Many factors require unique consideration of rural mental health issues. All of these factors point to a much different reality than that of more urban counterparts and many of the factors relate to geography. A myriad of issues surround geography including: separation from road systems, creating access barriers for most goods and services; higher cost for transportation, goods and services; and the isolation experienced by rural Alaskans.

Mental health service provision in villages and rural communities is very different than in urban Alaska. Mental health services are more scarce, with many villages having no mental health-related services or a single paraprofessional to address all human service needs. Rural and village mental health service providers feel enormous responsibility for community wellbeing, yet are often cut off from outside forms of support. Efforts to increase mental health services through Medicaid refinancing have not been effective and applicable to rural Alaska, which has increased concerns about the inequitable distribution of resources to rural Alaskan communities.

Special efforts are needed to address the unique mental health needs of rural Alaska. Efforts should based on a strengths perspective, emphasize culturally-based service models and enhance programs that have demonstrated success, such as the Rural Human Services Worker Program. At the same time, the extent and interrelation of significant social issues (domestic violence, sexual assault, mental health, alcoholism/drug abuse, suicide) in rural communities needs to be recognized; integrated program approaches that address the interrelation of these issues need to be promoted and enhanced. When these approaches are combined with adequate resources and more effective networking between rural and urban communities, significant improvements will result in the mental health of rural Alaska.