Among today’s 1.5 million nursing home residents, up to 80% have one or more psychiatric diagnoses including: Alzheimer’s disease, depression, anxiety disorders, and psychotic disorders.
There is a general consensus in long-term care settings that the availability of adequate mental health services for those in need is lacking.
63% of long-term care residents may be affected
65% of depressed residents exhibit anxiety
50% of more of long-term care residents have some form of dementia or cognitive impairment
40% of residents with cognitive impairment/behavioral issues received antipsychotic drugs without a psychosis diagnosis
$13B was spent in 2007 on atypical antipsychotic drugs
A recent survey of nursing homes in 6 states found that 38% of nursing home residents were in need of psychiatric evaluation, but only half had adequate psychiatric consultation treatment. The greatest unmet need was in rural and small nursing homes. Approximately half of nursing homes find it difficult to obtain psychiatric services, and only one fifth of nursing home residents with identified psychiatric disorders see mental health specialists for treatment. Those who are least likely to see mental health specialists are the oldest and most physically impaired. Thus, there is a considerable unmet need for mental health services in nursing homes. Only the minority of individuals who need treatment get it.
There is a significant need for mental health services in rural America.
The following factors are particular challenges to the provision of mental health services in rural communities:
Rural mental health specialists are scarce. Recognizing that this must change, the Center for Rural Affairs identifies mental health services as one of the top health reform issues for rural America. Unfortunately, this need for mental health care has not been met with widely available and accessible mental health services in rural areas. Despite the substantive calling for mental health services in rural areas, many barriers prevent rural Americans from receiving the care they need. These barriers revolve around issues of availability and accessibility. In many rural communities, mental health services are simply not available. In fact, more than 85 percent of the 1,669 federally designated mental health professional shortage areas are rural. And only in rural America did the National Advisory Committee on Rural Health find entire counties with no practicing psychiatrists, psychologists, or social workers. This desperate lack of trained mental health professionals means that individuals who need emergency care will likely be transported out of their communities to other locations where care is available.
Limited rural health services, and/or services that are not in keeping with current science, increase the odds that people will not get care to prevent problems or reduce their severity in a timely manner. Preventing, rather than treating, mental disorder is not only cost effective, but supports quality of life, healthy families and productivity throughout life.
This is our philosophy of care.
Our approach is proactive. We see individuals on a frequent and consistent basis decreasing the need for emergency situations.
The culture of rural areas, including a history of self-sufficiency and lack of anonymity, inhibits rural residents from accessing available assistance. As one rural, Maryland woman: “My counselor said, ‘mental disorder is just like diabetes. With diabetes you have to take medicine. With mental disorders, you also have to take medicine.’ Well, that’s all great and wonderful, now tell the public that.”
Nearly half of the American population is affected by a mental disorder at some time in their lives. Yet, the misconceptions, myths, and cultural taboos associated with mental illness may be the most significant barriers that keep people with mental disorders from seeking and receiving treatment in rural areas. Factors that may make people feel ashamed of their mental health issues and avoid seeking care include:
Because of their small size and close-knit society, rural communities are known for knowing everybody and everybody’s personal life. Patients entering a mental health provider’s office are more likely to be seen by people they know than in an urban environment.
Familiarity such as this can cause the mental healthcare seeker to feel insecure in regards to confidentiality and privacy which may suppress their willingness to seek professional care.
This is a benefit of telemedicine. They receive care in the location where they reside which protects their privacy and makes them more comfortable receiving care.
Often rural residents are unaware of their mental health status, availability of services or their eligibility for services. A multi-state study of rural women found that far fewer acknowledged depression or anxiety as problem than tested for depressive symptoms. Rural resident may self-medicate through use of drugs and alcohol resulting in higher rates of alcohol abuse and dependence than among urban residents.
This is where we at Brighter Day Health can help.
Barriers related to the availability of mental health care services in rural areas may be reduced through the use of telehealth technology. Telehealth refers to the use of current information technologies and telecommunication systems to make health education and health care available despite distance or travel barriers.
According to the Health Research and Services Administration, telemental health services are in the top three most used telehealth services.
Through this technology, individual and family consultation and care may be offered in rural clinics and hospitals, community mental health centers and long term care facilities.
It also allows for ongoing education and training of rural mental health practitioners and staff.