Violent and destructive behavior among the severely mentally ill in rural areas: evidence from Arkansas' community mental health system.

A comparison of rates of violence among admissions to the Arkansas State Hospital system between urban and rural areas tested the hypothesis that thresholds for admission to the hospital were greater in rural than in urban areas. Data on violent and destructive behavior were recorded from the medical records of 609 patients. Logistic regression was used to model the presence or absence of violent behavior in urban and rural admissions controlling for selected demographic and clinical characteristics. Results indicated that rural patients showed increased likelihood of violent and destructive behavior prior to admission supporting the hypothesis that barriers to mental health services in rural areas may be creating differential thresholds of service access and utilization. The increased rate of violence was particularly evident in those using substances prior to admission in rural areas suggesting that community management of the violent, substance abusing patient may be particularly difficult for rural areas.