Rural Mental Health Overview A Rural Hospital Perspective A Regional Perspective.
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Transcript of Rural Mental Health Overview A Rural Hospital Perspective A Regional Perspective.
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Rural Mental Health
Overview A Rural Hospital Perspective A Regional Perspective
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Overview Rural Mental Health
Rick Peterson, Ph.D. LMFT, CFLE, Past- President NARMH, Associate Professor,
Texas A&M AgriLife Extension
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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
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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
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Overview Rural Mental Health
Acceptability Accessibility
Availability
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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”
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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
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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
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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
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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
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Jeff Barnhart, CEO- Ochiltree General Hospital
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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.
Unhappy Law Enforcement
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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.
Rep. Jose Menéndez, District 124
Rep. John FrulloDistrict 84
Sponsors
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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.
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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.
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Relating to the detention and transportation of a person with a mental illness
Senator Judith Zaffirini (D-Laredo)
Sponsor
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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.
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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.
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Rural Mental Health- Rural Mental Health-
A Regional A Regional PerspectivePerspective
Jim Womack, Texas Panhandle Centers Behavioral and Developmental Health- Director of Planning,Regence Health Network- Board of Directors
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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
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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
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Recent Strategies for Addressing Issues TELEPSYCHIATRY- REGIONAL
CLINICS AND JAILS MOBILE CRISIS OUTREACH CBT OPEN ACCESS
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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
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Restored Funding
Increased funding for mental health through this Legislative Session- just now back to FY2003 funding after 2 cycles of cuts.
1115 Waiver
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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.
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Continuum of Care
CHILD AND ADOLESCENT WRAPAROUND SERVICES
30 DAY INTENSIVE OUTPATIENT TREATMENT
CRIMINAL JUSTICE DIVERSION
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CRISIS RESPITE
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Peer Support
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Veteran’s Peer Support
Partnership with Central Plains Center
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New Funding
Opportunity for new crisis and prevention funding?
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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