Mona M. Counts, Ph.D., CRNP, FNAP, FAANP
American Academy of Nurse Practitioners
John A. Gale, MS
National Rural Health Association
Leonard J. Haas, Ph.D.
American Psychological Association
Nancy J. Kennedy, Dr.P.H.
Substance Abuse and Mental Health Services Administration
Kathleen A. Rounds, Ph.D., MPH, MSW
National Association of Social Workers
The Secretary's Rural Health Task Force identified access to mental health services as a priority problem in rural areas. Rural residents with mental health problems (including substance abuse) often suffer disproportionately due to shortages of available specialty mental health services, effects of stigma, and other barriers. Local primary care delivery systems provide much of the mental health care in rural communities. The Department of Health and Human Services (DHHS) and other federal agencies have invested significant resources in developing programs and tools to enhance the capacity of primary care providers to assess, refer, and treat people with mental health needs. Our initiative focuses on collecting and packaging the various tools, programs, and models that have been developed; identifying and addressing the barriers to integration of primary care and mental health services; and creating incentives to encourage states to promote integration in rural communities with the greatest need.
Rural Health Care Realities
Twenty percent of the U.S. population (70 million Americans) live in rural areas. Rural communities exhibit incredible diversity. Local delivery systems vary in their levels of integration, and the demands made upon them. Although nationally the rate of rural and urban mental health problems are similar, the prevalence of these problems varies among rural communities based on the specific composition of their population. Local delivery systems need assistance understanding the impact of this variation in their communities and organizing their resources to best meet local needs.
The Role of Primary Care in the Delivery of Rural Mental Health Services
Every year, approximately 20% of adults and children in the United States are diagnosed with a mental disorder. Rural residents are more likely to receive mental health services from their primary care providers. Consumers find primary care delivery systems to be less stigmatizing than the specialty mental health sector and more easily accessible.
Rural Mental Health Care and System Integration
Rural mental health care is generally delivered by a fragmented and non-integrated assortment of providers and services. Each (including primary care, specialty mental health, human services, and support networks) has a role to play in serving rural residents and can be a potential access point to the local delivery system. Each must serve as a door to the entire system.
Existing Initiatives
DHHS has a number of initiatives to support the role of primary care providers in the delivery of mental health services. For example, Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid Services (CMMS) provide incentives to community health centers and rural health clinics to deliver mental health services to people living in medically underserved areas. HRSA and Substance Abuse and Mental Health Services Administration (SAMHSA) have convened four summits in 23 states to help providers and communities to develop and implement plans to integrate local mental health and primary care services. The Department of Veterans Affairs has developed screening and assessment tools and treatment protocols for primary care providers to improve their ability to identify and treat mental health problems.
We recommend that the Secretary:
Through the use evidence-based assessment tools and treatment protocols as well as grassroots development efforts, communities can enhance their capacity to provide mental care by building upon their unique combination of strengths and resources and by targeting existing barriers to service. States can support these efforts by serving as advocates for rural mental health services and elevating the understanding of rural issues that is often absent in discussions of mental health policy.