title: Understanding Treatment Gaps for Mental Health, Alcohol, and Drug Use in South Dakota: A Qualitative Study of Rural Perspectives.
abstract: More than 25% of US adults experience mental health or substance use conditions annually, yet less than half receive treatment. This study explored how rural participants with behavioral health conditions pursue and receive care, and it examined how these factors differed across American Indian (AI) and geographic subpopulations.
  
  
  
  We undertook a qualitative follow-up study from a statewide survey of unmet mental health and substance use needs in South Dakota. We conducted semistructured phone interviews with a purposive sample of key informants with varying perceptions of need for mental health and substance use treatment.
  
  
  
  We interviewed 33 participants with mental health (n = 18), substance use (n = 9), and co-occurring disorders (n = 6). Twenty participants (61.0%) lived in rural communities that did not overlap with AI tribal land. Twelve participants (34.3%) were AI, 8 of whom lived on a reservation (24.2%). The discrepancy between actual and perceived treatment need was related to how participants defined mental health, alcohol, and drug use "problems." Mental health disorders and excessive alcohol consumption were seen as a normal part of life in rural and reservation communities; seeking mental health care or maintaining sobriety was viewed as the result of an individual's willpower and frequently related to a substantial life event (eg, childbirth). Participants recommended treatment gaps be addressed through multicomponent community-level interventions.
  
  
  
  This study describes how rural populations view mental health, alcohol, and drug use. Enhancing access to care, addressing discordant perceptions, and improving community-based interventions may increase treatment uptake.
authors.affiliation: Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon.|Robert F. Wagner School of Public Service, New York University, New York, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Broffman
authors.affiliation: Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon.|Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.
authors.forename: Margaret
authors.initials: M
authors.lastname: Spurlock
authors.affiliation: Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dulacki
authors.affiliation: Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon.
authors.forename: Amy
authors.initials: A
authors.lastname: Campbell
authors.affiliation: Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon.
authors.forename: Fanny
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Center for Outcomes Research and Education, Providence Health & Services, Portland, Oregon.
authors.forename: Bill
authors.initials: B
authors.lastname: Wright
authors.affiliation: Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon.|Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.|Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.affiliation: Master of Public Health Program, North Dakota State University, Fargo, North Dakota.
authors.forename: Donald
authors.initials: D
authors.lastname: Warne
authors.affiliation: Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon.|Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D013023:South Dakota; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: alcohol abuse; drug abuse; mental health; policy; qualitative research