In rural areas of the United States (US), the incidence of suicide among youth (≤12 years) increased 15.2% annually from 1999 to 2018, nearly double the increase observed in urban areas (8.3%). Lower provider density is associated with higher suicide rates. This study aimed to document disparities in the geographic distribution of mental health facilities that serve US youth.

Methods

Facility data were obtained from the Substance Abuse and Mental Health Services Administration (2019). Facilities serving youth were defined as those that accept youth (≤12 years) for treatment. Rurality was classified by zip code into four levels: metropolitan, micropolitan, small town, and rural. We calculated the proportion of zip codes with ≤1 facility and≤1 youth-serving facility. Proportions were calculated across rurality and compared using chi-squared tests.

Results

Across the 30,347 US zip codes, 18.6% had any mental health facility; 14.9% of zip codes had a facility serving youth. Significant disparities existed across geography: 5.1% of rural zip codes had any facility, compared to 17.6-23.1% of the more urban zip codes (p<0.01). Similarly, 4.5% of rural zip codes had a youth-serving mental health facility, compared to 18.8%, 15.4%, and 17.6% of small town, micropolitan, and metropolitan zip codes, respectively (p<0.01).

Conclusions

Rural youth have significantly limited access to mental health facilities compared to more urban-dwelling peers. Given that higher rates of suicide deaths have been documented among rural-residing youth, it is imperative that access to services match community needs. Mental health care should be accessible to youth regardless of geography.