WICHE Mental Health Report
August 06, 2007
Volume 1, Number 7
RECENT ISSUES: February 2007 . March 2007 . April 2007 . May 2007 . June 2007 . July 2007
In this Issue:
InFocus: Accessibility of Mental Health Services:
Despite comparable prevalence rates for mental disorders among rural and urban residents, rural residents are less likely to have access to services or providers. Three components of access to mental health resources put rural residents at a significant disadvantage: knowledge, transportation, and financing.
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Knowledge – knowing when one needs care and knowing what care options are available.
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Transportation – placing patients and providers in the same location.
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Financing – paying for services.
Knowledge
An essential element of access is knowing when one needs care and what care options are available. In both respects, the rural experience differs from the urban one.
Compared to their urban peers, rural residents have less knowledge of the need for mental health care: the ability to recognize symptoms and assess the impact on functioning. Insufficient knowledge of symptoms leads to seeking care later in the course of their disorders when symptoms are more severe and persistent. Perceived need for care is so low that even minimal barriers in other areas can prevent a person from seeking assistance.
Rural residents are also less likely to be informed of the services available to them, especially when services are few and far between. Lower ratios of mental health providers in rural areas is directly related to lower access of mental health services.
One response to overcoming these barriers is a marketing effort to enhance rural knowledge of mental illnesses, treatment options/best practices and local resources. However, administrators and providers of rural mental health services express apprehension about creating an increased demand when current resources are often over-utilized. Nevertheless, consumers, noting “they couldn’t go because they didn’t know,” believe public education should be among the top priorities for enhancing the rural mental health care system.
Transportation
The ability to travel to services and to pay for those services is a significant barrier to rural Americans. Physically and psychologically accessible and affordable transportation services may be unavailable, especially to rural children, people with disabilities and the elderly. Public transportation is often not an option to rural consumers of mental health services. Rural consumers and families must often travel hundreds of miles weekly to access care available only in larger communities. In response, many rural mental health providers operate some form of transportation service to bring consumers to care—an operational cost not often incurred by their urban counterparts.
Financing
Financing clearly plays a role in access to mental health services. “Who pays for services” is a sensitive question that drives much political debate at all government levels. The topic of financing is complex with numerous contributing and mitigating factors, which are difficult to condense. This section provides a glance at three areas: uninsured and underinsured, Medicaid, and families.
Uninsured and Underinsured
Two-thirds of uninsured rural residents are poor or near-poor, meaning their family income is less than 200 percent of the poverty level. Many rural residents are self-employed or work for small businesses. Typically, these employees do not have employer-based health insurance or their employers offer only a catastrophic plan.
Catastrophic plans, as opposed to full health coverage plans, have high annual deductibles and only cover serious injuries and illnesses requiring hospitalization, surgery, and related treatments. Mental health services are typically not covered by catastrophic plans and even the full health coverage plans offered by some employers are beginning to exclude many debilitating mental illnesses from eligibility. In response to increasing insurance premiums, many small businesses are discontinuing insurance coverage for their employees, dropping coverage for dependents, increasing the employee’s contribution to the premium and deductibles, or not providing health insurance at all. As a result, increasing numbers of rural residents are paying out-of-pocket for basic and comprehensive services.
In addition, since many un/underinsured people work, they are often ineligible for government-sponsored benefits (such as Medical Assistance). In both scenarios, the consumer loses. They are not eligible for government assistance because they have a job, yet they cannot afford to pay for healthcare outright.
Medicaid
Approximately one-fourth of the rural poor qualify for Medicaid, compared to 43 percent of low-income urban residents. The cost of health services only partially reimbursed by Medicare and Medicaid may be too expensive for some rural residents. Further complicating the cost issue is the lack of Federal strategies for sustainable mental health services. In addition, rural programs often operate in areas with limited financial resources to leverage as matching funds for other grant support.
Families
Most families in need can obtain some type of CHIP funding. However, for those that fall through the cracks, lack of insurance can be especially tragic for families with children with serious emotional disturbances. Parents are struggling to make a living and provide for their children, while confronting serious behavioral issues in the home. Such situations can lead to reactive depressive and anxiety conditions, as well as to child abuse and neglect. Too often, parents face the unthinkable choice of relinquishing custody of their child to obtain mental health treatment because they cannot pay for care. It has been estimated that more than 25 percent of families face this crisis each year . While the data are not extensive in this area, those data would suggest that rural families with lower rates of insurance coverage and provider availability may be at greater risk of facing this dilemma.
FYI…
The National Council JOBank
www.nccbh.org/jobank
Join us in building a quality mental health and addictions treatment workforce
Post your executive, administrative, and clinical openings on the National Council JOBank andreach a targeted national talent pool of candidates interested in behavioral healthcare jobs. Post for just $250 ($125 for National Council member organizations).
The National Council's JOBank is the only web-based, national recruitment service dedicated to behavioral health.
Our upgraded, user-friendly technology now allows you to post and pay online. Just go to www.nccbh.org/jobank and follow the simple steps. Questions? Call us at 301.984.6200.
The National Council for Community Behavioral Healthcare is a not-for-profit 501(c)(3) association representing 1,300 organizations that provide treatment and rehabilitation to help people recover from mental illnesses and addiction disorders. National Council members serve nearly six million adults, children, and families in communities across America.
Office of Rural Health Policy announces:
The Rural Health Network Development Planning Grant Program
Purpose
To provide support to entities that need assistance to plan, organize and develop a health care network because they do not have a significant history of collaboration and are not sufficiently evolved to apply for a three year Rural Health Network Development Grant. This support may be sufficient to jumpstart a network into becoming operational and developing strategies for becoming sustainable. The grant program supports one year of planning to develop and operationalize health care networks, consisting of at least three health care providers, in rural areas.
Successful applicants can use one-year Planning Grants for laying the foundation of a rural health network to:
- Identify potential collaborating network partners in the community/region
- Convene potential collaborating network partners
- Conduct planning activities, which could include:
- Undertaking a community health needs assessment
- Identifying the most critical need of potential network partners to ensure their viability
- Identifying factors that will lead to the networks sustainability, i.e. enumerating the benefits that will accrue to network participants if their network is successful
- Developing a business, operation or strategic plan
- Developing a plan for the networks sustainability
- Carrying out organization development activities, e.g. creating a formal MOA/MOU establishing a network board establishing bylaws; applying for 501(c)3 status, etc or
- Begin carrying out network activities, including activities to promote the networks sustainability.
Funding Preference
(1) Those applicants where the service area is located in officially designated health professional shortage areas (HPSAs)or medically underserved communities (MUCs) or serve medically underserved populations (MUPs;
(2) Applicants whose projects focus on primary care, and wellness and prevention.
A Technical Assistance Conference Call has been scheduled for August 23, 2007 at 2:00 PM Eastern Time. To register for this call e-mail Mary Collier at mcollier@hrsa.gov before noon Eastern Time August 23. The call in information will be returned by e-mail as soon as we receive your registration. The information on how to register will also be available on the web at www.ruralhealth.hrsa.gov.
Application Available |
Jun 29, 2007 |
| Application Deadline | Oct 05, 2007 8:00 PM ET |
| Estimated Project Start Date | Mar 01, 2008 |
| Estimated Project End Date | Feb 28, 2009 |
| Estimated Amount of this Competition | $1,020,000.00 |
| Estimated Number of Awards | 12 |
| Estimated Average size of Awards | $85,000.00 |
| Announcement Number | HRSA-08-003 |
| CFDA Number | 93.912 |
Optimism and Hard Work Pay Off for Washington Health Care Workers
The Campaign for Quality Mental Health Care is led by mental health care workers united for a better mental health system in Washington State. The Campaign is a project of Service Employees International Union (SEIU), Washington's largest union of health care workers.
Due to the grassroots actions of SEIU and community mental health care workers, clinicians are now actively involved in creating a public mental health system that pays more attention to the essential components of a stable workforce. In the 2007-09 Washington State budget, the Legislature set aside more than $24.4 million — $15 million in state funds, matched by $9.4 million in federal funds— to improve the wages and benefits of community mental health workers. As a result, on average community mental health workers will receive at least 8% compensation increases in the next two years.
To find out more information about the campaign process and how you can make a difference in your community, check out the webpage:
http://www.seiu1199nw.org/action/2006mhcampaign/
Or the video:
http://www.youtube.com/watch?v=VhS7eqW9o0w
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Job Opportunities
Recent Job Announcements Webpage
On this page you will find recent job announcements pertaining to either the WICHE West or to rural mental health areas.
WICHE MH Personnel
Dennis Mohatt, MA Mental Health Program Director
Scott Adams, Psy.D. Associate Program Director
Chuck McGee, MA Project Director
Mimi McFaul, Psy.D. Research Associate
Candice Tate, Ph.D. Research Associate
Fran Dong, Statistical Analyst
Jenny Shaw, Administrative & Project Coordinator
Tell Us How the WICHE Mental Health Program Has Impacted You
The Western Interstate Commission for Higher Education is seeking your comments on how our services have affected mental health services in rural communities. Please send an e-mail telling how WICHE has influenced you to ctate@wiche.edu. We would also love to hear your nominations for promising rural practices. Feel free to also contact us with requests for state-specific rural assistance or to just ask us a question about our experience with rural mental issues and public policy.
Subscriber Services
To subscribe or unsubscribe to the WICHE Newsletter send an e-mail to ctate@wiche.edu
