Rural Areas Need Solutions for Lack of Mental Health Care Options
> 6/4/2007 12:28:44 PM

Anyone who has read Faulkner knows that rural Americans face mental health problems as dark and complex as those that plague any urbanite. Yet, the Health Resources and Services Administration's Shortage Designation Branch reports that there are 1,621 rural areas with a dearth of mental health professionals. The definition of these shortage areas is relatively simple--one criterion is a population-to-psychiatrist ratio greater than or equal to 30,000:1, but the reasons behind these deficits are harder to understand.

"It's more peaceful here; there are lots of open spaces and birds and animals," gushes Elizabeth Bhargava to Psychiatric News about her work at the Ozarks Medical Center in West Plains. Given such praise, why are those open spaces so hard to fill with psychiatrists instead of birds? Some of the reasons are discussed in the same article from May's Psychiatric News. For one thing, the sheer amount of space can be daunting. Caseworkers, already overburdened by the flood of patients for which they must care, often spend a large portion of their day merely traveling back and forth on dubious dirt roads. Lower pay is another reason why rural communities have a hard time attracting enough psychiatrists. While the cost of living may be lower, the relative value of salaries is often not enough compensation because rural companies do not always pay for expensive mental health visits. Additionally, there is a catch-22 of sorts that hinders recruitment efforts�psychiatrists are reluctant to move to areas where they will have few colleagues. Besides the lack of camaraderie, there is the practical matter of a lack of an experience-pool to draw from. Psychiatric News describes how Dr. Kenneth Gladieux rues this missing resource, as he discusses the lack of mentors or collaborators.

Some states have tried to be proactive about the lack of mental health professionals. But it was clear, even a decade ago, that this was a complex issue largely tied to other issues in health care. Establishing networks can help make rural psychiatrists feel part of the wider community by supplying them with mentors and contacts from state universities, but it is really only one step in the process.

Another way that the shortage is being alleviated is the National Health Service Corps, which pays for the medical schooling of students in exchange for a commitment to a year of service for every year spent studying. This is a good deal for all parties; underprivileged students are given an opportunity to learn and small towns are assigned much-needed doctors. However, a 9-year study in The Journal of American Medical Association showed that the NHSC had significant hurdles to overcome. Retention of NHSC and non-NHSC doctors in rural areas differed 29% to 52%.

Another strategy used to lure psychiatrists is the granting of J-1 visas. There are many foreign doctors who are eager to practice in America, but are not picky about the exact region in which they will be working. Often, in exchange for a visa, and the opportunity to practice medicine, foreign doctors can fill the void left by Americans more interested in moving to urban centers.

A third strategy being tested is the retraining of general practice doctors to handle common mental health problems. The University of Missouri offers an 84-hour course designed to give physicians additional tools to diagnose the mental problems that they are most likely to encounter. This is more of a stop-gap measure than a true solution, as the complexity of mental health along with the myriad of treatment options make it difficult for most GPs to provide a full complement of services.

All of the strategies discussed above are helping to mitigate the shortage of adequate mental health care, but these are not tenable long-term solutions. Instead, technological innovation will more likely be the key that helps to mediate the suffering of those dealing with mental illness who lack access to valuable support. Even the most remote communities now have access to high speed internet connections and phone lines that facillitate communication across the state, the country and even the world. No matter how isolated your community, your problems can be addressed remotely with a variety of online tools, from electronic messages and Internet counseling to personality tests and dream analysis. New computers arrive with video camera technology and video chat software built in, making face-to-face consultations or therapy sessions a reality even when no therapist is present. Rural areas must keep trying to attract needed doctors and therapists, but they can also certainly benefit from looking to new communication tools to find the help that's already out there.


What about telemedicine?
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Posted by: Sandra 6/4/2007 2:25:44 AM

Telemedicine is certainly becoming a more viable option as technological hurdles are overcome. We have covered the progress of this method in previous articles. For example, here is a story about last years' meeting of the New Clinical Drug Evaluation Unit, wherein Dr. Donald Hilty maded a well-received presentation on telepsychiatry. Also, here's a link to a NYT story that we covered on Dr. Sara Gibson, who not only discusses the benefits of telemedicine, but actually runs a successful practice in a less urban environment.
Posted by: Blogmeister 6/5/2007 10:23:16 AM

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