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Cuts can strike even harder in rural areas, where mental health services were spotty to begin with.

Christopher R. Larrison, a social work professor at the University of Illinois at Urbana-Champaign, tracks public funding for mental health and said outpatient treatment options in rural areas often vanish for good when they’re cut and don’t return when state finances improve.

“Many people in rural areas, they don’t leave their communities. They just don’t get served,” Larrison said. “This causes huge problems for police departments and emergency rooms, which have been taking cuts, too, and aren’t prepared to take over services for others.”

Mental health advocates hope that the federal health care overhaul taking effect after 2014 will help add services for the mentally ill _ but their hopes are dim that things will get better before then.

“It’s a bleak time across the board,” said Sarah Steverman, director of state policy for Mental Health America, an advocacy group that did not work on the NAMI study.