The conditions of these partnerships are changing with radical shifts in the organization of health and mental health services due to changing health and mental health policies. The consumer movement has influenced rural mental health services but the voices of consumers and family members have played a relatively minor role in the literature. Specific groups within rural communities pose special needs. The migration away from rural areas has meant that many communities have a large proportion of elderly residents. The needs of children remain important as communities struggle to establish and maintain prevention efforts, to create effective treatment approaches, to support families, and to create mechanisms for coordination of care.
Cultural issues play a critical role in defining appropriate approaches.
Yet rural communities are part of an ever changing world. As gambling casinos bring economic prosperity to some Native American communities, for example, these social changes also create changing relationships within communities that pose ongoing challenges to the promotion of mental health. Substance abuse remains an important mental health problem in rural communities. Issues of substance abuse are compounded for some individuals who also suffer from various types of mental illnesses. Access to care has been an important concern in rural mental health.