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This retrospective study compared the clinical and sociodemographic characteristics of inpatient psychiatric admissions in a west Texas behavioral health treatment facility before and during the coronavirus disease 2019 pandemic. The treatment facility serves the Texas panhandle and its surrounding rural regions. Results showed that the pandemic was significantly associated with a longer length of hospital stay and an increase in admissions with a documented history of psychiatric medication use and substance use, as well as suicidal ideation/behavior. Significant differences also were found in employment status, living situation, and ethnicity between the prepandemic and pandemic periods. Objectives: The association between the coronavirus disease (COVID-19) pandemic and adverse mental health outcomes has been well documented; however, little is known about its impact in rural areas of the United States. This study aims to characterize and compare inpatient psychiatric admissions in West Texas before and during the initial months of the COVID-19 pandemic. Methods: A retrospective study was conducted using the electronic health records of 1392 inpatient psychiatric admissions from period A (March 13, 2019–July 3, 2019) to period B (March 13, 2020–July 3, 2020). Results: During period B, there was a significant increase in the length of stay (P < 0.01) compared with period A. The pandemic was associated with an increased history of psychiatric medication use (P < 0.01), substance use (P ≤ 0.01), and suicide risk at the time of admission (P < 0.01). Significant differences were found in employment status (P < 0.01), living situation (P < 0.01), and ethnicity (P = 0.03). Conclusions: Rural communities in West Texas experienced a decrease in psychiatric hospitalizations during the beginning of the COVID-19 pandemic, followed by an increase as lockdown restrictions began to lift; this warrants further investigation into healthcare service utilization during the pandemic. [ABSTRACT FROM AUTHOR]