Building the rural mental health system: from De Facto system to quality care.

About 20% of Americans live in rural America, yet the rural mental health infrastructure has yet to be firmly established. This is due in part to a pervasive belief about the tranquility of rural places and the relatively stress-free environment that they produce. In this chapter an adaptation of the Rural De Facto Mental Health Systems Model produced by Fox and her associates at the Southeastern Rural Mental Health Research Center is presented and used to organize the scientific state of the field of rural mental health services research. As many nurses have stood at the forefront of that research, the research of several prominent rural mental health nurse researchers and the innovative research they have produced are reviewed. The chapter concludes with a discussion of research that is needed to move the science of rural mental health services research forward, as well as a discussion of policy initiatives that may be necessary to foster the development and implementation of that research agenda.