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. Cultural codes, lack of services and trained professionals, distance, and economic problems have compounded problems of access. At the same time, changing organizational patterns under the rubric of managed care now pose new challenges. The movement of managed care has changed the vocabulary of mental health services.