How States Can Boost Behavioral Health Services in Rural Communities

A new federal grant program may offer states throughout the U.S. an opportunity to expand and improve access to behavioral health services in rural communities as states prepare for the programmatic and budget implications of recent changes to federal Medicaid policy.

The Rural Health Transformation (RHT) Program, authorized as part of the congressional reconciliation bill passed in July 2025, will distribute a combined $50 billion to approved states over five years to improve health outcomes in rural areas. Importantly, states can use the funds to boost access to essential resources for people with substance use disorders and mental health conditions, including those at risk for suicide.  

Bolstering behavioral health care to prevent suicide and overdose deaths in rural communities is critical. Rural residents are at a higher risk for suicide than urban residents, and the suicide rate increased 48% in the nation’s rural areas from 2000 to 2018. Rates of prescription opioid and methamphetamine overdose deaths were higher in rural counties than in urban counties in 2020. And people who reside in less populated areas often face significant challenges to receiving adequate care—for instance, traveling long distances to reach a health care provider and/or lacking reliable transportation. Further, limited access to technology, such as reliable broadband internet service, can keep people from accessing a full range of telehealth services.

The RHT Program has the potential to address some of these issues and connect rural areas to essential behavioral health services. States could use these funds to:

1) Improve suicide screening and discharge protocols at rural hospitals.

For people experiencing suicidality—suicidal thoughts, plans, or actions—hospitals and other health care settings can provide lifesaving interventions. And a proven first step in achieving that is through universal screening, in which hospitals evaluate all incoming patients for suicide risk, regardless of their reasons for seeking care, and then connect at-risk patients to appropriate services. RHT funds could help rural hospitals expand the workforce and training needed to implement universal screening and effective discharge protocols—such as engaging in formal safety planning; offering counseling on removing objects that could be used in a suicide attempt, like firearms or medications, from patients’ environments (also known as lethal means counseling); and ensuring that patients receive warm hand offs to outpatient care—all of which are shown to reduce a patient’s risk of suicide.

2) Bolster telehealth services for substance use treatment.

Since the COVID-19 pandemic, telehealth treatment has been a lifeline for patients with opioid use disorder (OUD). Through virtual visits via video or phone, people from a wide variety of locations, abilities, and living situations have connected with health care providers to receive buprenorphine—an FDA-approved medication for OUD that significantly reduces the risk of overdose death. Helping providers expand telehealth capabilities could help rural health care facilities start treatment for and retain more patients with OUD.

3) Expand medication access in federally qualified health centers (FQHCs).

These federally funded community health centers serve individuals regardless of income and provided care to 1 in 5 rural residents in 2024, making them a critical access point for people with OUD in areas where specialty services may not be available. In recent years, FQHCs have worked to expand access to proven medications for OUD, but the treatments are still not available at all facilities. Research shows that more state funding could help health centers get these lifesaving medications to more people who need them.

4) Scale-up mobile opioid treatment programs (OTPs).

OTPs are the only health care facilities that offer all three medicines approved to treat OUD, including methadone, which is only available at OTPs and has proved to reduce the risk of overdose and help people stay in treatment. But many rural communities lack OTPs. Policymakers can address this disconnect by funding mobile OTPs. These traveling units bring health care providers and affordable treatment options directly into communities to meet people where they are, regardless of their location.

5) Increase naloxone access.

Naloxone is a safe and effective way to reverse an opioid overdose, and anyone can administer it—even without having any medical training. Policymakers can expand access to this lifesaving drug in rural areas by encouraging pharmacies to stock it, ensuring all emergency first responders carry it, and making it available in school and community settings.

With applications for RHT Program funding due Nov. 5, states looking for evidence-based interventions to improve behavioral health should consider using this opportunity to make an investment in their communities by implementing these and other strategies.  

Alexandra Duncan directs The Pew Charitable Trusts’ substance use prevention and treatment initiative, and Kristen Mizzi Angelone directs Pew’s suicide risk reduction project.