Access to Mental Healthcare Providers as an Indicator for Fatal Drug Overdoses in Rural Tennessee, 2019-2021

Mental health conditions are common comorbidities seen in drug overdoses. Evidence has shown substance use disorder (SUD) and mental health conditions often share an origin cause and more successful treatment when addressed together, simultaneously (Buckley, Journal of Clinical Psychiatry, 67, 5, 2006). With fatal overdoses increasing annually and the large prevalence of mental health conditions in Tennessee (TN), our aim was to determine if lack of access to mental healthcare providers was associated with higher fatal overdoses with mental health comorbidities, particularly in rural TN. For our analyses, fatal drug overdoses in all of TN were captured by the State Unintentional Drug Overdose Surveillance System (SUDORS). Hospital Discharge Data System data was then linked to SUDORS cases for deaths among TN residents who had an autopsy between 2019 and 2021. Analysis was limited to decedents with a mental health condition determined through ICD-10 codes and autopsy reports. Descriptive statistics were calculated stratified by rural or urban and geographic mental health professional shortage area (MHPSA) or non-MHPSA based on county of residence. Chi-square tests were conducted to determine differences. Unadjusted and adjusted logistic regression were conducted to determine the relationship between living in a MHPSA and living in a rural county among drug overdose decedents with mental health conditions. We identified 2639 (48.4%) decedents with a mental health condition between 2019 and 2021 out of 5458 total overdoses. Overall, 30.2% of decedents with a mental health condition lived in a MHPSA and 18.6% lived in a rural county. Analyses found that a higher proportion of decedents with a mental health condition lived in a rural MHPSA (37.1%) compared to an urban MHPSA (10.6%). Decedents with a mental health condition in a rural county had greater odds of living in a MHPSA compared to decedents with a mental health condition in an urban county adjusting for age, sex, and race (aOR = 4.68; CI, 3.79, 5.78). Mental health conditions, drug overdoses, and SUDs are closely associated in TN. Rural residents of the state who live in a MHPSA are less likely to have sufficient access to providers to meet their needs. Future research should work to identify ways to reduce barriers to mental healthcare services throughout the state to ensure equity in healthcare access for all.