De facto mental health services in the rural south

J Health Care Poor Underserved. 1995;6(4):434-68. doi: 10.1353/hpu.2010.0003.


Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto 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 of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Aged
  • Attitude to Health
  • Female
  • Health Care Reform / legislation & jurisprudence
  • Health Services Accessibility
  • Humans
  • Male
  • Medically Underserved Area*
  • Mental Disorders / epidemiology
  • Mental Health Services / organization & administration*
  • Mental Health Services / standards
  • Middle Aged
  • Rural Health Services / organization & administration*
  • Rural Health Services / standards
  • Social Environment
  • Southeastern United States / epidemiology