincus, & Brown, 2014). Moreover, a 5.6 percent prevalence of major depression and SMI was found in large metropolitan areas, while a 6 percent prevalence of major depression and SMI was found in rural areas. Also, rural areas have had limited availability for mental health services (NRHA, 2017) ;(Douthit, Dwowlatzky, & Biswas, 2015). As of June 2018, 53.1 percent of the mental health provider’s shortage areas were in non-metropolitan areas (HRSA, 2018). Thus, rural residents were less likely to receive treatment (Eberhardt & Pamuk, 2004). This fact has led to healthcare disparities between rural and urban residents (NRHA, 2017).