Mental health

Publications

Alphabetical list. You can also view by publication date.

Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems
Date: 10 / 2010
Author(s): Jennifer D. Lenardson, Erika C. Ziller, David Lambert, Melanie M. Race, Anush Yousefian
Research center: Maine Rural Health Research Center
Topics: Children, Mental health
Report Number: #45
Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care.
Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges
Date: 10 / 2001
Author(s): Donna C. Bird, Patricia Dempsey, David Hartley
Research center: Maine Rural Health Research Center
Topics: Mental health, Workforce
Report Number: Working Paper No. 23
Reviews efforts to address mental health workforce needs in underserved rural areas and addresses three questions: 1) How is health and mental health workforce adequacy currently measured? 2) How do unique characteristics of rural communities and the mental health service delivery system challenge current methods for determining workforce adequacy? 3) What role has the federal government played in addressing health and mental health workforce needs in underserved rural areas? Finds that current workforce adequacy measurements all focus on physicians and are limited by the lack of a commonly accepted way to obtain needed data and by widely varying estimates of adequate population-to-provider ratios. In addition, the pluralistic and minimally coordinated nature of the mental health services system makes it difficult to translate methods for estimating workforce adequacy from health to mental health. Finally, there are several federal efforts to address workforce needs that foster training, provide scholarships, fund demonstration programs, and allow foreign medical graduates to serve in underserved areas. Makes several recommendations pertaining to the collection of data, field-testing of estimation models, and increasing the supply of mental health service providers.
Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers
Date: 08 / 2009
Author(s): Mimi McFaul, Jim Ciarlo, Jean Demmler, Christa Smith, Tamara DeHay
Research center: WICHE Center for Rural Mental Health Research
Topics: Frontier health, Mental health
Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. Includes a Suicide Prevention Toolkit for rural primary care providers.
Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents with Dementia (Research & Policy Brief)
Date: 09 / 2001
Author(s): Elise J. Bolda, Kimberly Mooney Murray
Research center: Maine Rural Health Research Center
Topics: Long term care, Mental health
Assesses whether the potentially higher utilization of nursing facility services in rural communities can be attributed to differences in use patterns by older adults with dementia. Specifically, addresses the question of whether rural nursing facility residents with dementia are less impaired at the time of their admission to a nursing facility than urban residents with dementia.
Are Advanced Practice Nurses A Solution To Rural Mental Health Workforce Shortages?
Date: 04 / 2004
Author(s): David Hartley, Valerie Hart, Nancy Hanrahan, Stephenie Loux
Research center: Maine Rural Health Research Center
Topics: Mental health, Nurses, Workforce
Report Number: Working Paper No. 31
Summarizes the clinical skills and prescriptive authority of Advanced Practice Psychiatric Nurses (APPNs), and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs. Includes information on prescription authority and collaboration requirements for each state, as well as state distribution of APPNs.
Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper)
Date: 02 / 2010
Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief)
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief)
Date: 03 / 2010
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Research center: WICHE Center for Rural Mental Health Research
Topics: Health insurance and the uninsured, Mental health
Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper)
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief)
Date: 05 / 2009
Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.
Community-Level Risk Factors for Depression Hospitalizations
Date: 09 / 2005
Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost
Research center: WICHE Center for Rural Mental Health Research
Topics: Mental health, Rural statistics and demographics
Report Number: Working Paper
Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
Date: 09 / 2005
Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
Research center: WICHE Center for Rural Mental Health Research
Topics: Mental health, Rural statistics and demographics
Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
Depression in Rural Populations: Prevalence, Effects on Life Quality, And Treatment-Seeking Behavior
Date: 05 / 2005
Author(s): Janice C. Probst, Sarah Laditka, Charity G. Moore, Nusrat Harun, M. Paige Powell
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Mental health
Using the National Health Interview Survey and the NHIS-administered depression scale from the Comprehensive International Diagnostic Interview to explore depression among rural versus urban residents, the authors found that the prevalence of major depression was significantly higher among rural (6.11%) than among urban (5.16%) populations. However, nearly all individuals scoring positive for depression reported that their symptoms interfered with their life or activities (46.67% rural, 44.25% urban). Persons without any health insurance were less likely to have communicated with a physician than were the privately or publicly insured. Additionally, the likelihood that an individual with depression would have communicated with a practitioner rose as the person's self reported health declined.
Depression in Rural Populations: Prevalence, Effects on Life Quality, and Treatment-Seeking Behavior (Fact Sheet)
Date: 2005
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Mental health
To explore the prevalence of selected mental health diagnoses across rural populations, including rural minority residents, they studied information obtained by the 1999 National Health Interview Survey (NHIS), a nationally representative survey of more than 30,000 U.S. adults.
Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers
Date: 10 / 2009
Author(s): Scott J. Adams, Stan Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topics: Children, Mental health, Pharmacy and prescription drugs
Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers.
Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
Date: 09 / 2005
Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
Date: 2006
Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Citation: Journal of Rural Health, 22(4), 343-350
Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast
Date: 08 / 2009
Author(s): Mimi McFaul, Dennis Mohatt, Jim Ciarlo, John M. Westfall
Research center: WICHE Center for Rural Mental Health Research
Topics: Mental health, Technology
Primary care providers (PCPs) are often the first and only resource for rural and frontier residents needing mental health care. Training on mental health issues is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient alternative for PCPs to obtain the information they need to treat the mental health needs of their patients.
Effects of Race and Poverty on Perceived Stress Among Rural Women
Date: 2005
Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley
Research center: South Carolina Rural Health Research Center
Topics: Mental health, Minority health, Poverty, Women
Citation: Coward RT, Davis LA et al, Eds., Rural women's health: Mental, behavioral and physical issues. p. 197-215. New York, NY: Springer Publishing Company
Encouraging Rural Health Clinics to Provide Mental Health Services
Date: 05 / 2010
Author(s): John Gale, David Hartley, Barbara Shaw, Stephanie Loux
Research center: Maine Rural Health Research Center
Topics: Mental health, Rural Health Clinics (RHCs)
This study examined changes in the delivery of mental health services by Rural Health Clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings:
- Approximately 6% of independent and 2% of provider-based RHCs offer mental health services.
- 38% of study RHCs reported their mental health services were not profitable but continued to provide them in response to community and patient needs.
- An important factor in the development of RHC mental health services is the presence of a local champion who spearheads the development effort.
Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers
Date: 10 / 2006
Author(s): David Lambert, John Gale
Research center: Maine Rural Health Research Center
Topics: Federally Qualified Health Centers (FQHCs), Mental health
Citation: Kansas City, MO: National Rural Health Association
Provides information on models for integrating mental health services in rural community health centers, viability of linkages between primary care and mental health providers, resources available, reimbursement, treatment philosophy, diversification, referral and enhancement. Available for purchase.
Medicaid Managed Behavioral Health in Rural Areas
Date: 01 / 2001
Author(s): David Lambert, John Gale, Donna Bird, David Hartley
Research center: Maine Rural Health Research Center
Topics: Medicaid and S-CHIP, Mental health
Report Number: Working Paper No. 24
Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
Medicaid Managed Behavioral Health Programs in Rural Areas (Research and Policy Brief)
Date: 08 / 2001
Author(s): David Lambert, John Gale, Donna Bird, David Hartley
Research center: Maine Rural Health Research Center
Topics: Medicaid and S-CHIP, Mental health
Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services.
Mental Health and Rural America: 1994-2005
Date: 2006
Author(s): Dennis Mohatt, Scott J. Adams, Mimi M. Bradley, Chad A. Morris
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Includes an annotated bibliography.
Mental Health Care in Rural Communities: the Once and Future Role of Primary Care
Date: 2006
Author(s): John A.Gale, David Lambert,
Research center: Maine Rural Health Research Center
Topics: Health services, Mental health
Citation: North Carolina Medical Journal, 67(1), 66-70
Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas.
Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
Date: 09 / 2005
Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
Research center: Maine Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
Report Number: Working Paper No. 32
Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
Mental Health Problems Have Considerable Impact on Rural Children and their Families (Policy Brief)
Date: 10 / 2010
Author(s): Jennifer D. Lenardson, Erika C. Ziller, David Lambert, Melanie M. Race, Anush Yousefian
Research center: Maine Rural Health Research Center
Topics: Children, Mental health
Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This policy brief provides information on prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.
Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children
Date: 09 / 2005
Author(s): Charity G. Moore, Michael Mink, Janice C. Probst, Mark Tompkins, Andy Johnson, Shereca Hughley
Research center: South Carolina Rural Health Research Center
Topics: Children, Mental health
The study used the 2001 National Health Interview Survey to assess the prevalence of sub-clinical mental health problems among children, the degree to which children with potential problems use mental health and general providers for these problems, and the degree of unmet need. Key findings include: 1) Nearly 1 of every 4 rural children has a potential mental health problem as derived from the Strengths and Difficulties Questionnaire (SDQ).; 2) Age, sex, family income, parental education, living situation, health insurance status, and previously diagnosed developmental disorder were all associated with sub-clinical mental health problems in children.; 3) Less than 1 out of 5 parents of rural or urban children with sub-clinical mental health problems had seen or talked to a mental health professional about the child in the past 12 months.; and 4) Characteristics associated with mental health care utilization were race/ethnicity, insurance status, level of education in the child's family, living situation, and previous diagnosis of a developmental disorder. Among roughly 2.9 million rural children with a potential mental health problem as defined by the SDQ score, two thirds (68.1%) are living in a HPSA-mental health designated area. This translates to over 1.9 million children with mental health problems but living in areas where very minimal to no resources are available for their care.
Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children (Fact Sheet)
Date: 2005
Research center: South Carolina Rural Health Research Center
Topics: Children, Mental health
Children in rural areas have fewer mental health resources available. To assess the need for services among rural children, they studied information from the 2001 National Health Interview Survey, a nationally representative survey of the U.S. population. Possible mental health problems were identified based on the Strengths and Difficulties Questionnaire (SDQ).
Mental Health Services in Rural Jails (Policy Brief)
Date: 09 / 2009
Author(s): Melanie Race, Anush Yousefian, David Lambert, David Hartley
Research center: Maine Rural Health Research Center
Topic: Mental health
The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles.
Mental Health Services in Rural Jails (Working Paper)
Date: 08 / 2010
Author(s): Melanie M. Race, Anush Yousefian, David Lambert, David Hartley
Research center: Maine Rural Health Research Center
Topic: Mental health
Report Number: Working Paper #42
Using a qualitative approach, this study explored the role of rural jails in the mental health systems in rural communities, investigating how rural jails manage mental health and substance abuse problems among inmates, determining barriers to providing mental health services faced by rural jails, and identifying promising practices for service delivery. Rural jail administrators and mental health providers understood the need for mental health services for jail inmates but were constrained by inadequate community mental health resources, lack of coordination with community mental health providers, and infrastructure challenges including facilities, transportation, training, and legal processes. Promising practices include short-term hold policies, separation of inmates with mental health concerns, and regular communication among stakeholders.
Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas
Date: 2006
Author(s): Laura-Mae Baldwin, Miriam M. Patanian, Eric H. Larson, Denise M. Lishner, Larry B. Mauksch, Wayne J. Katon, Edward Walker, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Mental health, Workforce
Citation: Journal of Rural Health, 22(1), 50-8
The authors sought to identify mental health shortage areas using existing licensing and survey data, and found that notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio. They concluded that states gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.
One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention
Date: 2005
Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Citation: Psychological Medicine, 35(6), 839-854
Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism
Date: 2006
Author(s): Jennie C. I. Tsao, Aram Dobalian, Brenda A. Wiens, Julius A. Gylys, Garret D. Evans
Research center: ORHP-funded Individual Grantees
Topics: Emergency preparedness, Mental health
Citation: Journal of Rural Health, 22(1), 78-82
Describes the need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities.
Preventing Hospitalization in Depressed Rural Patients
Date: 09 / 2005
Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request.
Provision of Mental Health Services by Rural Health Clinics
Date: 05 / 2010
Author(s): John A. Gale, Barbara Shaw, David Hartley, Stephenie Loux
Research center: Maine Rural Health Research Center
Topics: Mental health, Rural Health Clinics (RHCs)
The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health services is the presence of an internal champion (typically clinicians or senior administrators) who identify the need for and undertake implementation of services, help overcome internal barriers, and direct resources to the development of services.
PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers
Date: 2006
Author(s): Jennie C. I. Tsao, Aram Dobalian, Brenda A. Wiens, Julius A. Gylys, Art Clawson, Robert Brooks
Research center: ORHP-funded Individual Grantees
Topics: Emergency preparedness, Mental health, Public health, Substance abuse
Citation: Southern Medical Journal, 99(8), 817-822
Reports the results of a study that looked at rural primary care providers' knowledge of likely mental disorders, their risk factors, and preferred treatment options following a public health emergency.
Role of Community Mental Health Centers as Rural Safety Net Providers
Date: 05 / 2002
Author(s): David Hartley, Donna C. Bird, David Lambert, John Coffin
Research center: Maine Rural Health Research Center
Topics: Federally Qualified Health Centers (FQHCs), Mental health
Report Number: Working Paper No. 30
Investigates the extent to which those organizations formerly designated as community mental health centers (CMHCs) currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants. Findings: Based on three comparative case studies, CMHCs continue to believe that it is within their mission to act as a mental health safety net, but all three also acknowledged that their priority population is now SPMI (serious and persistent mental illness) adults and SED (seriously emotionally disturbed) children. Their ability to serve indigent clients who do not fall into these categories depends on their ability to cross-subsidize such services with funds designated for their priority populations. These providers were also able to fund some safety net services with grant funds made available through federal and regional programs, often targeted to outreach and prevention. In Minnesota and Oregon, county government and county funded social services also supplemented the safety net in meaningful ways. Lacking such county involvement, the Maine CMHC was forced to use waiting lists to manage the demand for free care. We conclude that county funding and grant writing are two ways that CMHCs have been able to plug the otherwise widening hole in the rural mental health safety net. Based on the findings, the report recommends an explicit discussion of the mental health safety net, both urban and rural, using the Institute of Medicine's report on America's Health Care Safety Net as a model. Also recommended are outreach programs to facilitate access to services for rural residents experiencing stress, depression and anxiety, and a shift from diagnosis-specific funding to the use of a family systems approach for those thus referred.
Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison
Date: 2005
Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care
Date: 11 / 2008
Author(s): Erika Ziller, Nathaniel Anderson, Andrew Coburn
Research center: Maine Rural Health Research Center
Topic: Mental health
Findings suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents.
Key facts include: 8% of rural adults say that they are in "fair" or "poor" mental health versus 6% of urban adults;
Among those using mental health services, rural residents are more likely than urban residents to use medication but not therapy. Practice guidelines for quality mental health treatment recommend that medications be given in combination with therapy;
Both rural and urban adults have greater cost sharing for their mental health care than for their total health care use. The percentages do not differ by residence; however, rural residents may be at greater risk of forgoing mental health care due to costs.
This Research & Policy Brief is based on a longer study by the authors. For more information about this study, please contact Erika Ziller at eziller@usm.maine.edu
Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
Date: 2006
Author(s): Donald Sawyer, John Gale, David Lambert
Research center: Maine Rural Health Research Center
Topics: Frontier health, Mental health, Substance abuse, Telehealth
Citation: Waite Park, MN: National Association of Rural Mental Health
Discusses barriers to mental and behavioral health service delivery in rural America. Includes model programs and model policy strategies for rural mental and behavioral health care delivery. Also discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery.
Rural Children Don't Receive the Mental Health Care They Need (Policy Brief)
Date: 01 / 2009
Author(s): David Lambert, Erika C. Ziller, Jennifer D. Lenardson
Research center: Maine Rural Health Research Center
Topics: Children, Mental health
Just over one-third of all children with a mental health problem received a mental health visit in the past year. Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children. Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas.
Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
Date: 08 / 2007
Author(s): Stephenie Loux, David Hartley, David Lambert
Research center: Maine Rural Health Research Center
Topics: Health services, Hospitals and clinics, Mental health
Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored.
Rural-Urban Differences in Depression Care (Working Paper)
Date: 10 / 2009
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.
Rural-Urban Differences in Depression Prevalence: Implications for Family Medicine
Date: 10 / 2006
Author(s): Janice C. Probst, Sarah B. Laditka, Charity G. Moore, Nusrat Harun, M. Paige Powell, Elizabeth G. Baxley
Research center: South Carolina Rural Health Research Center
Topic: Mental health
Citation: Family Medicine, 38(9), 653-60
Reports results of a study that examined the prevalence of depression in rural versus urban areas. An estimated 2.6 million rural adults suffer from depression. The unadjusted prevalence of depression was significantly higher among rural than urban populations (6.1% versus 5.2% ). After adjusting for rural/urban population characteristics, however, the odds of depression did not differ by residence. Depression risk was higher among persons likely to be encountered in a primary care setting: those with fair or poor self-reported health, hypertension, with limitations in daily activities, or whose health status changed during the previous year.
Rural-Urban Differences in Work Patterns Among Adults With Depressive Symptoms
Date: 03 / 2008
Author(s): Lisa Morris, Stephenie Loux, Erika Ziller, David Hartley
Research center: Maine Rural Health Research Center
Topic: Mental health
Report Number: Working Paper #38
This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, individuals with depressive symptoms work less than those not depressed. Although the findings indicate no significant difference between depressed rural and urban residents in maintaining employment, questions remain about rural access to mental health services, such as employee assistance, productivity on the job, and the survival or coping strategies of rural workers with depressive symptoms.
Smallest Rural Hospitals Treat Mental Health Emergencies
Date: 2006
Author(s): David Hartley, Stephenie Loux
Research center: Maine Rural Health Research Center
Topics: Hospitals and clinics, Mental health
Report Number: Research and Policy Brief
Discusses the extent to which rural emergency rooms encounter and treat mental health patients.
Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
Date: 2006
Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson
Research center: WICHE Center for Rural Mental Health Research
Topic: Mental health
Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773
Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.
State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
Date: 05 / 2002
Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
Research center: Maine Rural Health Research Center
Topics: Legislation and regulation, Mental health, Workforce
Report Number: Working Paper No. 29
Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries
Date: 10 / 2005
Author(s): Garth Kruger, Jacque Gray
Research center: Upper Midwest Rural Health Research Center
Topics: Mental health, Minority health
Report Number: Policy Brief
Compared nationally, North Dakota ranks 13th in the nation for suicide (14.4 suicides per 1000,000 people). This policy brief looks at three broad areas in addressing this preventable tragedy: 1) an understanding of factors associated with suicide; 2) information about specific trends such as race, gender, location, and costs; 3) an awareness of suicide prevention strategies that address these factors through public policy and community action.
Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
Date: 2007
Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian
Research center: Maine Rural Health Research Center
Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
Citation: Journal of Rural Health, 23(2), 108-115
Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.

Topics Centers Researchers Other Resources Search		Mental health Publications Alphabetical list. You can also view by publication date. Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems Date: 10 / 2010 Author(s): Jennifer D. Lenardson, Erika C. Ziller, David Lambert, Melanie M. Race, Anush Yousefian Research center: Maine Rural Health Research Center Topics: Children, Mental health Report Number: #45 Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges Date: 10 / 2001 Author(s): Donna C. Bird, Patricia Dempsey, David Hartley Research center: Maine Rural Health Research Center Topics: Mental health, Workforce Report Number: Working Paper No. 23 Reviews efforts to address mental health workforce needs in underserved rural areas and addresses three questions: 1) How is health and mental health workforce adequacy currently measured? 2) How do unique characteristics of rural communities and the mental health service delivery system challenge current methods for determining workforce adequacy? 3) What role has the federal government played in addressing health and mental health workforce needs in underserved rural areas? Finds that current workforce adequacy measurements all focus on physicians and are limited by the lack of a commonly accepted way to obtain needed data and by widely varying estimates of adequate population-to-provider ratios. In addition, the pluralistic and minimally coordinated nature of the mental health services system makes it difficult to translate methods for estimating workforce adequacy from health to mental health. Finally, there are several federal efforts to address workforce needs that foster training, provide scholarships, fund demonstration programs, and allow foreign medical graduates to serve in underserved areas. Makes several recommendations pertaining to the collection of data, field-testing of estimation models, and increasing the supply of mental health service providers. Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers Date: 08 / 2009 Author(s): Mimi McFaul, Jim Ciarlo, Jean Demmler, Christa Smith, Tamara DeHay Research center: WICHE Center for Rural Mental Health Research Topics: Frontier health, Mental health Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. Includes a Suicide Prevention Toolkit for rural primary care providers. Admission Severity and Mortality Rates Among Rural and Urban Nursing Facility Residents with Dementia (Research & Policy Brief) Date: 09 / 2001 Author(s): Elise J. Bolda, Kimberly Mooney Murray Research center: Maine Rural Health Research Center Topics: Long term care, Mental health Assesses whether the potentially higher utilization of nursing facility services in rural communities can be attributed to differences in use patterns by older adults with dementia. Specifically, addresses the question of whether rural nursing facility residents with dementia are less impaired at the time of their admission to a nursing facility than urban residents with dementia. Are Advanced Practice Nurses A Solution To Rural Mental Health Workforce Shortages? Date: 04 / 2004 Author(s): David Hartley, Valerie Hart, Nancy Hanrahan, Stephenie Loux Research center: Maine Rural Health Research Center Topics: Mental health, Nurses, Workforce Report Number: Working Paper No. 31 Summarizes the clinical skills and prescriptive authority of Advanced Practice Psychiatric Nurses (APPNs), and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs. Includes information on prescription authority and collaboration requirements for each state, as well as state distribution of APPNs. Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper) Date: 02 / 2010 Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief) Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief) Date: 03 / 2010 Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Research center: WICHE Center for Rural Mental Health Research Topics: Health insurance and the uninsured, Mental health Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper) Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief) Date: 05 / 2009 Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression. Community-Level Risk Factors for Depression Hospitalizations Date: 09 / 2005 Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost Research center: WICHE Center for Rural Mental Health Research Topics: Mental health, Rural statistics and demographics Report Number: Working Paper Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics. Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet) Date: 09 / 2005 Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost Research center: WICHE Center for Rural Mental Health Research Topics: Mental health, Rural statistics and demographics Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates. Depression in Rural Populations: Prevalence, Effects on Life Quality, And Treatment-Seeking Behavior Date: 05 / 2005 Author(s): Janice C. Probst, Sarah Laditka, Charity G. Moore, Nusrat Harun, M. Paige Powell Research center: South Carolina Rural Health Research Center Topics: Health disparities, Mental health Using the National Health Interview Survey and the NHIS-administered depression scale from the Comprehensive International Diagnostic Interview to explore depression among rural versus urban residents, the authors found that the prevalence of major depression was significantly higher among rural (6.11%) than among urban (5.16%) populations. However, nearly all individuals scoring positive for depression reported that their symptoms interfered with their life or activities (46.67% rural, 44.25% urban). Persons without any health insurance were less likely to have communicated with a physician than were the privately or publicly insured. Additionally, the likelihood that an individual with depression would have communicated with a practitioner rose as the person's self reported health declined. Depression in Rural Populations: Prevalence, Effects on Life Quality, and Treatment-Seeking Behavior (Fact Sheet) Date: 2005 Research center: South Carolina Rural Health Research Center Topics: Health disparities, Mental health To explore the prevalence of selected mental health diagnoses across rural populations, including rural minority residents, they studied information obtained by the 1999 National Health Interview Survey (NHIS), a nationally representative survey of more than 30,000 U.S. adults. Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers Date: 10 / 2009 Author(s): Scott J. Adams, Stan Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topics: Children, Mental health, Pharmacy and prescription drugs Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers. Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients Date: 09 / 2005 Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request. Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients Date: 2006 Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Citation: Journal of Rural Health, 22(4), 343-350 Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients. Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast Date: 08 / 2009 Author(s): Mimi McFaul, Dennis Mohatt, Jim Ciarlo, John M. Westfall Research center: WICHE Center for Rural Mental Health Research Topics: Mental health, Technology Primary care providers (PCPs) are often the first and only resource for rural and frontier residents needing mental health care. Training on mental health issues is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient alternative for PCPs to obtain the information they need to treat the mental health needs of their patients. Effects of Race and Poverty on Perceived Stress Among Rural Women Date: 2005 Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley Research center: South Carolina Rural Health Research Center Topics: Mental health, Minority health, Poverty, Women Citation: Coward RT, Davis LA et al, Eds., Rural women's health: Mental, behavioral and physical issues. p. 197-215. New York, NY: Springer Publishing Company Encouraging Rural Health Clinics to Provide Mental Health Services Date: 05 / 2010 Author(s): John Gale, David Hartley, Barbara Shaw, Stephanie Loux Research center: Maine Rural Health Research Center Topics: Mental health, Rural Health Clinics (RHCs) This study examined changes in the delivery of mental health services by Rural Health Clinics (RHCs), their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Key Findings: Approximately 6% of independent and 2% of provider-based RHCs offer mental health services. 38% of study RHCs reported their mental health services were not profitable but continued to provide them in response to community and patient needs. An important factor in the development of RHC mental health services is the presence of a local champion who spearheads the development effort. Integrating Primary Care and Mental Health: Current Practices in Rural Community Health Centers Date: 10 / 2006 Author(s): David Lambert, John Gale Research center: Maine Rural Health Research Center Topics: Federally Qualified Health Centers (FQHCs), Mental health Citation: Kansas City, MO: National Rural Health Association Provides information on models for integrating mental health services in rural community health centers, viability of linkages between primary care and mental health providers, resources available, reimbursement, treatment philosophy, diversification, referral and enhancement. Available for purchase. Medicaid Managed Behavioral Health in Rural Areas Date: 01 / 2001 Author(s): David Lambert, John Gale, Donna Bird, David Hartley Research center: Maine Rural Health Research Center Topics: Medicaid and S-CHIP, Mental health Report Number: Working Paper No. 24 Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services. Medicaid Managed Behavioral Health Programs in Rural Areas (Research and Policy Brief) Date: 08 / 2001 Author(s): David Lambert, John Gale, Donna Bird, David Hartley Research center: Maine Rural Health Research Center Topics: Medicaid and S-CHIP, Mental health Study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas. Describes these programs in terms of Medicaid populations served, program design, and implementation model. Describe the experience of programs regarding access to and coordination of services. Mental Health and Rural America: 1994-2005 Date: 2006 Author(s): Dennis Mohatt, Scott J. Adams, Mimi M. Bradley, Chad A. Morris Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Includes an annotated bibliography. Mental Health Care in Rural Communities: the Once and Future Role of Primary Care Date: 2006 Author(s): John A.Gale, David Lambert, Research center: Maine Rural Health Research Center Topics: Health services, Mental health Citation: North Carolina Medical Journal, 67(1), 66-70 Discusses issues related to the delivery of mental health services in the United States. Addresses how these issues complicate the delivery of services in rural areas. Offers an argument for integrating primary care and mental health in rural areas. Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey Date: 09 / 2005 Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian Research center: Maine Rural Health Research Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health Report Number: Working Paper No. 32 Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind. Mental Health Problems Have Considerable Impact on Rural Children and their Families (Policy Brief) Date: 10 / 2010 Author(s): Jennifer D. Lenardson, Erika C. Ziller, David Lambert, Melanie M. Race, Anush Yousefian Research center: Maine Rural Health Research Center Topics: Children, Mental health Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This policy brief provides information on prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs. Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children Date: 09 / 2005 Author(s): Charity G. Moore, Michael Mink, Janice C. Probst, Mark Tompkins, Andy Johnson, Shereca Hughley Research center: South Carolina Rural Health Research Center Topics: Children, Mental health The study used the 2001 National Health Interview Survey to assess the prevalence of sub-clinical mental health problems among children, the degree to which children with potential problems use mental health and general providers for these problems, and the degree of unmet need. Key findings include: 1) Nearly 1 of every 4 rural children has a potential mental health problem as derived from the Strengths and Difficulties Questionnaire (SDQ).; 2) Age, sex, family income, parental education, living situation, health insurance status, and previously diagnosed developmental disorder were all associated with sub-clinical mental health problems in children.; 3) Less than 1 out of 5 parents of rural or urban children with sub-clinical mental health problems had seen or talked to a mental health professional about the child in the past 12 months.; and 4) Characteristics associated with mental health care utilization were race/ethnicity, insurance status, level of education in the child's family, living situation, and previous diagnosis of a developmental disorder. Among roughly 2.9 million rural children with a potential mental health problem as defined by the SDQ score, two thirds (68.1%) are living in a HPSA-mental health designated area. This translates to over 1.9 million children with mental health problems but living in areas where very minimal to no resources are available for their care. Mental Health Risk Factors, Unmet Needs, and Provider Availability for Rural Children (Fact Sheet) Date: 2005 Research center: South Carolina Rural Health Research Center Topics: Children, Mental health Children in rural areas have fewer mental health resources available. To assess the need for services among rural children, they studied information from the 2001 National Health Interview Survey, a nationally representative survey of the U.S. population. Possible mental health problems were identified based on the Strengths and Difficulties Questionnaire (SDQ). Mental Health Services in Rural Jails (Policy Brief) Date: 09 / 2009 Author(s): Melanie Race, Anush Yousefian, David Lambert, David Hartley Research center: Maine Rural Health Research Center Topic: Mental health The prevalence of mental illness among prison and jail inmates has attracted increasing attention in both mental health and criminal justice circles. Mental Health Services in Rural Jails (Working Paper) Date: 08 / 2010 Author(s): Melanie M. Race, Anush Yousefian, David Lambert, David Hartley Research center: Maine Rural Health Research Center Topic: Mental health Report Number: Working Paper #42 Using a qualitative approach, this study explored the role of rural jails in the mental health systems in rural communities, investigating how rural jails manage mental health and substance abuse problems among inmates, determining barriers to providing mental health services faced by rural jails, and identifying promising practices for service delivery. Rural jail administrators and mental health providers understood the need for mental health services for jail inmates but were constrained by inadequate community mental health resources, lack of coordination with community mental health providers, and infrastructure challenges including facilities, transportation, training, and legal processes. Promising practices include short-term hold policies, separation of inmates with mental health concerns, and regular communication among stakeholders. Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas Date: 2006 Author(s): Laura-Mae Baldwin, Miriam M. Patanian, Eric H. Larson, Denise M. Lishner, Larry B. Mauksch, Wayne J. Katon, Edward Walker, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Mental health, Workforce Citation: Journal of Rural Health, 22(1), 50-8 The authors sought to identify mental health shortage areas using existing licensing and survey data, and found that notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio. They concluded that states gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning. One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention Date: 2005 Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Citation: Psychological Medicine, 35(6), 839-854 Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism Date: 2006 Author(s): Jennie C. I. Tsao, Aram Dobalian, Brenda A. Wiens, Julius A. Gylys, Garret D. Evans Research center: ORHP-funded Individual Grantees Topics: Emergency preparedness, Mental health Citation: Journal of Rural Health, 22(1), 78-82 Describes the need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. Preventing Hospitalization in Depressed Rural Patients Date: 09 / 2005 Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost Research center: WICHE Center for Rural Mental Health Research Topic: Mental health The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request. Provision of Mental Health Services by Rural Health Clinics Date: 05 / 2010 Author(s): John A. Gale, Barbara Shaw, David Hartley, Stephenie Loux Research center: Maine Rural Health Research Center Topics: Mental health, Rural Health Clinics (RHCs) The number of Rural Health Clinics (RHCs) providing specialty mental health services remains limited. This study examined changes in the delivery of mental health services by RHCs, their operational characteristics, barriers to the development of services, and policy options to encourage more RHCs to deliver mental health services. Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by doctoral-level psychologists and/or clinical social workers. Models used to provide mental health services include contracted and/or employed clinicians housed in the same facility as primary care providers. A key element in the development of mental health services is the presence of an internal champion (typically clinicians or senior administrators) who identify the need for and undertake implementation of services, help overcome internal barriers, and direct resources to the development of services. PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers Date: 2006 Author(s): Jennie C. I. Tsao, Aram Dobalian, Brenda A. Wiens, Julius A. Gylys, Art Clawson, Robert Brooks Research center: ORHP-funded Individual Grantees Topics: Emergency preparedness, Mental health, Public health, Substance abuse Citation: Southern Medical Journal, 99(8), 817-822 Reports the results of a study that looked at rural primary care providers' knowledge of likely mental disorders, their risk factors, and preferred treatment options following a public health emergency. Role of Community Mental Health Centers as Rural Safety Net Providers Date: 05 / 2002 Author(s): David Hartley, Donna C. Bird, David Lambert, John Coffin Research center: Maine Rural Health Research Center Topics: Federally Qualified Health Centers (FQHCs), Mental health Report Number: Working Paper No. 30 Investigates the extent to which those organizations formerly designated as community mental health centers (CMHCs) currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants. Findings: Based on three comparative case studies, CMHCs continue to believe that it is within their mission to act as a mental health safety net, but all three also acknowledged that their priority population is now SPMI (serious and persistent mental illness) adults and SED (seriously emotionally disturbed) children. Their ability to serve indigent clients who do not fall into these categories depends on their ability to cross-subsidize such services with funds designated for their priority populations. These providers were also able to fund some safety net services with grant funds made available through federal and regional programs, often targeted to outreach and prevention. In Minnesota and Oregon, county government and county funded social services also supplemented the safety net in meaningful ways. Lacking such county involvement, the Maine CMHC was forced to use waiting lists to manage the demand for free care. We conclude that county funding and grant writing are two ways that CMHCs have been able to plug the otherwise widening hole in the rural mental health safety net. Based on the findings, the report recommends an explicit discussion of the mental health safety net, both urban and rural, using the Institute of Medicine's report on America's Health Care Safety Net as a model. Also recommended are outreach programs to facilitate access to services for rural residents experiencing stress, depression and anxiety, and a shift from diagnosis-specific funding to the use of a family systems approach for those thus referred. Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison Date: 2005 Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Rural Adults Face Parity Problems and Other Barriers to Appropriate Mental Health Care Date: 11 / 2008 Author(s): Erika Ziller, Nathaniel Anderson, Andrew Coburn Research center: Maine Rural Health Research Center Topic: Mental health Findings suggest that a multi-level approach is essential for meeting the mental health service needs of rural residents. Key facts include: 8% of rural adults say that they are in "fair" or "poor" mental health versus 6% of urban adults; Among those using mental health services, rural residents are more likely than urban residents to use medication but not therapy. Practice guidelines for quality mental health treatment recommend that medications be given in combination with therapy; Both rural and urban adults have greater cost sharing for their mental health care than for their total health care use. The percentages do not differ by residence; however, rural residents may be at greater risk of forgoing mental health care due to costs. This Research & Policy Brief is based on a longer study by the authors. For more information about this study, please contact Erika Ziller at eziller@usm.maine.edu Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices Date: 2006 Author(s): Donald Sawyer, John Gale, David Lambert Research center: Maine Rural Health Research Center Topics: Frontier health, Mental health, Substance abuse, Telehealth Citation: Waite Park, MN: National Association of Rural Mental Health Discusses barriers to mental and behavioral health service delivery in rural America. Includes model programs and model policy strategies for rural mental and behavioral health care delivery. Also discusses the roles that telehealth and that the State Offices of Rural Health should play in service delivery. Rural Children Don't Receive the Mental Health Care They Need (Policy Brief) Date: 01 / 2009 Author(s): David Lambert, Erika C. Ziller, Jennifer D. Lenardson Research center: Maine Rural Health Research Center Topics: Children, Mental health Just over one-third of all children with a mental health problem received a mental health visit in the past year. Controlling for other characteristics that affect access to care, rural children are 20% less likely to have a mental health visit than urban children. Having Medicaid or SCHIP increases the likelihood that a child will receive services, and this is pronounced in rural areas. Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier Date: 08 / 2007 Author(s): Stephenie Loux, David Hartley, David Lambert Research center: Maine Rural Health Research Center Topics: Health services, Hospitals and clinics, Mental health Inpatient Psychiatric Units (IPUs) may not only be an important source of care for rural residents, but may also assist in the development of community-based services and the recruitment of mental health professionals. This study investigates the typical characteristics and admission processes of IPUs in rural hospitals with less than 50 beds, as well as the community-based services available to them when discharging patients. Reasons for developing these IPUs as well as the barriers to opening and operating a rural IPU and factors that have led some to close are also explored. Rural-Urban Differences in Depression Care (Working Paper) Date: 10 / 2009 Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy. Rural-Urban Differences in Depression Prevalence: Implications for Family Medicine Date: 10 / 2006 Author(s): Janice C. Probst, Sarah B. Laditka, Charity G. Moore, Nusrat Harun, M. Paige Powell, Elizabeth G. Baxley Research center: South Carolina Rural Health Research Center Topic: Mental health Citation: Family Medicine, 38(9), 653-60 Reports results of a study that examined the prevalence of depression in rural versus urban areas. An estimated 2.6 million rural adults suffer from depression. The unadjusted prevalence of depression was significantly higher among rural than urban populations (6.1% versus 5.2% ). After adjusting for rural/urban population characteristics, however, the odds of depression did not differ by residence. Depression risk was higher among persons likely to be encountered in a primary care setting: those with fair or poor self-reported health, hypertension, with limitations in daily activities, or whose health status changed during the previous year. Rural-Urban Differences in Work Patterns Among Adults With Depressive Symptoms Date: 03 / 2008 Author(s): Lisa Morris, Stephenie Loux, Erika Ziller, David Hartley Research center: Maine Rural Health Research Center Topic: Mental health Report Number: Working Paper #38 This study addresses the issue of poor mental health among young to middle-career rural residents and how their employment may be affected. Using the National Longitudinal Survey of Youth (NLSY), a nationally representative survey of adults, the authors investigate how depressive symptoms affect employment patterns, and the extent to which such effects differ by rural and urban residence. Analysis of the data identified the rural sample as more likely to be married, have less education, are less likely to be black or Hispanic, and less likely to have health insurance than the urban sample. For both rural and urban subjects, individuals with depressive symptoms work less than those not depressed. Although the findings indicate no significant difference between depressed rural and urban residents in maintaining employment, questions remain about rural access to mental health services, such as employee assistance, productivity on the job, and the survival or coping strategies of rural workers with depressive symptoms. Smallest Rural Hospitals Treat Mental Health Emergencies Date: 2006 Author(s): David Hartley, Stephenie Loux Research center: Maine Rural Health Research Center Topics: Hospitals and clinics, Mental health Report Number: Research and Policy Brief Discusses the extent to which rural emergency rooms encounter and treat mental health patients. Stakeholder Benefit From Depression Disease Management: Differences by Rurality? Date: 2006 Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson Research center: WICHE Center for Rural Mental Health Research Topic: Mental health Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773 Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems. State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce Date: 05 / 2002 Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird Research center: Maine Rural Health Research Center Topics: Legislation and regulation, Mental health, Workforce Report Number: Working Paper No. 29 Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation. Suicide in North Dakota: A Dialogue Across State and Tribal Boundaries Date: 10 / 2005 Author(s): Garth Kruger, Jacque Gray Research center: Upper Midwest Rural Health Research Center Topics: Mental health, Minority health Report Number: Policy Brief Compared nationally, North Dakota ranks 13th in the nation for suicide (14.4 suicides per 1000,000 people). This policy brief looks at three broad areas in addressing this preventable tragedy: 1) an understanding of factors associated with suicide; 2) information about specific trends such as race, gender, location, and costs; 3) an awareness of suicide prevention strategies that address these factors through public policy and community action. Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms Date: 2007 Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian Research center: Maine Rural Health Research Center Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health Citation: Journal of Rural Health, 23(2), 108-115 Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face. Related Topics These related topics also list publications: Substance abuse (18 items)

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