Mental health service utilization in rural areas nationally in the Veterans Health Administration.

Abstract

There has been increasing concern that rural Americans are at high risk for mental health problems but have limited access to mental health services. The Veterans Health Administration (VHA) is responsible for providing equitable care to all eligible veterans and thus offers a unique opportunity to identify systemic propensities for inequitable provision of specific mental health services in rural areas. This article compares the utilization of services in rural and urban areas nationally in the VHA. Zip codes from VHA administrative databases and rural-urban commuting area codes were used to classify all Fiscal Year 2012 VHA service users into those living in urban, large rural, small rural, and isolated rural communities. Because of large sample sizes, effect sizes (risk ratios and Cohen’s d) rather than p values were used to identify substantial group differences in sociodemographic characteristics, diagnoses, and measures of service use (especially subtypes of mental health service use). The results demonstrate that of 5,252,056 VHA service users, 1,563,680 (29.8%) were from the three non-urban areas and altogether 1,332,001 (25.4%) used specialty mental health services. There were few substantial demographic or diagnostic differences between rural and urban veterans but notably veterans in rural areas were less likely to have substance use diagnoses and substantially less likely to receive subspecialty mental health services such as intensive case management, psychosocial rehabilitation, and homeless services. These results suggest that rural and urban VHA service users make similar use of mental health services overall but those disparities primarily affect sub-specialty mental health services. (PsycInfo Database Record (c) 2025 APA, all rights reserved)