Rural-urban differences in psychiatric status and functioning among clients with severe mental illness

Studies of clients with severe mental illness (SMI) typically focus on individuals in larger urban areas. Less is known about clients in rural and smaller urban areas. Here we compare the psychiatric status, home and community activities of daily living, and social and vocational functioning of 1600 adult clients with SMI from 18 small-city and rural Wisconsin counties. Rural clients are less likely to have a diagnosis of schizophrenia or organic brain syndrome; have higher levels of general pathology, including more belligerent, bizarre, nervous, and depressive behaviors; and engage in fewer vocational activities than urban clients.