New Rural Mental Health Services Resource Center Being Established

Letter to the Field No. 1

A new "resource center" for states, agencies, and services-delivery personnel involved in mental health care for people residing in isolated rural areas has been funded by the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration. Named the Frontier Mental Health Services Resource Network, its basic mission is the collection, analysis, and synthesis of knowledge regarding needs for and delivery of mental health services in rural "frontier" U.S. counties with population densities of six or fewer persons per square mile. Nearly all such counties are found in fifteen western mountains-and-plains states and Alaska (see Figure 1).

Figure 1.

The Network consists of eight experts in various domains of rural mental health. It is based at the University of Denver, but is largely decentralized-most members are located elsewhere in Colorado, North Dakota, or Michigan. Some administrative and communication functions of the Network are housed at Boulder, Colorado with the Mental Health Program of the Western Interstate Commission for Higher Education (WICHE).

Five main information topics involving frontier rural mental health (MH) services have been identified for allocating the work among the rural mental health experts comprising the Network; these include:

• Strategies for surveillance of the need for MH services of various kinds in frontier areas, and the demand for MH services (including strategies to raise demand to levels more appropriate to needs).
• Strategies for surveillance of the availability and accessibility of MH services in these areas (including those provided in the general-medical care sector), and strategies to increase both their availability and accessibility.
• MH interventions appropriate for frontier areas, including (1) "models" of MH services organization and delivery (both in medical-care systems and "free-standing" or independently based services), (2) "standard" interventions, especially those for severely and persistently mentally ill persons, as well as interventions appropriate for special populations (children, elderly, ethnic minorities, etc.), and (3) costs and outcomes of different service organizations and intervention strategies.
• Identification of MH provider types and skills necessary for adequate frontier-area care, including strategies for recruiting, training, and retaining providers for these areas.
• Identification of models and components of integrated communications systems appropriate for linking MH caregivers, administrators, back-up care consultants, and possibly consumers with each other in isolated areas where distances between these parties are substantial and constitute a significant geographic obstacle to services availability and accessibility.

The initial phase of the three-year project is in-depth exploration of the above topics and collection of both published and unpublished (or "fugitive") materials on MH service needs, demand, providers, interventions, and inter-communications. Each Network member is responsible for drafting a comprehensive, integrated summary of the available knowledge in their assigned domain, and for linking this knowledge with other domains being addressed by other Network members. Reader are asked to assist Network staff in identifying and accessing these materials, by calling their attention to "fugitive" materials of which they are aware and by helping staff to obtain them.

In the second year of the project, the focus will shift to evaluation of the draft knowledge syntheses by persons from sample frontier counties who are involved in the delivery of MH care in those areas. Participating in both individual document exchanges and subsequent focus group meetings to be held in rural areas, the local residents and caregivers will critique the findings and recommendations of the various topic drafts, and provide their objections, insights, and suggestions for revisions to Network authors. In turn, the authors will incorporate these evaluative responses into their knowledge syntheses as is practical.

In all three years, but primarily in the late second and third years, the project will focus on dissemination of the knowledge syntheses to individuals, organizations, and agencies involved in rural frontier MH service delivery. Dissemination methods will include publication of materials, conducting workshops in connection with professional meetings, and providing telephone and written technical assistance to those persons or agencies that request it.

A major thrust of the knowledge synthesis efforts will involve review of current electronic communication technology that may facilitate in various ways the delivery of MH services in frontier rural areas, and determining its costs and potential benefits. Telephone conferences, computer networks, and videoconferencing are among the communications tools that will be reviewed, and the Network itself will utilize as many of these different technologies as is practical to acquire firsthand knowledge about their potential. Telephone conferences have already been used to convene "meetings" of the Network's 10-member Advisory Committee that has been formed to assist Network staff in developing high quality syntheses and summaries of available knowledge.

Members of the Network and their assigned knowledge synthesis topics in frontier rural-area MH service delivery are as follows:

James Ciarlo, PhD, University of Denver research psychologist (Principal Investigator and Project Director) - strategies for assessing need for MH services in frontier rural areas;

Jack Geller, PhD, Wisconsin Rural Health Research Center director, Marshfield Medical Research Foundation - availability and accessibility of medically-based MH care, and also medically-based and independently-based models of MH care;

Dennis F. Mohatt, WICHE Mental Health Program director - frontier services for severely and persistently mentally ill persons

Charles Holzer III, PhD, University of Texas Medical Branch medical sociologist - availability and accessibility of independently-based MH services, and also utilization of rural MH services;

Andrew Keller, PhD, Mental Health Corporation of Denver assistant deputy director and psychologist - managed behavioral health care in frontier rural areas;

Walter LaMendola, PhD, private telecommunications consultant and former professor of social work - integrated communication and telemedicine systems for rural MH service delivery;

Frank McGuirk, PhD, Mental Health Corporation of Denver deputy director and psychologist - required care provider skills and provider recruitment, training, and retention;

Dennis Mohatt, MA, Individual & Community Services deputy director, Nebraska Department of Health & Human Services - availability and accessibility of independently-based MH services;

James Sorensen, PhD, University of Denver professor of accountancy - costs and outcomes of MH interventions and services organization;

John ("Jack") Wackwitz, PhD, Colorado Division of Mental Health research psychologist - strategies for assessing rural demand for MH services;

Morton Wagenfeld, PhD, Western Michigan University sociologist and professor of community health services - Mental health interventions and care strategies, including services appropriate to special populations.

The membership of the Network's Advisory Committee includes:

Peter Beeson, PhD, Nebraska Department of Health & Human Services Finance & Support;

Liz Breshears, MEd, MSW, Nevada Department of Human Resources;

H. Ed Calahan, MEd, Texas Department of Mental Health/Mental Retardation;

Sheila Cooper, consumer advocate and rural New Mexico resident;

Michael Enright, PhD, private psychology practice, Jackson, Wyoming;

Richard Lippincott, MD (psychiatry), Louisiana Department of Health and Hospitals;

Arthur McDonald, PhD, Psychological Services Dept., Dull Knife Memorial Foundation;

Carol Miller, EMT/MPH, Frontier Education Network and Mountain Management, Ojo Sarco, New Mexico;

Mike Romero and Mary Van Pelt, San Luis Valley Mental Health Center consumer/outreach worker team, Alamosa, CO;

Roger Schauer, MD (family medicine), University of North Dakota School of Medicine

Write us with comments on our site This project is supported by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration Contract No. 280-94-0014

Frontier Mental Health Resource Network
Please send comments and suggestions on this home page to Dennis F. Mohatt at dmohatt@wiche.edu
http://www.wiche.edu/mentalhealth/Frontier