Living in a rural area doesn’t mean you will be less likely to suffer from mental health problems. It does mean you will be less likely to have easy access to diagnosis and care. Even though rural residents are in poorer health generally than those living elsewhere, they have less access to treatment, partly because so many rural hospitals and health clinics have closed in recent years.
For men, who are more reluctant to seek help for mental health problems and, according to Men’s Health Network, almost four times more likely to commit suicide than women, that scarcity of trained providers presents a major barrier to help that could be lifesaving.
Community health centers, which provide primary care to about 10 million low income and uninsured patients from rural areas every year, often see patients suffering from Post-Traumatic Stress Disorder, bipolar disorder and other serious mental illnesses. But 55 percent of counties in the United States do not have a single practicing psychiatrist, according to the National Alliance on Mental Illness (NAMI).
The insufficiency of mental health care in rural communities prompted the Patient-Centered Outcomes Research Institute (PCORI) to fund a number of studies and trials to examine the efficacy of using telecommunications technology to provide clinical care from a distance. One study compares the use of two different methods of providing telepsychiatry at 15 rural community health centers in Arkansas, Michigan and Washington.
With one method, telepsychiatry-collaborative care, each patient has a video appointment with a mental health doctor who confirms the patient’s diagnosis and recommends medicines for treatment. A primary care provider carries out the treatment plan and writes prescriptions. A care manager at the community center meets in person or by phone with the patient regularly to provide behavioral therapy, to make sure the patient takes medicines correctly and to determine if the treatment is working. The primary care provider consults with the mental health doctor, who can recommend a different treatment if needed.
With a second method, telepsychiatry-enhanced referral, each patient has a video appointment with a mental health doctor to come up with a treatment plan, which can include medicines and/or counseling. Patients who are prescribed counseling have regular video appointments at the community health center with a mental health doctor.
The two methods will be evaluated with the help of patient surveys about their care, health condition and quality of life conducted at the beginning and after six and 12 months. Patients and primary care providers will also be surveyed about their experiences getting and giving treatment. When the study is complete later this year, it will provide evidence to show which is the more effective way of providing telepsychiatry.
Studies like this may contribute to improving mental health care in rural communities, but they won’t help those, especially men, suffering from mental health problems who don’t seek care.
Mental Health America provides online screening tools that can help those who may be suffering from mental illness determine whether they should seek help. Men’s Health Network has developed a booklet, “Your Head: An Owner’s Manual,” geared toward men that highlights screening guidelines, symptoms and treatments. MHN also offers a special brochure for those suffering from PTSD.
New understanding of brain science suggests that longer periods of abnormal thoughts and behavior have cumulative effects and can limit capacity for recovery, making early detection and effective intervention critically important to treating mental illness, according to a brief published by the American Mental Health Counselors Association. Early intervention that interrupts the negative course of some mental illnesses may lessen long-term disability, the brief states.
As this emerging science suggests, research that helps community health centers more effectively diagnose and treat mental illness offers hope for reducing the enormous suffering diseases of the mind cause in underserved rural communities.
