The emergency department (ED) may be an important gateway to care for both mental health (MH) and substance abuse (SA). However, there is concern around the over reliance on the ED for MH and SA services with focus on lack of resources, cost of care, quality of care, increased waiting times, and overcrowding. Understanding who is using the ED more often for both MH and SA may allow communities to identify preventive services for these individuals, reducing the strain on EDs, and providing more relevant, appropriate, and less costly care. This study helps identify trends among women in rural and urban communities who utilize the ED for MH/SA.