Evaluating policies to improve access to mental health services in rural areas

Shiner, Brian; Gottlieb, Daniel J.; Rice, Korie; Forehand, Jenna; Snitkin, Meghan; Watts, Bradley V.

doi:10.1111/jrh.12674

Cited by 12 publications

(4 citation statements)

References 47 publications

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“…In this study, rural and urban Hispanic VA patients had similar rates of mental health services use overall across the period of observation. In related work, we recently showed that following policy changes to increase mental health access in 2008 and 2014, rural Hispanic VA patients were more likely to use mental health services and received an equivalent number of visits to rural non‐Hispanics 24 . In this current work, we found similar rates of mental health access and a prominent trend of increased rates of mental health diagnosis in both rural and urban Hispanic patients comparing 2005‐2019.…”

Section: Discussionsupporting

confidence: 68%

“…and received an equivalent number of visits to rural non-Hispanics. 24 In this current work, we found similar rates of mental health access and a prominent trend of increased rates of mental health diagnosis in both rural and urban Hispanic patients comparing 2005-2019. However, the rates of most mental health diagnoses were higher in urban Hispanic patients compared to rural Hispanic patients.…”

Section: F I G U R Esupporting

confidence: 66%

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Examination of increasing suicide rates among rural Hispanic VA patients

Shiner

Peltzman

Forehand

et al. 2022

The Journal of Rural Health

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Purpose Death by suicide is increasing more rapidly among Hispanics than non‐Hispanics who use United States Department of Veterans Affairs (VA) health services, and the increase is most rapid among those living in rural areas. Our goal was to identify characteristics of rural Hispanic VA patients that contribute to this emerging disparity. Methods We linked electronic medical records from the VA, personnel data from the US Department of Defense, mortality data from the US National Death Index, and data on area characteristics from the US Census Bureau to examine suicide trends among Hispanic VA patients from 2005 through 2019. After identifying the strongest predictors of suicide in the rural and urban Hispanic populations, we examined how those characteristics changed over time. Findings Age and sex‐adjusted suicide mortality rates were consistently higher for rural versus urban Hispanic patients beginning in 2012, with the most recent rolling 5‐year average rates being 31.0 per 100,000 for rural compared to 20.3 per 100,000 for urban in 2019. Models to predict suicide had fair performance in the rural (accuracy = 0.62, 95% CI: 0.51, 0.73) and urban (accuracy = 0.67, 95% CI: 0.63, 0.70) groups. Mental health diagnoses were predictive of suicide among rural Hispanic patients, but there was no evidence that mental health diagnoses were increasing more rapidly in rural compared to urban patients. Conclusions While we confirmed that there is a higher rate of death by suicide among rural Hispanic VA patients relative to their urban counterparts, we were unable to identify clear drivers of this finding.

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Section: Discussionsupporting

confidence: 68%

Section: F I G U R Esupporting

confidence: 66%

Examination of increasing suicide rates among rural Hispanic VA patients

Shiner

Peltzman

Forehand

et al. 2022

The Journal of Rural Health

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“…Defence families are those with a currently serving member, whereas Veteran families are those with an ex‐serving member (hereafter Defence families). Living in regional and rural Australian communities profoundly impacts the ability of residents to take advantage of delivery modalities and payment methods to access mental health services 4 despite having a high need for these services. Australian research reports that the Defence family members, especially partners of those deployed, experience unique caregiving stressors, poor marital adjustment and life satisfaction and significantly higher levels of depression, stress and anxiety, when compared with population norms 5 .…”

Section: Introductionmentioning

confidence: 99%

Parental perceptions of social and emotional well‐being of young children from Australian military families

Rogers,

Johnson,

Coffey

et al. 2023

Australian J Rural Health

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IntroductionMany Australian Defence Force (ADF) and Veteran families are affected by the stressors of Defence family life, including frequent and prolonged parental deployments, and frequent relocations.ObjectiveTo address a gap in information about Defence and Veteran (hereafter Defence) parents' knowledge, confidence and resources to support their young children's well‐being and build their resilience.DesignThis study used a mixed methods design to explore Defence parent's perceptions of their young children's (aged 2–8 years) social and emotional well‐being and understanding of their children's responses to unique stressors as well as their confidence in providing support. Data from 41 parents were available.FindingsOverall, parents reported positive well‐being evaluation of their children. However, just over a third of parents also reported that their children rarely cope well on two indicators combined (adapting to new situations and sharing negative emotions with others). Significantly, more than half of the parents (61%) were only partially confident in their ability to assist their children to cope with unique stressors in military families. Qualitative data provided further insights into children's struggle with relocations and parental absence and the challenges parents face in supporting them. Parents reported having limited access to effective age‐ and culturally appropriate resources to support their young children.DiscussionIn a first‐of‐its kind study, we found that Australian Defence parents reported their young children were coping on most of the key well‐being indicators. However, awareness of currently available supports for children remains a barrier as well as access to contextualised, age‐ and culturally appropriate resources are lacking.ConclusionThere is a need for access to free, quality, online, research‐based Australian resources to support young children from Defence families, especially for those living in regional and rural locations and are less likely to have access to mental health and other specialist supports.

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“…For example, some have posed solutions like virtual care options such as video telehealth to improve access to specialty care 10 ; however, this solution only partially meets this need. 11 Many rural residents prefer in-person modalities and/or lack sufficient access to broadband for high-quality video conference, and many healthcare needs require in-person assessment and treatment, making recruitment and retention of providers in these areas important elements to addressing rural health disparities. 12 Many programs and funding mechanisms have been introduced to support rural health workforce development over the past 3 decades.…”

Section: Introductionmentioning

confidence: 99%

Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review

et al. 2023

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Access to healthcare continues to be a top priority and prominent challenge in rural communities, with 20% of the total U.S. population living in rural areas while only 10% of physicians practice in rural areas. In response to physician shortages, a variety of programs and incentives have been implemented to recruit and retain physicians in rural areas; however, less is known about the types and structures of incentives that are offered in rural areas and how that compares to physician shortages. The purpose of our study is to conduct a narrative review of the literature to identify and compare current incentives that are offered by rural physician shortage areas to better understand how resources are being allocated to vulnerable areas. We reviewed published peer-reviewed articles from 2015–2022 to identify incentives and programs designed to address physician shortages in rural areas. We augment that review by examining the gray literature, including reports and white papers on the topic. Identified incentive programs were aggregated for comparison and translated into a map that depicts high, medium, and low levels of geographically designated Health Professional Shortage Areas (HPSAs) and the number of incentives offered by state. Surveying current literature regarding different types of incentivization strategies while comparing to primary care HPSAs provides general insights on the potential influence of incentive programs on shortages, allows easy visual review, and may provide greater awareness of available support for potential recruits. Providing a broad overview of the incentives offered in rural areas will help illuminate whether diverse and appealing incentives are offered in the most vulnerable areas and guide future efforts to address these issues.

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Evaluating policies to improve access to mental health services in rural areas

Cited by 12 publications

References 47 publications

Examination of increasing suicide rates among rural Hispanic VA patients

Examination of increasing suicide rates among rural Hispanic VA patients

Parental perceptions of social and emotional well‐being of young children from Australian military families

Current Programs and Incentives to Overcome Rural Physician Shortages in the United States: A Narrative Review

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