The Affordable Care Act has brought ongoing changes in health care, but there are still issues surrounding those living with mental illness, particularly in rural areas, where there is a significant lack of mental health care available.
In rural populations, the rates of depression exceed those in urban populations, and suicide rates among teenagers and adults are significantly higher in rural areas than in urban areas.
As a mother and nurse living and working in rural of Connecticut, I have found that obtaining mental health services can be a time-consuming, frustrating process.
The biggest obstacle has been the distance of travel and wait times associated with obtaining appointments and staying on track with providers for medication management. There is a significant lack of psychiatrists, and most available providers are at least a half-hour away. Follow-up appointments must be made well in advance, and typically, the providers move around and are in two or three different locations, depending on their schedules in a particular week. On multiple occasions, the mental health providers I have dealt with have transferred to locations farther away.
The obstacles for patients residing in long-term care facilities are just as concerning. There doesn’t seem to be enough mental health providers to handle the number of patients in long-term care who need their services. And there are no alternative resources for these patients other than the part-time provider who comes in once a week, or the local hospital emergency rooms.
This becomes frustrating, time-consuming and costly for patients and their families. If a patient has suicidal ideation or becomes combative, we typically have to send him to the hospital emergency room for further observation because we don’t have adequate resources to address their crisis. The hospitals typically send them back to us if there aren’t any beds available to keep them. If an incident happens after hours and medications need to be adjusted, we typically have to wait for the part-time provider to come in on their next scheduled day, and it remains our responsibility to maintain their safety as well as the safety of others.
A service that has been effective for treating mental health illness in rural areas are walk-in centers. Walk-in centers not only address the provider shortage, but they also eliminate long wait times for appointments, and provide prompt and effective service. These centers are based on self-referral, and patients can have face-to-face visits with a provider. This increases the motivation for individuals to seek help when they need it.
Along with walk-in centers, the utilization of tele-health within these centers has shown to improve mental health services in rural areas. Through the use of telephones, video conferencing, email and Internet, tele-health can connect clinicians and consumers. Treatment can begin fairly quickly and can be done from a distance. Tele-health has also been shown to reduce the stigma associated with mental illness by increasing autonomy and privacy for clinicians and consumers.
With the ongoing issues that are present with mental illness and rural populations, I am hoping that more positive initiatives such as walk-in centers and tele-health can be implemented in rural areas so people living with mental illness can get the services they need.
Holly Atkinson, a resident of Plymouth, is a nursing student at the University of Saint Joseph and has been a practicing LPN for five years, working primarily with geriatric patients suffering from dementia and adults living with other psychiatric co-morbidities.