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In 2016, about 60 million individuals, or 19.3% percent, of the United States (U.S.) population lived in rural areas (USCB, 2016). Also, 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, 2014). To illustrate, less 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 et al., 2012). Also, the 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 (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 et al., 2014). Furthermore, 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 (NHRA, 2017); (Douhit et al., 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).
A lack of providers, in addition to other challenges, has led to many states developing behavioral health aide’s models (Hecke, 2012). Alternatively, telehealth has been utilized. Varying definitions, policies, and regulations across states surround how telehealth has been used (CCHP, 2017). Telehealth, also known as telemedicine, has used technology to deliver healthcare services and clinical information through telecommunications technology (HRSA, 2013); (ATA, 2016); (AHRQ, 2016).