Rural Mental Health and
Primary Care
Lessons learned from a statewide
workgroup.
Primary care is not the safety
net system for mental health
care in rural Minnesota. It is
the system.
~Jack Gellar, rural health researcher
Challenges
Shortage of rural
providers in both
mental health and
primary care
Lack of provider
training
Inadequate
reimbursement
structure
Stigma and
need for better
public information
What Did We Do?
Created an overview of services
and needs
Explored promising practices and
examples of collaborative models for
primary care
Developed recommendations
for Commissioner of Health
and other policymakers
Challenges:
Breadth of the topic
Defining mental health and primary
care
Broad workgroup membership with
individual areas of interest
Surveys—content and implementation
Keys to Success
Engagement of workgroup
Balancing large and small group work
Meeting results packets
Need, nice and nuts rule
What did we find out?
Too often help is a car ride away—
without gasoline.
~physician in northeastern Minnesota
Minnesota Mental Health Landscape
An estimated 950,060 Minnesotans
have some type of mental
health problem
25% increase in rural hospital mental
health inpatient days
Suicide fatality rates are higher in rural
Minnesota (11.1/100,000 compared to 8.7/100,000
urban)
Mental Health Workforce
7.3 psychiatrists for
every 100,000
people in rural
Minnesota (national
average is
16/100,000)
Only 19 child
psychiatrists practice
outside the 7-county
metro area
13 rural counties
had no psychologists
Workforce Training Data
Three psychiatric residency training
programs in Minnesota, none with a
rural site component
Two advanced practice psychiatric nurse
training programs. One has a rural
component
Primary Care Survey
Increase in mental/behavioral issues
among patients in past 2-3 years
Most do not routinely screen for
mental/behavioral issues
Majority would like more training
and education
Substance abuse biggest issue
of concern
Snapshot:Primary Care
Figure A:
"Over the last 2-3 years, do you believe the proportion of
patients presenting with mental/behavioral issues in you your
clinic has: "
70%
60%
60%
50%
35%
40%
30%
20%
6%
10%
0%
Increased
Stayed the same
Other
Snapshot: Primary Care
Figure F:
"If a Patient Has to Travel Outside the Community for Treatment,
How Far On Average Would He/She Have to Travel?"
more than 40 miles
46%
21 - 40 miles
33%
Less than 20 miles
21%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Critical Access Hospital Survey
We have become adept at jumping
through many administrative and other
barriers to find care for our mental
health patients. Sometimes we fail…
our regional support system fails us
every day.
~Survey Respondent
Snapshot: Emergency Rooms
40% are seeing an increase in ER
visits for mental and behavioral
health issues
32% of visits are for anxiety
and depression
29% of visits are for substance abuse
Snapshot: Emergency Rooms
Question #16: Comfort Level
40.0
37.5
35.0
35.0
30.0
25.0
percent
25.0
20.0
15.0
10.0
5.0
2.5
0.0
Very Comfortable
Somewhat Comfortable
Somewhat Uncomfortable
Very Uncomfortable
Promising Practices:
Collaboration is Key
Community Assessment: Fond du Lac
Abuse Counseling Program
Community Collaboration: Shared Care,
Detroit Lakes
Telehealth psychology in Big Fork
Psychologist in primary care clinic in
Detroit Lakes
We can no longer do business as usual.
We must screen, identify and treat in
primary care clinics. To do this,
collaboration if required, and rural
providers must be trained and supported.
In addition, funding streams must be
redesigned to reimburse and support
collaborative models of care.
~Rural mental Health and Primary Care Workgroup
Recommendation Areas
Health Professionals
Health Systems
Public Policy
Health Professionals
Enhanced mental
health training for
primary care
students (MDs,
RNs, PAs)
Rural site
experiences for
mental health
and primary
care students
Mental health
related continuing
education for
primary care
practitioners
Health Systems
Promote collaborative care models
Develop common set of mental
health benefits
Promote and expand telehealth
Improve delivery of mental health crisis
services in rural hospital ERs
Create an understandable guide to
payment system
Public Policy
Rural mental health voice in
development of electronic
medical records
Support rural mental health crisis
response team development
Promote CAH mental health emergency
QA projects
Public Policy
Create coordinated data collection and
analysis system for mental health
incidence, prevalence and treatment
Improve Medicare coverage for
mental illness
We don’t want this to be a report that
gathers dust on someone’s shelf.
~Work group member
New Connections for
Community
Mental Health—
Statewide Telehealth
Crisis Intervention
Minnesota
Psychiatric Society—
Rural Education
Initiatives
Rural Mental Health and Primary
Care
Linda Norlander RN MS
Rhonda Wiering RN
Linda.norlander@health.state.mn.us
651-282-6317
507-247-2242
Rhonda@tylerhealthcare.org
C.J. Peek PhD
cjpeek@visi.com
612-827-8109
Report Available at:
http://www.health.state.mn.us/divs/chs/rhpcrpts.htm