Rural Mental Health

1. Rural Mental Health

2. Rural Mental Health • Overview • A Rural Hospital Perspective • A Regional Perspective

3. Overview Rural Mental Health Rick Peterson, Ph.D. LMFT, CFLE, Past- President NARMH, Associate Professor, Texas A&M AgriLife Extension

4. Overview Rural Mental Health • 20% of U.S. population rural • More poverty, older, lacks health insurance, less likely to seek care due to stigma • Higher rates of suicide, depression, domestic violence and child abuse • Rural youth higher rates of substance abuse: alcohol, tobacco, methamphetamines, prescription drugs, inhalants, marijuana, cocaine. • Persistent disparities in rates, severity, and outcomes of mental health

5. Overview Rural Mental Health • Mental Health shortage areas – lack doctoral level practitioners • High rates of turnover and lack of training specific to rural • Funding for rural mental health lags behind funding for other disparity groups

6. Overview Rural Mental Health Accessibility Acceptability Availability

7. Mental Health Services:The AAA Approach • Accessibility • Distance to services • Payment – fragmented • Funding for rural mental health lags behind funding for other disparity groups • No wrong door – “Medical Home”

8. Mental Health Services:The AAA Approach • Availability - shortage of providers • More than 85% of MH shortage areas are in rural areas and more than half of all U.S. counties do not have a single psychologist, psychiatrist, or social worker • Rural hospitals may not be equipped to handle mental health and substance abuse patients • County and small town law enforcement have little training or expertise to handle mental health patients

9. Mental Health Services:The AAA Approach • Availability - shortage of providers • Workforce - lower salaries, limited social/ cultural outlets, increased provider turnover and burnout. • Training issues - lack of training programs focus on rural providers • Funding for rural mental health lags behind funding for other disparity groups

10. Mental Health Services:The AAA Approach • Acceptability of services • Lower due to increased stigma • Decreased anonymity in seeking psychological services • Lack of understanding of the mental health system and consumer education • Cultural issues – language, type of trauma, treatment

11. Overview Rural Mental Health • Because of lower accessibility, availability and acceptability rural residents suffering from mental health disorders tend to • Enter mental health care later, • Enter with more serious symptoms, • As a result require more intensive treatment

12. Mental Health Issues from the Rural Hospital Perspective Jeff Barnhart, CEO- Ochiltree General Hospital

13. Unhappy Law Enforcement Location • North Texas State Hospital-215 miles • Big Spring State Hospital- 350 miles • Psychiatric hospital 125 miles away, however this facility is rarely an option. • Law enforcement resources already strained. • Deputy often committed to patient for hours, prior to transport. • Sheriff feels that this a medical issue. • There is no law against mental illness.

14. Relating to the authority of emergency room physicians and certain certified emergency medical services professionals to hold a person believed to have a mental illness; establishing mental health crisis intervention certification for certain emergency medical services personnel. Sponsors HB 245 Rep. Jose Menéndez, District 124 Rep. John Frullo District 84

15. HB 245 • Would have allowed physicians to issue a 24 hour hold on mental health patients. • Although well intentioned, this had the potential to be problematic for rural hospitals. • Physician initiated 24 hour hold, then hospital is charged with holding them. • Once the hold was placed, because there would have no longer been a warrant involved, law enforcement would not technically be responsible for transport to the state hospital.

16. Problematic • Unlike larger hospitals, rural hospitals generally speaking are not equipped to handle mental health patients from a staffing or facility standpoint. • This would also leave them responsible for transport to the state mental hospital. • The issue of restraints.

17. Relating to the detention and transportation of a person with a mental illness Sponsor SB 36 Senator Judith Zaffirini (D-Laredo)

18. SB36 A jail or similar detention facility may not be deemed  suitable for detention of a person taken into custody , except in an extreme emergency that existed because of hazardous weather or the occurrence of a disaster that threatens the safety of the proposed patient or person transporting the proposed patient.

19. Problematic • Again, unlike larger hospitals, rural hospitals, generally speaking, are not equipped to handle mental health patients from a staffing or facility standpoint. • This would also leave them responsible for transport to the state mental hospital. • The issue of restraints.

20. Although these died, they are two examples that further show that our mental health system is broken.

21. Rural Mental Health- A Regional Perspective Jim Womack, Texas Panhandle Centers Behavioral and Developmental Health- Director of Planning, Regence Health Network- Board of Directors

22. Mental Illness in the Texas Panhandle • NAMI and NIMH Statistics: • 25% of US population experience a mental health disorder in a given year. • 6%-17% of U.S. population experience a serious emotional/mental illness in their lifetime. • Local Service Area Population=403,000 • MHD 100,750 = Odessa • SMI 24,200 > Plainview

23. Veterans in Rural Areas • Only 23 to 40 percent sought psychiatric help due to fear of being stigmatized • Shame arising from stigma worsens depression and social alienation -increases rates of treatment non-compliance

24. Recent Strategies for Addressing Issues • Telepsychiatry- Regional Clinics and Jails • Mobile Crisis Outreach • CBT • Open Access

25. Strategies for Addressing Issues- New Opportunities • Restored Funding • Physical and Behavioral Health Care Integration • Continuum of Care • Crisis Respite • Peer Support • Veteran’s Peer support

26. Restored Funding • Increased funding for mental health through this Legislative Session- just now back to FY2003 funding after 2 cycles of cuts. • 1115 Waiver

27. Physical and Behavioral Health Care Integration WHY: • People receiving behavioral health services need better access to primary care. • People with serious mental health conditions die an average of 25 years earlier. • Many mental and physical disorders are co-occurring. • Integrated care decreases depression, improves quality of life, decreases stress and lowers rates of psychiatric hospitalization. • Lower overall health costs.

28. Continuum of Care • Child and Adolescent Wraparound Services • 30 Day Intensive outpatient Treatment • Criminal Justice Diversion

29. Crisis Respite

30. Peer Support

31. Veteran’s Peer Support Partnership with Central Plains Center

32. New Funding • Opportunity for new crisis and prevention funding?

33. Thank You Rick Peterson 979-845-1877 Texas A&M AgriLife Extension Jeff Barnhart Ochiltree General Hospital 806-435-3606 Jim Womack Texas Panhandle Centers 806-351-3326