Mental Health Services in Rural Primary Care
Posted on May 18, 2007
Working together, physicians, researchers, and mental health clinicians can provide effective services for their clients. There are advantages for everyone involved in collaboration:
- physicians spend less time on mental health issues while learning more about behavioral issues that can effect their patients' health
- mental health practitioners more can easily coordinate and communicate with physicians, and provide continuity of care to their clients
- researchers can develop and evaluate prevention and intervention programs
- patients have easier access to the services they need, they are less dependent on physicians for mental health needs, and confidentiality is increased
After graduation, trainees are given postdoctoral fellowships, assigned to a rural site, and given responsibility for all clinic operations. Pre-docs are trained for 6 months; post-docs for 1 year at the primary care setting. They are supervised both by physicians and psychologists, then take part in co-therapy with their supervisors. When they are ready to provide care independently, they continue to work closely with their supervisors. They also learn about empirically-supported interventions. A little over half of the graduates from the training program work in rural settings, and 13 out of 14 of our sites are staffed by these graduates. (We also ensure that all clinicians at the sites are well-qualified; they can be master's level practitioners, post-docs, or assistant or associate professors).
To sustain the sense of community and collaboration, we schedule monthly videoconferencing using Polycom technology. All outreach sites have televideo capabilities through their local hospital systems and costs of the conferencing are covered by the Munroe-Meyer Institute. During these monthly meetings, we spend some time on administrative topics (billing, scheduling patients, etc.), provide updates on research projects, and discuss various clinical topics.
We've also learned that there are areas that are too remote to benefit from our program. We have two strategies for extending our reach to these places - we are currently training more students and trying to get them placed in these distant settings, and we are developing a telehealth clinic, which can provide care via teleconferencing to counties with populations of fewer than 6 people per square mile. We are also striving to develop individualized programs to address different community concerns. For example, one community is interested in helping learning disabled children, another needs services for their Hispanic clients, and a third has significant problems with teen pregnancy.
We also need to develop a comprehensive research infrastructure that can make use of the rich database that these clinics can provide. With an infrastructure in place to support research, people could more easily investigate mental health outcomes in primary care as well as the effectiveness of various collaborative models.
Bray, J. & McDaniel, S. (1998). Behavioral health practice in primary care settings. In L. VandeCreek and S. Knapp (Eds.), Innovations in clinical practice: A source book, vol. 16 (pp. 313-323). Sarasota, FL: Professional Resource Exchange, Inc.
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