DE-FACTO MENTAL-HEALTH-SERVICES IN THE RURAL SOUTH

Health care reform efforts highlighted the continuing scarcity of ment al health services for the rural poor. Most mental health services are provided in the general medical sector a concept first described by R egier and colleagues in 1978 as the defacto mental health service syst em, rather than through formal mental health specialist services. The defacto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature o f the de facto system in rural areas with large minority populations r emains largely unknown due to minimal available data. This article exa mines the availability, accessibility, and use of mental health servic es in the rural South and the applicability of the defacto model to ru ral areas. The critical need for data necessary to inform changes in h ealth care relative to rural mental health service delivery is emphasi zed.