In the early 1980s, local affiliates of the National Mental Health Association in states with large rural populations began to notice sharp increases in incidences of suicide, family violence, alcohol abuse, depression, and other psychological and emotional problems. These problems may link to negative economic conditions in rural America. In 1987, the National Action Commission on the Mental Health of Rural Americans studied the issue by reviewing the research and data on the incidence and prevalence of psychological and emotional problems in rural America. Based on two hearings held by the Commission, this document describes the social economic changes and related mental health issues in 1980's rural America. The information was analyzed in the context of the existent mental health service system in rural America. A set of recommendations were made for improving access to mental health care for rural Americans and enhancing the quality of services available to this population. Eighteen recommendations are in five categories: (1) legislative and administrative changes for improving service delivery; (2) state-wide planning on funding rural mental health service and the lawful coverage of mental health insurances; (3) public education including training general caregivers and resource people, encouraging mental health service use by reducing the stigma placed on service facilities, and linking rural mental health agencies to school systems to provide information and assistance; (4) increasing funding to expand training and to secure placement of rural professional mental health personnel; and (5) targeting a significant portion of the funds of the National Institute of Mental Health on clinical and service research dealing with rural issues. (ALL)