Rural Mental Health

Overview A Rural Hospital Perspective A Regional Perspective

Overview Rural Mental Health

Rick Peterson, Ph.D. LMFT, CFLE, Past- President NARMH, Associate Professor,

Texas A&M AgriLife Extension

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

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

Overview Rural Mental Health

Acceptability Accessibility

Availability

Mental Health Services:The 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”

Mental Health Services:The 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

Mental Health Services:The 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

Mental Health Services:The 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

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

Jeff Barnhart, CEO- Ochiltree General Hospital

Location

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.

Unhappy Law Enforcement

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.

Rep. Jose Menéndez, District 124

Rep. John FrulloDistrict 84

Sponsors

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.

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.

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

Senator Judith Zaffirini (D-Laredo)

Sponsor

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.

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.

Rural Mental Health- Rural Mental Health-

A Regional A Regional PerspectivePerspective

Jim Womack, Texas Panhandle Centers Behavioral and Developmental Health- Director of Planning,Regence Health Network- Board of Directors

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 Population=403,000 MHD 100,750 = Odessa SMI 24,200 > Plainview

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

Recent Strategies for Addressing Issues TELEPSYCHIATRY- REGIONAL

CLINICS AND JAILS MOBILE CRISIS OUTREACH CBT OPEN ACCESS

Strategies for Addressing Issues- New Opportunities

RESTORED FUNDING PHYSICAL AND BEHAVIORAL

HEALTH CARE INTEGRATION CONTINUUM OF CARE CRISIS RESPITE PEER SUPPORT VETERAN’S PEER SUPPORT

Restored Funding

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

1115 Waiver

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.

Continuum of Care

CHILD AND ADOLESCENT WRAPAROUND SERVICES

30 DAY INTENSIVE OUTPATIENT TREATMENT

CRIMINAL JUSTICE DIVERSION

CRISIS RESPITE

Peer Support

Veteran’s Peer Support

Partnership with Central Plains Center

New Funding

Opportunity for new crisis and prevention funding?

Thank You

Rick Peterson

979-845-1877

Texas A&M AgriLife Extension

Jeff Barnhart

Ochiltree General Hospital

806-435-3606

Jim Womack

Texas Panhandle Centers

806-351-3326