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This sociological review of the literature analyzes the delivery of psychiatric services in rural America. Nonsocial, demographic, socioeconomic, interpersonal, and ideological influences are considered. Factors encouraging change in the psychiatric service system (for example, shifting demographic realities, new environmental stimuli, and progressive attitudes toward social reform) contrast with, and vie against, factors favoring the status quo (for example, conservative attitudes, resistances to change, and limited resources). It is against this backdrop of instability that psychiatric service needs develop and are acknowledged--or effectively ignored--by the psychiatric service system in rural communities.
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