STRENGTHENING RURAL BEHAVIORAL HEALTH SYSTEMS IN ARKANSAS: A SYSTEMS-ORIENTED REVIEW USING VETERANS TO EXAMINE BROADER SYSTEM CHALLENGES

Authors: Justin Works, Anita Sego, Stephanie Rose & Amy Tallents

ABSTRACT 

Rural Arkansas faces persistent behavioral health disparities, intensified by geographic isolation, workforce shortages, fragmented care systems, and limited access to specialized mental health and substance use services. Veterans living in rural communities often experience these barriers disproportionately because they frequently navigate multiple healthcare systems while facing elevated risks of suicide, substance use disorders, and co-occurring behavioral health conditions. This narrative review examines the behavioral health system factors that contribute to disparities in access, care coordination, and health outcomes across rural Arkansas using veterans as a population through which broader systemic challenges can be examined and understood. National literature is synthesized alongside Arkansas-specific policy documents, statewide surveillance reports, behavioral health system assessments, and findings from the Arkansas Veteran Well-Being Needs Assessment to identify barriers and opportunities for system improvement. Across the literature, behavioral health inequities consistently emerge from the interaction of workforce shortages, limited crisis response capacity, fragmented communication and care coordination, transportation barriers, cultural stigma, inadequate financing, and insufficient community-based infrastructure. Evidence further supports integrated behavioral healthcare, workforce recruitment and retention initiatives, expansion of community mental health and crisis services, telebehavioral health, strengthened data infrastructure, and cross-sector collaboration as key strategies for improving access and continuity of care. Arkansas has established a strong policy foundation through statewide behavioral health planning and investment in community- based services; however, significant opportunities remain to strengthen rural behavioral health systems, particularly for veterans and other underserved populations. A systems-oriented approach that integrates prevention, crisis response, coordinated care, workforce development, and continuous evaluation offers the greatest potential to reduce behavioral health disparities and improve long-term outcomes across rural Arkansas.

REFERENCES

  1. Arkansas Center for Health Improvement. (2025). Overview of the Rural Health Transformation Program in Arkansas. https://achi.net/publications/overview-of-the-rural-health-transformation-program-in-arkansas/
  2. Arkansas Department of Health, Injury and Violence Prevention. (2023). Suicides in Arkansas: Annual report 2023. https://healthy.arkansas.gov/wp-content/uploads/Suicide-Annual-Report-2023.pdf
  3. Arkansas Department of Human Services, Office of Substance Abuse and Mental Health. (2024). Office of Substance Abuse and Mental Health strategic initiatives plan 2024–2025. https://humanservices.arkansas.gov/wp-content/uploads/OSAMH-Strategic-Initiatives-Plan-2024-2025.pdf
  4. Arkansas Department of Human Services. (2024). Roadmap to a healthier Arkansas. https://humanservices.arkansas.gov/wp-content/uploads/Roadmap-to-a-Healthier-Arkansas-Report.pdf
  5. Baum, N., & King, J. (2020). The behavioral health workforce in rural America: Developing a national recruitment strategy. Center for Health and Research Transformation. https://www.healthworkforceta.org/wp-content/uploads/2023/07/BHWRC_The-Behavioral-Health-Workforce-in-Rural-America.pdf
  6. Bonfine, N., Blank Wilson, A., & Munetz, M. R. (2020). Meeting the needs of justice-involved people with serious mental illness within community behavioral health systems. Psychiatric Services, 71(4), 355–363. https://doi.org/10.1176/appi.ps.201900453
  7. Burns, A., Menachemi, N., Yeager, V. A., Vest, J. R., & Mazurenko, O. (2023). Adoption of best practices in behavioral health crisis care by mental health treatment facilities. Psychiatric Services, 74(9), 950–957. https://doi.org/10.1176/appi.ps.20220427
  8. Clarke, D. E., & Glick, I. D. (2020). The crisis in psychiatric hospital care: Changing the model to continuous, integrative behavioral health care. Psychiatric Services, 71(2), 165–169. https://doi.org/10.1176/appi.ps.201900259
  9. Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22(1), 438. https://doi.org/10.1186/s12913-022-07829-2
  10. Dickinson, W. P., Gritz, M., Knierim, K. E., Kirchner, S., Fernald, D. H., Gottsman, A., Wiggins, K., & Dickinson, L. M. (2025). Successful implementation of integrated behavioral health. Journal of the American Board of Family Medicine, 38, 107–118. https://doi.org/10.3122/jabfm.2024.240081R1
  11. Drake, R. E., & Bond, G. R. (2021). Psychiatric crisis care and the more is less paradox. Community Mental Health Journal, 57(7), 1230–1236. https://doi.org/10.1007/s10597-021-00829-2
  12. Guidehouse, Inc. (2024). Arkansas Community Mental Health Center study. Arkansas Department of Human Services, Office of Substance Abuse and Mental Health. https://humanservices.arkansas.gov/wp-content/uploads/CMHC-Report-final-04_26_2024.pdf
  13. Hallett, E., Simeon, E., Amba, V., Howington, D., McConnell, K. J., & Zhu, J. M. (2024). Factors influencing turnover and attrition in the public behavioral health system workforce: Qualitative study. Psychiatric Services, 75(1), 25–32. https://doi.org/10.1176/appi.ps.20220516
  14. Harris, B. R., & Gallant, K. C. (2023). In their own voice: Behavioral health care delivery barriers in rural New York. Journal of Rural Mental Health, 47(4), 221–231. https://doi.org/10.1037/rmh0000237
  15. Kallenberg, G. A., & Sieber, W. J. (2024). Integrated behavioral health plus: The best of the worlds of collaborative care management, primary care behavioral health, and primary care. Families, Systems, & Health, 42(3), 454–463. https://doi.org/10.1037/fsh0000885
  16. McGinty, E. E. (2023). The future of public mental health: Challenges and opportunities. The Milbank Quarterly, 101(Suppl. 1), 532–551. https://doi.org/10.1111/1468-0009.12622
  17. Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463–467. https://doi.org/10.1017/cts.2020.42
  18. Palomin, A., Takishima-Lacasa, J., Selby-Nelson, E., & Mercado, A. (2023). Challenges and ethical implications in rural community mental health: The role of mental health providers. Community Mental Health Journal, 59, 1442–1451. https://doi.org/10.1007/s10597-023-01151-9
  19. Rose, S., Works, J., Traw, S., Fronk, C., Smith, B., & Sego, A. (2026). Veteran well-being in Arkansas: A comprehensive needs assessment on suicide and addiction. International Journal of Research in Education Humanities and Commerce, 7(3), 44–64. https://doi.org/10.37602/IJREHC.2026.7304
  20. Stewart, R. W., Bowers, H., Brockie, T., Olsson, C. A., Fisher, P. A., Tandon, S. D., & Howard, J. T. (2021). Mental health and the NIMHD research framework in rural America. Journal of Clinical and Translational Science, 5(1), e163. https://doi.org/10.1017/cts.2021.833
  21. Treatment Advocacy Center. (2023). Arkansas state hospital system. https://www.tac.org/wp-content/uploads/2023/10/Arkansasbedsinformation.pdf