CRITICAL ISSUES IN REFORMING RURAL MENTAL-HEALTH-SERVICE DELIVERY

Critical issues in reforming rural mental health service delivery syst ems under health care reform are outlined. It is argued that the exclu sive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural areas, which shou ld focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural area s are delineated and three assumptions about the structure of rural co mmunities which are shaping the dialogue on rural health and mental he alth service delivery are examined. These assumptions include the noti on that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and th at rural dwellers represent a low risk population which can be effecti vely served through existing facilities and by extending existing serv ices.