Rural mental health coverage under health care reform

Abstract

Efforts to integrate services and financing under health care reform hold benefits for provision of services to rural mentally ill persons. Remote areas pose a particular challenge as the unique characteristics of rural America are even more evident. The model for managed care in remote rural areas will differ from those used in urban and their adjacent rural areas. Universal coverage would remove the barriers to accessing care for this population, but does not assure availability of adequate mental health services are or providers in rural areas. Characteristics of currently available rural mental health services are presented and obstacles to expanded delivery under health care reform are outlined.

Use, Quality, and Outcomes of Care for Mental Health: The Rural Perspective

“…The overall effect is that rural providers are being managed less than their urban counterparts. Moreover, because many rural areas have the capacity to support only one managed care health plan, only one provider organization, and only one large employer, the rural health market is best characterized as managed cooperation rather than managed competition (Lomicka 1997;Fox, Merwin, and Blank 1995;Shelton and Frank 1995;Casey, Wellever, and Moscovice 1997).…”

Ethical Considerations in Rural Health Care: A Pilot Study of Clinicians in Alaska and New Mexico

“…Depression and alcoholism, once perceived as "city problems," are now experienced at higher rates in rural than urban areas (Wagenfeld, Murray, Mohatt, & DeBruyn, 1997), and suicide rates in rural areas have surpassed urban rates hi some regions. Sequellae of depression are intensified by greater rural economic fragility (Shelton & Frank, 1995). Also, rural compared to non-rural residents have higher rates of chronic illnesses and life-threatening conditions, such as cancer, heart disease, diabetes, and arthritis (Thurston-Hicks, Paine, & Hollifield, 1998).…”

Effects of a clinical feedback system on client and therapist outcomes in a rural community mental health center

“…Often, rural patients will seek help for their mental health symptoms through primary care physicians, chiropractors, or local healers; or they may be involved with the criminal justice system (Sullivan, Jackson & Sprintzer, 1996). Obstacles to appropriate airal mental health services delivery include issues of availability, accessibility, and acceptability (Blank et al, 1995;Shelton & Frank, 1995). Therefore, results of studies on rural populations may not be generalizable to urban areas.…”