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Rural Race and Ethnicity

Inaccessible Mental Healthcare How Structural Inequalities Racialized Mental Health Access in Taos, New Mexico Aidan Bridge*, Morgan Montanez, Morgan Montanez,

Rural mental healthcare access is often framed as a problem of distance and provider shortages, but these explanations can obscure how policy decisions and structural inequalities produce racialized gaps in care. This paper examines barriers to mental healthcare in Taos County and the Town of Taos, New Mexico, during the COVID-19 pandemic, with attention to how historical trauma, internal colonization, and gentrification shape both need and access. Using secondary qualitative analysis of 58 semi-structured interviews collected in 2021 as part of Morgan Montañez’s dissertation research on rural inaccessibility in northern New Mexico, I analyze previously underexamined themes related to mental and behavioral health. Transcripts were coded using grounded theory techniques (Strauss and Corbin), including in vivo coding and subcoding focused on mental health service availability, affordability, and household coping strategies. Findings center on a pervasive “absence of care”: respondents describe limited or disappearing local programs, long waits, and long-distance travel for services—especially for psychiatric and medication management. Barriers are compounded by insurance status and the uneven availability of Medicaid-accepting providers, producing a stratified landscape in which more affluent residents can access private and alternative services while Taoseños face constrained options. In the absence of formal care, residents report reliance on informal supports, crisis lines with inconsistent responsiveness, and police intervention as a de facto mental health response—often escalating rather than resolving crises. I argue that these conditions reflect not only rural scarcity but the downstream effects of state-level behavioral health restructuring in the early 2010s and ongoing political-economic strategies that deepen racialized inequality. The paper concludes with implications for rural mental health policy, emphasizing culturally grounded, locally staffed services and infrastructure investments that address both access and historical trauma.