Rural Mental Health

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Rural Mental Health
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Rural Mental Health

• Overview
• A Rural Hospital Perspective
• A Regional Perspective

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Overview Rural Mental Health
Rick Peterson, Ph.D. LMFT, CFLE, Past- President
NARMH, Associate Professor, Texas AM AgriLife
Extension
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Overview Rural Mental Health

• 20 of U.S. population rural
• More poverty, older, lacks health insurance, less
  likely to seek care due to stigma
• Higher rates of suicide, depression, domestic
  violence and child abuse
• Rural youth higher rates of substance abuse
  alcohol, tobacco, methamphetamines, prescription
  drugs, inhalants, marijuana, cocaine.
• Persistent disparities in rates, severity, and
  outcomes of mental health

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Overview Rural Mental Health

• Mental Health shortage areas lack doctoral
  level practitioners
• High rates of turnover and lack of training
  specific to rural
• Funding for rural mental health lags behind
  funding for other disparity groups

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Overview Rural Mental Health
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Mental Health ServicesThe AAA Approach

• Accessibility
• Distance to services
• Payment fragmented
• Funding for rural mental health lags behind
  funding for other disparity groups
• No wrong door Medical Home

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Mental Health ServicesThe AAA Approach

• Availability - shortage of providers
• More than 85 of MH shortage areas are in rural
  areas and more than half of all U.S. counties do
  not have a single psychologist, psychiatrist, or
  social worker
• Rural hospitals may not be equipped to handle
  mental health and substance abuse patients
• County and small town law enforcement have little
  training or expertise to handle mental health
  patients

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Mental Health ServicesThe AAA Approach

• Availability - shortage of providers
• Workforce - lower salaries, limited social/
  cultural outlets, increased provider turnover and
  burnout.
• Training issues - lack of training programs
  focus on rural providers
• Funding for rural mental health lags behind
  funding for other disparity groups

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Mental Health ServicesThe AAA Approach

• Acceptability of services
• Lower due to increased stigma
• Decreased anonymity in seeking psychological
  services
• Lack of understanding of the mental health system
  and consumer education
• Cultural issues language, type of trauma,
  treatment

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Overview Rural Mental Health

• Because of lower accessibility, availability and
  acceptability rural residents suffering from
  mental health disorders tend to
• Enter mental health care later,
• Enter with more serious symptoms,
• As a result require more intensive treatment

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Mental Health Issues from the Rural Hospital
Perspective
Jeff Barnhart, CEO- Ochiltree General Hospital
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Location
Unhappy Law Enforcement

• North Texas State Hospital-215 miles
• Big Spring State Hospital- 350 miles
• Psychiatric hospital 125 miles away, however this
  facility is rarely an option.

• Law enforcement resources already strained.
• Deputy often committed to patient for hours,
  prior to transport.
• Sheriff feels that this a medical issue.
• There is no law against mental illness.

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HB 245

• Relating to the authority of emergency room
  physicians and certain certified emergency
  medical services professionals to hold a person
  believed to have a mental illness establishing
  mental health crisis intervention certification
  for certain emergency medical services personnel.

Sponsors
Rep. Jose Menéndez, District 124
Rep. John Frullo District 84
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HB 245

• Would have allowed physicians to issue a 24 hour
  hold on mental health patients.
• Although well intentioned, this had the potential
  to be problematic for rural hospitals.
• Physician initiated 24 hour hold, then hospital
  is charged with holding them.
• Once the hold was placed, because there would
  have no longer been a warrant involved, law
  enforcement would not technically be responsible
  for transport to the state hospital.

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Problematic

• Unlike larger hospitals, rural hospitals
  generally speaking are not equipped to handle
  mental health patients from a staffing or
  facility standpoint.
• This would also leave them responsible for
  transport to the state mental hospital.
• The issue of restraints.

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SB 36

• Relating to the detention and transportation of a
  person with a mental illness

Sponsor
Senator Judith Zaffirini (D-Laredo)
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SB36

• A jail or similar detention facility may not
  be deemed  suitable for detention of a person
  taken into custody , except in an extreme
  emergency that existed because of hazardous
  weather or the occurrence of a disaster that
  threatens the safety of the proposed patient or
  person transporting the proposed patient.

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Problematic

• Again, unlike larger hospitals, rural hospitals,
  generally speaking, are not equipped to handle
  mental health patients from a staffing or
  facility standpoint.
• This would also leave them responsible for
  transport to the state mental hospital.
• The issue of restraints.

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Although these died, they are two examples that
further show that our mental health system is
broken.
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Rural Mental Health- A Regional Perspective
Jim Womack, Texas Panhandle Centers Behavioral
and Developmental Health- Director of
Planning, Regence Health Network- Board of
Directors
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Mental Illness in the Texas Panhandle

• NAMI and NIMH Statistics
• 25 of US population experience a mental health
  disorder in a given year.
• 6-17 of U.S. population experience a serious
  emotional/mental illness in their lifetime.

• Local Service Area Population403,000
• MHD 100,750 Odessa
• SMI 24,200 gt Plainview

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Veterans in Rural Areas

• Only 23 to 40 percent sought psychiatric help due
  to fear of being stigmatized
• Shame arising from stigma worsens depression and
  social alienation -increases rates of treatment
  non-compliance

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Recent Strategies for Addressing Issues

• Telepsychiatry- Regional Clinics and Jails
• Mobile Crisis Outreach
• CBT
• Open Access

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Strategies for Addressing Issues- New
Opportunities

• Restored Funding
• Physical and Behavioral Health Care Integration
• Continuum of Care
• Crisis Respite
• Peer Support
• Veterans Peer support

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Restored Funding

• Increased funding for mental health through this
  Legislative Session- just now back to FY2003
  funding after 2 cycles of cuts.
• 1115 Waiver

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Physical and Behavioral Health Care Integration

• WHY
• People receiving behavioral health services need
  better access to primary care.
• People with serious mental health conditions die
  an average of 25 years earlier.
• Many mental and physical disorders are
  co-occurring.
• Integrated care decreases depression, improves
  quality of life, decreases stress and lowers
  rates of psychiatric hospitalization.
• Lower overall health costs.

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Continuum of Care

• Child and Adolescent Wraparound Services
• 30 Day Intensive outpatient Treatment
• Criminal Justice Diversion

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Crisis Respite
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Peer Support
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Veterans Peer Support
Partnership with Central Plains Center
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New Funding

• Opportunity for new crisis and prevention
  funding?

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Thank You

• Rick Peterson
• 979-845-1877
• Texas AM AgriLife Extension
• Jeff Barnhart
• Ochiltree General Hospital
• 806-435-3606
• Jim Womack
• Texas Panhandle Centers
• 806-351-3326