Rural Areas in the United States are Depleted of Youth-Serving Mental Health Facilities and Suicide Prevention Services

The spectrum of rurality has not been reflected in previous research on rural and urban youth mental health services and does not examine the availability of suicide prevention services. This study used 2 taxonomies of rurality to document the distribution of US mental health facilities that serve youth and offer suicide prevention services.

Youth living in highly rural areas of the United States, where rates of suicide are increased, had little access to suicide prevention services compared with urban areas. These findings, from a cross-sectional study, were published in JAMA Network Open.

Researchers from Washington State University used The Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator to extract data for 9475 mental health treatment facilities in the United States. Data about each facility was extracted from the National Mental Health Services Survey conducted between 2017 and 2019.

Urban classifications were on the basis of ZIP Code Tabulation Areas (ZCTAs). Counties were graded for level of urbanization on the basis of 2013 development from 1 (most urban) to 9 (most rural).

Among all 41,083 ZCTAs included in this study, 13.7% had a youth-serving mental health facility. Among ZCTAs with a facility, 3.9% were located in rural areas, 11.7% in micropolitan areas (areas that have at least one urban cluster of >10,000 and <50,000), 12.1% in metropolitan areas, and 15.0% in small towns (P <.001).

Of the youth-serving facilities, 3.0% of rural centers provided suicide prevention services which was significantly lower (P <.001) compared with facilities in metropolitan areas (7.9%), micropolitan areas (9.4%), or small towns (11.5%).

Among all 3223 counties included in this study, 63.7% had a youth-serving mental health facility. A smaller proportion of highly rural counties (score 8/9) had mental-health facilities (29.8%) compared with any county with a score >7 (>60%).

This study did not investigate the rates of facility use. Although access is an important factor to consider, rates of seeking help for mental health or for suicide prevention may not be constant throughout the US and may be a contributing factor for the discrepancy of suicide rates among youth in different urban areas throughout the country.

Distribution of youth-serving mental health facilities was similar among metropolitan, micropolitan, and small-town areas but significantly depleted in the most rural areas. As suicide rates are increased among young individuals living in urban areas, these data suggested that the rural areas are in need of increased access to suicide-prevention services.


Graves JM, Abshire D A, Mackelprang JL, et al. Association of rurality with availability of youth mental health facilities with suicide prevention services in the US. JAMA Netw Open. 2020;3(10):e2021471. doi: 10.1001/jamanetworkopen.2020.21471.