The availability of mental health care for individuals living in rural areas presents unique challenges. These communities often have little or no access to mental health services and providers.
Instead, they are forced to rely on general practitioners who lack the expertise to provide accurate diagnoses. Moreover, if services are available, they may not be up to par, with providers needing to cover a wide geographic area with constrained financial and staffing resources.
The issues of privacy and anonymity are frequently barriers to receiving treatment in rural locations. Individuals often fear being the object of gossip in a community where others may recognize their car at a therapist’s parking lot or see them picking up a prescription at the pharmacy. At times, the provider themselves are friends or acquaintances, resulting in a reluctance to receive care.
These challenges can significantly impact rural residents in crises. For example, a person with an undiagnosed mental condition may not receive proper care during an emergency. Or it may be too embarrassing to admit that they are experiencing a mental health break or even having suicidal thoughts.
Alarmingly, statistics show that suicide rates are highest in rural America. In fact, between 2013-2015, the suicide rate was 55 percent higher in rural areas. Moreover, the gap between urban and rural areas has grown steadily from 1999 to 2015, with the gap widening more quickly since 2007.
Given these challenges, it has become necessary for rural communities to adopt Mobile Crisis Solutions to address their unique circumstances. Those strategies might include such things as:
- Using technology in collaboration with Crisis Intervention and Mobile Crisis Response Teams
- Expanding telehealth options
- Building on existing programs
- Matching resources to meet community needs
Using Technology in Collaboration with Crisis Intervention and Mobile Crisis Response Teams
The Crisis Intervention Team (CIT) program is a community-based approach that creates connections between law enforcement, mental health providers, emergency services, and individuals with mental illness. According to NAMI (National Alliance on Mental Illness), “Through collaborative community partnerships and intensive training, CIT improves communication, identifies mental health resources for those in crisis, and ensures officer and community safety.”
Lack of mental health crisis services in this country, especially in rural locations, has resulted in police officers acting as first responders. Ideally, the officer will have received CIT training and will de-escalate the situation and divert the individual away from the criminal justice system and into treatment. Alternatively, in communities with an effective Mobile Crisis Response program, the situation can frequently be resolved without involving law enforcement.
Technology is a critical component of an effective partnership with CITs and Mobile Crisis Response Teams. It can provide the means to share limited or expensive resources across large geographic areas and multiple jurisdictions. Sharing information can increase the communities’ ability to provide services more cost-effectively. Ensuring that this sensitive data is secure can be challenging, but Julota solves that problem seamlessly. All health information recorded by the teams is protected by an additional layer of security that is compliant with all data privacy and security regulations governed by law such as HIPAA, 42 CFR Part 2 (to protect substance use treatment records), and CJIS (Criminal Justice Information System).
The award-winning community information software provides a simple, accessible user interface that meets all security and privacy compliance. With cloud computing, law enforcement and mental health professionals can access data and update records in the field, all on their own devices, such as tablets or smartphones. In addition, with Julota’s multidirectional sharing, Crisis Intervention Teams and Mobile Response Teams can make referrals for service and provide options beyond jail or the emergency room.
Expanding Telehealth Options for Mobile Health Response
In recent years, telehealth has become an effective way to provide mental health care to people across the country. It is defined as “…the use of communications technologies to provide health care from a distance. These technologies may include computers, cameras, videoconferencing, the Internet, and satellite and wireless communications.”
Providing services like mental health care using telehealth in rural areas is more feasible than staffing their facilities with specialty providers. It allows for improved access to specialists like psychiatrists and psychologists and can reduce challenges patients encounter, such as transportation, distance, mobility problems, and stigma. Telehealth also improves communication between providers and patients.
Because of the increased need for telehealth services due to the pandemic, Medicare and Medicaid have expanded coverage for healthcare services using this method of care. In September 2021, the Centers for Medicare and Medicaid Services (CMS) awarded funding to health care entities that participate in the CHART (Community Health Access and Rural Transformation) model. Through the program, health care facilities can expand telehealth services for their patients and address disparities in lagging technological and care-delivery innovations in rural areas.
Building on Existing Mobile Health Response Programs
Choosing to build on existing programs may be beneficial in rural areas. That could include specialized training for mobile crisis responders and law enforcement to address a broader range of crises. Current programs might also benefit from the addition of new tools and resources.
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently provided grants that increased access to facilities that supply community-based support for those in need of mental health treatment and substance use disorder services. The grant program will help establish services in new facilities and make services more robust at existing facilities. It mainly focuses on improving the quality of mental and substance use disorder treatment services. This includes 24/7 crisis intervention services for persons with substance use or mental health disorders and children and adolescents with severe emotional disturbances.
In fall 2021, the Centers for Medicare and Medicaid Services (CMS) also awarded new funding to support rural health care access and innovation, including expanding Mobile Crisis Intervention solutions. The grant funding will assist states in integrating community-based Mobile Crisis Intervention services into Medicaid programs. It will be used specifically to conduct community assessments and develop services for people experiencing a crisis related to a mental health disorder or substance use.
Crisis intervention services are a vital tool for de-escalating a person in crisis. Ideally, this intervention will reduce the number of individuals with mental and behavioral disorders in the criminal justice system. In addition, a robust mental health crisis service can ensure that crises are managed in a way that provides the best possible care resulting in a path toward recovery. Medicare and Medicaid services can now provide for this type of care delivery.
Matching Resources to Meet Community Needs
Strategies for finding resources to meet the mental health needs of rural communities often differ from those in larger areas. Some examples might be:
- Involving all police officers in CIT training
- Grant-funded support for rural residency programs in psychiatry
- Providing help through mental health organizations
Let’s examine these in more detail.
Involving all police officers in CIT training
Traditionally, most police departments in the U.S. train only about twenty-five to thirty percent of their officers in Crisis Intervention. However, because rural communities experience such disparity in mental health needs, many have chosen to train all their officers. Providing this additional training ensures that a CIT-trained officer is always available to respond to crises. Funding for the training is available through public or private grants.
Grant-funded support for rural residency programs in psychiatry
The grant program under the Rural Residency Planning and Development (RRPD) Program provides funding for the development of rural residency programs in psychiatry and other specialties. It was created to address physician shortages and challenges faced by rural communities. The programs are accredited medical residency training programs that focus on physicians who practice in rural locations and devote more than fifty percent of their time in residency there.
Providing help through mental health organizations
Organizations like NAMI (National Alliance on Mental Illness) and SAMHSA (Substance Abuse and Mental Health Services Administration) can play a crucial role in bolstering mental health support in rural locations. NAMI Support groups provide support through lived experience to assist recovery and build trust among peers with similar experiences. Trained Facilitators and Peers lead group discussions, teach recovery skills, and function as coaches for others experiencing mental challenges. Community members can be trained and certified through NAMI state training. In addition, today’s technology allows for groups to meet online, making them accessible to everyone.
SAMHSA is the agency within the U.S. Department of Health and Human Services whose role is to advance the behavioral health of the country. Their mission is “to reduce the impact of substance abuse and mental illness on America’s communities.” They are dedicated to improving access to and quality of substance use and mental health disorder care in every community.
SAMHSA offers many programs designed to improve the quality and delivery of behavioral health services across the nation. These include Behavioral Health Equity, which is the right to quality health care for all populations, and early intervention and treatment as healthier alternatives to detaining those with mental health conditions in the justice system. SAMHSA also helps faith-based and other community organizations to deliver effective behavioral health-based services.
Rural communities’ challenges in providing adequate access to mental health care services are real but not insurmountable. As these communities move forward in seeking answers, Mobile Crisis Solutions will play a vital role. From Crisis Intervention teams to emerging technologies and community partnerships, Julota can help. Our software provides a safe and secure interoperable platform for sharing data between healthcare, law enforcement, and data systems.