Focus on rural mental health: Synthesis of rural mental
health research provides good and bad news about use, quality
and results
A recently released report, prepared by a team of NIMH funded
researchers provides considerable insight into what is known
about mental health care in rural America. The report is based
on an extensive review of the rural mental health services
research literature since 1990.
While prevalence rates for serious mental disorders are similar
in rural and urban communities, differences exist in the treatment
experience. Rural persons with depression perceive services
to be less accessible and treatment to be less acceptable
than their metropolitan peers; however the study found no
difference in service use or one-year symptom outcomes. By
contrast, for persons with bipolar disorder and schizophrenia
rural residents have worse symptom outcomes than their metropolitan
counterparts. This is especially true if there is co-occurring
substance abuse. The report also reveals that studies have
shown higher suicide rates among rural persons with depression
and among rural adults and youth.
While there is no difference in one-year symptom outcomes
for persons with depression in rural vs. urban settings, the
per capita cost of care for rural persons was significantly
less ($379 vs. $612 in Y2K dollars), which the report attributes
to rural residents being less intensive users of specialty
care services. This finding is consistent with studies of
expenditures in physical health care, that also find lower
costs for treating physical health problems in rural settings.
The report also noted that a $1.00 increase in the cost of
depression treatment was associated with a $1.42 reduction
in the cost of treating physical health problems. No cost
offset was noted for urban residents.
As the West continues to meet the challenges of providing
mental health services to persons living in rural and frontier
areas, this report offers considerable information to assist
in the formation of public mental health policy and intervention
strategies. Since the report notes rural persons often seek
help for mental health problems outside the mental health
system, it may be prudent to educate rural primary care providers
and other potential gatekeepers to increase their ability
to refer individuals in need to existing mental health services
available in their communities or regions. Finally, the report
notes that perceptions of need for care and services available
were significantly lower than actual for rural persons. As
a result, educational and marketing strategies that improve
rural residents' understanding of mental illnesses and available
services can be a cost effective method to improve accessibility
of existing resources.
Source: Rost, K., Fortney,
J., Fischer, E. and J. Smith Use, Quality, and Outcomes of
Care for Mental Health: The Rural Perspective. 2001. Copies
are available via email at: Stephanie.Green@UCHSC.edu
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