<p>There is a dose–response relationship between the incidence of psychiatric issues and poverty. To better understand disparities related to extreme poverty and inequality, this study aims to investigate whether there is a difference in mental health services between counties identified as persistent poverty counties and those not identified. Data from the National Survey on Substance Abuse and Mental Health Services and the U.S. Census American Community Survey were analyzed. A random-effects logit regression analysis was performed to determine the likelihood of access to various types of mental health facilities, behavioral health services, medical services, screening services, emergency services, and ancillary services. Adjusted regression results revealed that persistent poverty county status was associated with a lower likelihood of residential facility services (<i>OR</i> = 0.65, 95% <i>CI</i> 0.45, 0.96), a higher likelihood of medication use (<i>OR</i> = 1.58, 95% <i>CI</i> 1.20, 2.09), and a higher likelihood of ancillary services (<i>OR</i> = 1.10, 95% <i>CI</i> 1.05, 1.16), especially chronic disease management, housing, intensive case management, and peer support. Meanwhile, fewer trauma-related treatments were available in these counties. A subsample of rural counties showed similar results. Mental health providers in persistent poverty counties were less likely to offer residential and behavioral health services and more likely to provide medication and ancillary services. Implications for mental health policy and practitioners are discussed.</p>