This is a descriptive, exploratory study which will investigate the role of the small rural hospital Inpatient Psychiatric Unit (IPU) from the perspectives of both the rural hospital, in terms of scope of services and revenue enhancement, and the regional mental health system, in terms of meeting the needs of outpatient mental health and primary care providers, law enforcement, and human services.

AHA survey data, Flex Monitoring Team data, and Substance Abuse and Mental Health Services Administration's list of inpatient mental health services were used to identify all rural hospitals with less than 50 beds that have inpatient psychiatric services. A list of 117 hospitals have been contacted, including both Critical Access Hospitals (CAHs) and non-CAHs. During the telephone survey of all identified IPUs, it was learned that many hospitals have closed their IPUs. We have subsequently begun a qualitative study of small rural hospitals that have closed their IPUs, to learn more about the circumstances leading to these closures. The final product will address research questions related to barriers to operating a rural IPU, including financial incentives and disincentives and the role of CAH eligibility in exacerbating or overcoming these barriers. Because the sample size will not allow robust estimates of differences among different levels of rurality, project staff will use the Rural Urban Commuting Area codes as a means of exploring differences among these units, particularly the differences related to adjacency to urban areas, as a means of generating recommendations and/or hypotheses for further research.

Final products of this project include a working paper, submission of an article to a peer-reviewed journal, and presentations at annual meetings of the National Rural Health Association, the National Association of Rural Health Clinics, and the National Association for Rural Mental Health.

Publications

• Rural Inpatient Psychiatric Units Improve Access to Community-Based Mental Health Services, but Medicare Payment Policy a Barrier
  Maine Rural Health Research Center
  Date: 08/2007
  This study investigates the characteristics/admission processes of inpatient psychiatric units (IPUs) in rural hospitals with less than 50 beds and the community-based services available to them when discharging patients. Reasons for developing IPUs, barriers to opening and operating a rural IPU, and factors leading some to close are also explored.