Mental Health Rural America: An Overview Morton O. Wagenfeld, Ph.D. J. Dennis Murray, Ph.D. Dennis F. Mohatt Menominee County Community Mental Health Center National Association for Rural Mental Health Jeanne C. DeBruyn Western Michigan University Published By Office of Rural Health Policy Office of Rural Mental Health Research U.S. Department of Health and Human Services This document was prepared by the authors under a subcontract with the National Rural Health Association, in collaboration with the National Association for Rural Mental Health. The NRHA was funded under contract no. HRSA 91-734 (P) with the Health Resources and Services Administration and contract no. 92MF03813701D with the National Institute of Mental Health. Cathy Wasem, Office of Rural Health Policy (HRSA) and Charles Windle, Ph.D., (NIMH) served as project officers. The views expressed in this report are those of the authors and do not necessarily reflect the views of the Health Resources and Services Administration (HRSA), the National Institute of Mental Health (NIMH), the Public Health Service (PHS), or the Department of Health and Human Services (DHHS). Foreword As the United States moves toward large-scale health care reform, understanding the special needs that exist in rural communities becomes more urgent. The scarcity of health care providers and facilities makes rural America a challenging venue for health care reform. In designing health care systems for rural areas we must consider the geographic barriers, high levels of poverty and population diversity of many rural areas. The goal of Mental Health and Rural America: 1980-1993 is to summarize current knowledge about mental health issues in rural America. This knowledge will facilitate national, state and community planning for health and mental health care. This publication is a joint effort of the Office of Rural Health Policy, Health Resources and Services Administration (HRSA), and the Office of Rural Mental Health Research, National Institute of Mental Health (NIMH). It has been written to present a more accurate view of contemporary rural America, and counter, among other misconceptions, the popular view that rural Americans are a homogenous population and culture. The farm crisis of the 1980s renewed interest in rural America, where population changes, economic crisis and natural disasters created significant stress on the population. For national and state health planning to be appropriate, it is crucial to have information about the prevalence of health and mental health problems, the conditions associated with these problems, the most cost-effective services to prevent and treat these problems, and the resources and service systems best able to provide needed services. Rural areas are often neglected in health care planning because it is easier and more economical to rely on existing urban models than to gather new information and to plan systems specifically suited for rural communities. As a result, rural communities are often forced to use or adapt service systems or service support mechanisms designed for conditions that differ greatly from those in most rural areas. Mental Health and Rural America: 1980-1993 provides policy-makers, researchers, educators and health care providers with the latest information and results from research concerning mental illness and health in rural areas. It also identifies gaps in knowledge where additional research is needed. This book should also be of use to service providers, policy-makers and citizens outside the immediate mental health arena, because of the role mental health plays in other types of services and societal functions. Certainly, this publication should become both a practical resource for providers of rural mental health services and a core document for national, state and community health planning for the future. Jeffrey Human Director Office of Rural Health Policy Health Resources and Services Administration Charles Windle Director Office of Rural Mental Health Research National Institute of Mental Health |