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Rural Workforce Issues
Overview
Behavioral Health Needs of Rural Communities
Many factors (e.g., economic, cultural) play a role in the mental health and mental health care of rural Americans. The prevalence of adults with severe mental illnesses and children with serious emotional disturbances is not significantly different in rural and urban areas. What appears to be different in rural America is the experience of individuals with mental illnesses and their families (Wagenfeld et al., 1994). This difference in experience appears to result in higher suicide rates for both rural adults and youth with serious emotional difficulties, which has been a trend in rural areas for over a decade (NFC-SRI , 2004; Institute of Medicine, 2002; Stack, 1982; Wagenfeld et al., 1994).
Three factors that often prevent rural individuals from receiving the mental health care they need include: Accessibility (knowing where and how to access mental health services); Availability (presence or absence of mental health services and providers); and Acceptability (a person's willingness to seek services and enter treatment). (Larson, Beeson, & Mohatt, 1993; Mohatt, 2000).
These barriers often lead rural residents with mental health needs to seek services later in the course of their disease when more serious and disabling symptoms are more likely. Persistent, untreated symptoms frequently requires more expensive and intensive treatment (Wagenfeld et al., 1994; New Freedom Commission on Mental Health : Subcommittee Report on Rural Issues, 2004).
Workforce Issues and Problems
The President's New Freedom Commission on Mental Health, Subcommittee on Rural Issues (2004) report identified several workforce issues specific to rural communities:
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More than 85% of 1,669 Federally designated mental health professional shortage areas are rural (Bird, Dempsey, & Hartley, 2001).
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Holzer and colleagues (2000) found that few psychiatrists, psychologists or clinical social workers practice in rural counties, and that the ratio of these providers to the populations worsens in more rural settings.
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For the past 40 years, approximately 60% of rural America has been under-served by mental health professions.
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The National Advisory Committee on Rural Health (1993) noted that across the 3,075 counties in the United States, 55% had no practicing psychiatrists, psychologists or social workers, and all of those counties were rural.
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These workforce shortages are even worse for specialty areas, such as children's mental health, older adult mental health, and minority mental health.
Many rural states face problems in attracting and keeping behavioral health professionals in rural communities, especially those who have training relevant to rural communities and their culture. Rural workforce strategies involve two primary aspects: 1) development of the existing workforce and 2) expansion of the workforce through recruitment and retention activities. The Institute of Medicine Report Crossing the Quality Chasm (2005) identifies a third strategy which is to enhance the "health readiness” of rural residents. This involves educating rural residents about the symptoms of mental illness so they can be more proactive in seeking care for possible mental health issues.
Promising Initiatives
In March, 2005, the Western Interstate Commission on Higher Education (WICHE) Mental Health Program facilitated a conference on rural workforce development ( Bridging the Gap: Bringing Higher Education and Mental Health Practice Together ) in Mesa, Arizona. This conference built on gains made during a previous workforce development conference in 2003. The stakeholders at the conference developed recommendations on how to link higher education programs with mental health disciplines to meet the growing need for mental health services in rural areas. Recommendations from this conference will be used to inform a national strategic plan for rural behavioral health workforce development for the Annapolis Coalition project. That plan, with support from SAMHSA, will hopefully give rise to new initiatives at the federal, state and local levels that will begin to solve what is quickly becoming a behavioral health care workforce crisis in rural areas.
States such as Alaska, Arizona, and Montana have been undertaking processes through which higher education, public mental health, and provider agencies work together to identify shared goals and activities to better integrate their systems, train existing providers, and attract students into the mental or behavioral health field. Specific activities have included creating "career ladders” in mental health, articulation of coursework across disciplines or from one degree level to the next, and distance learning for providers in remote areas.
(Note other promising initiatives listed in the "Links” section on this webpage.)
Links
WICHE Mental Health Program
http://www.wiche.edu/mentalhealth/WorkforceDevelopment.asp
http://www.wiche.edu/mentalhealth/conference/meetingminutes.asp
Alaska’s Behavioral Health Workforce Initiative
The Health Profession Tracking Program (HPTP) at the Center for Rural Health,
University of North Dakota School of Medicine and Health Sciences
http://www.med.und.nodak.edu/depts/rural/rhw/tracking/
National Association of Rural Mental Health Website
http://narmh.org/
The Office of Rural Health Policy
http://ruralhealth.hrsa.gov/
Rural Community College Initiative
http://www.mdcinc.org/rcci/philosophy.htm
Idaho State University Rural Institute of Rural Health
http://www.isu.edu/irh/
Texas Rural Community College Network
http://www.trccn.org/
Texas Tech University Health Sciences Center
http://www.ttuhsc.edu/ruralhealth/
Arizona Rural Recruitment and Retention Resources
http://www.rho.arizona.edu/WorkForce/RecruitRetain/
Rural Assistance Center
http://www.raconline.org/info_guides/hc_providers/
Senior Advisor Information
Dennis Mohatt, Senior Advisor on Rural Workforce Issues
Director,
WICHE Mental Health Program
PO Box 9752
Boulder, CO 80301
303-541-0256
dmohatt@wiche.edu
Resources
Quality Through Collaboration: The Future of Rural HealthCare
Institute of Medicine (November, 2004).
Examines the quality of health care in rural America. Includes recommendations to improve health care quality and safety in rural communities. Addresses workforce, information technology, finance and other factors that impact rural health care quality.
Muskie School of Public Service, Maine Rural Health Research Center
Are Advanced Practice Psychiatric Nurses a Solution to Rural Mental Health Workforce Shortages?
State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
The President’s New Freedom Commission on Mental Health Subcommittee on Rural Issues
Background Paper
http://www.samhsa.gov/samhsa_news/VolumeXII_6/article4.htm
The Workforce Crisis: SAMHSA's Response
The Rural Monitor Volume 11 Number 3 Winter 2005
Implications for the Rural Mental Health Workforce
2004 Report to the Secretary: Rural Health and Human Service Issues
National Advisory Committee on Rural Health and Human Services
University of North Dakota Center for Rural Health
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