taken, if needed, to ensure sufficient financial stability for rural health care delivery systems to undertake the desired changes described in this report.

The Funding of Rural Mental Health and Substance Abuse Services

Given the shortages of mental health and substance abuse providers in rural areas, the committee concludes that a comprehensive assessment is needed of the availability of mental health and substance abuse services in rural areas (recognizing that another IOM committee is currently exploring the implications of the Quality Chasm report for the field of mental health and addictive disorders).

Recommendation 7. The Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration should conduct a comprehensive assessment of the availability and quality of mental health and substance abuse services in rural areas. This assessment should cover services provided in both primary care and specialty settings, and should include the following:

  • A review of (1) the various insurance and direct service programs in the public and private sectors that provide financial support for the delivery of mental health and substance abuse services and (2) the populations served by these payers and programs.

  • An evaluation of the adequacy of current funding and an analysis of alternative options for better aligning the various funding sources and programs to improve the accessibility and quality of these services. Attention should be focused on identifying and analyzing options designed to encourage collaboration between primary care and specialty settings.


Barry CL, Gabel JR, Frank RG, Hawkins S, Whitmore HH, Pickreign JD. 2003. Design of mental health benefits: Still unequal after all these years. Health Affairs 22(5):127–137.

BDO Seidman. 2003. A Report on Shortfalls in Medicaid Funding for Nursing Home Care. Washington, DC: American Health Care Association.

Bird DC, Dempsey P, Hartley D. 2001. Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges. Portland, ME: Edmund S. Muskie School of Public Service, Maine Rural Health Research Center.

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