The Annapolis Coalition - Rural Workforce Issues

Rural Workforce Issues
Overview

Behavioral Health Needs of Rural Communities

Many factors (e.g., economic, cultural) play a role in the mental health and mental health care of rural Americans. The prevalence of adults with severe mental illnesses and children with serious emotional disturbances is not significantly different in rural and urban areas. What appears to be different in rural America is the experience of individuals with mental illnesses and their families (Wagenfeld et al., 1994). This difference in experience appears to result in higher suicide rates for both rural adults and youth with serious emotional difficulties, which has been a trend in rural areas for over a decade (NFC-SRI , 2004; Institute of Medicine, 2002; Stack, 1982; Wagenfeld et al., 1994).

Three factors that often prevent rural individuals from receiving the mental health care they need include: Accessibility (knowing where and how to access mental health services); Availability (presence or absence of mental health services and providers); and Acceptability (a person's willingness to seek services and enter treatment). (Larson, Beeson, & Mohatt, 1993; Mohatt, 2000).

These barriers often lead rural residents with mental health needs to seek services later in the course of their disease when more serious and disabling symptoms are more likely. Persistent, untreated symptoms frequently requires more expensive and intensive treatment (Wagenfeld et al., 1994; New Freedom Commission on Mental Health : Subcommittee Report on Rural Issues, 2004).

Workforce Issues and Problems

The President's New Freedom Commission on Mental Health, Subcommittee on Rural Issues (2004) report identified several workforce issues specific to rural communities:

More than 85% of 1,669 Federally designated mental health professional shortage areas are rural (Bird, Dempsey, & Hartley, 2001).
Holzer and colleagues (2000) found that few psychiatrists, psychologists, or clinical social workers practice in rural counties, and that the ratio of these providers to the population worsens as rurality increases.
For the past 40 years, approximately 60% of rural America has been underserved by mental health professions.
The National Advisory Committee on Rural Health (1993) noted that across the 3,075 counties in the United States, 55% had no practicing psychiatrists, psychologists, or social workers, and all of these counties were rural.
These workforce shortages are even worse for specialty areas, such as children's mental health, older adult mental health, and minority mental health.

Many rural states face problems in attracting and keeping behavioral health professionals in rural communities, especially those who have training relevant to rural communities and their culture. Rural workforce strategies involve two primary aspects: 1) development of the existing workforce and 2) expansion of the workforce through recruitment and retention activities. The Institute of Medicine Report Crossing the Quality Chasm (2005) identifies a third strategy which is to enhance the “health readiness” of rural residents. This involves educating rural residents about the symptoms of mental illness so they can be more proactive in seeking care for possible mental health issues.

Promising Initiatives

In March, 2005, the Western Interstate Commission on Higher Education (WICHE) Mental Health Program facilitated a conference on rural workforce development ( Bridging the Gap: Bringing Higher Education and Mental Health Practice Together ) in Mesa, Arizona. This conference built on gains made during a previous workforce development conference in 2003. The stakeholders at the conference developed recommendations on how to link higher education programs with mental health disciplines to meet the growing need for mental health services in rural areas. Recommendations from this conference will be used to inform a national strategic plan for rural behavioral health workforce development for the Annapolis Coalition project. That plan, with support from SAMHSA, will hopefully give rise to new initiatives at the federal, state and local levels that will begin to solve what is quickly becoming a behavioral health care workforce crisis in rural areas.

States such as Alaska, Arizona, and Montana have been undertaking processes through which higher education, public mental health, and provider agencies work together to identify shared goals and activities to better integrate their systems, train existing providers, and attract students into the mental or behavioral health field. Specific activities have included creating “career ladders” in mental health, articulation of coursework across disciplines or from one degree level to the next, and distance learning for providers in remote areas.
( Note other promising initiatives listed in the “Links” section on this webpage.)

References for this Overview are available here.

Links

WICHE Mental Health Program
http://www.wiche.edu/mentalhealth/WorkforceDevelopment.asp
http://www.wiche.edu/mentalhealth/conference/meetingminutes.asp

Alaska’s Behavioral Health Workforce Initiative
http://www.alaska.edu/health/downloads/BHP%20Init%20Final.pdf

The Health Profession Tracking Program (HPTP) at the Center for Rural Health,
University of North Dakota School of Medicine and Health Sciences
http://www.med.und.nodak.edu/depts/rural/rhw/tracking/

National Association of Rural Mental Health Website
http://narmh.org/

The Office of Rural Health Policy
http://ruralhealth.hrsa.gov/

Rural Community College Initiative
http://http://www.mdcinc.org/rcci/philosophy.htm

Idaho State University Rural Institute of Rural Health
http://www.isu.edu/irh/

Texas Rural Community College Network
http://www.trccn.org/

Texas Tech University Health Sciences Center
http://www.ttuhsc.edu/ruralhealth/

Arizona Rural Recruitment and Retention Resources
http://www.rho.arizona.edu/WorkForce/RecruitRetain/

Rural Assistance Center
http://www.raconline.org/info_guides/hc_providers/

Senior Advisor Information
Dennis Mohatt, Senior Advisor on Rural Workforce Issues
Director,
WICHE Mental Health Program
PO Box 9752
Boulder, CO 80301
303-541-0256
dmohatt@wiche.edu

Resources

Quality Through Collaboration: The Future of Rural HealthCare
Institute of Medicine (November, 2004).
Examines the quality of health care in rural America. Includes recommendations to improve health care quality and safety in rural communities. Addresses workforce, information technology, finance and other factors that impact rural health care quality.

Muskie School of Public Service, Maine Rural Health Research Center
Are Advanced Practice Psychiatric Nurses a Solution to Rural Mental Health Workforce Shortages?

State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce

The President’s New Freedom Commission on Mental Health Subcommittee on Rural Issues
Background Paper

http://www.samhsa.gov/samhsa_news/VolumeXII_6/article4.htm
The Workforce Crisis: SAMHSA's Response

The Rural Monitor Volume 11 Number 3 Winter 2005
Implications for the Rural Mental Health Workforce

2004 Report to the Secretary: Rural Health and Human Service Issues
National Advisory Committee on Rural Health and Human Services

University of North Dakota Center for Rural Health

BACK


Register for Updates Request Technical Assistance Contact Us
	Home About Us Action Plan Core Competencies Behavioral Health Pacesetter Award Governance Publications Presentations E-News Technical Assistance Links Innovation Register for Updates Special Topics Contact Us Join our mailing list	Rural Workforce Issues Overview Behavioral Health Needs of Rural Communities Many factors (e.g., economic, cultural) play a role in the mental health and mental health care of rural Americans. The prevalence of adults with severe mental illnesses and children with serious emotional disturbances is not significantly different in rural and urban areas. What appears to be different in rural America is the experience of individuals with mental illnesses and their families (Wagenfeld et al., 1994). This difference in experience appears to result in higher suicide rates for both rural adults and youth with serious emotional difficulties, which has been a trend in rural areas for over a decade (NFC-SRI , 2004; Institute of Medicine, 2002; Stack, 1982; Wagenfeld et al., 1994). Three factors that often prevent rural individuals from receiving the mental health care they need include: Accessibility (knowing where and how to access mental health services); Availability (presence or absence of mental health services and providers); and Acceptability (a person's willingness to seek services and enter treatment). (Larson, Beeson, & Mohatt, 1993; Mohatt, 2000). These barriers often lead rural residents with mental health needs to seek services later in the course of their disease when more serious and disabling symptoms are more likely. Persistent, untreated symptoms frequently requires more expensive and intensive treatment (Wagenfeld et al., 1994; New Freedom Commission on Mental Health : Subcommittee Report on Rural Issues, 2004). Workforce Issues and Problems The President's New Freedom Commission on Mental Health, Subcommittee on Rural Issues (2004) report identified several workforce issues specific to rural communities: More than 85% of 1,669 Federally designated mental health professional shortage areas are rural (Bird, Dempsey, & Hartley, 2001). Holzer and colleagues (2000) found that few psychiatrists, psychologists, or clinical social workers practice in rural counties, and that the ratio of these providers to the population worsens as rurality increases. For the past 40 years, approximately 60% of rural America has been underserved by mental health professions. The National Advisory Committee on Rural Health (1993) noted that across the 3,075 counties in the United States, 55% had no practicing psychiatrists, psychologists, or social workers, and all of these counties were rural. These workforce shortages are even worse for specialty areas, such as children's mental health, older adult mental health, and minority mental health. Many rural states face problems in attracting and keeping behavioral health professionals in rural communities, especially those who have training relevant to rural communities and their culture. Rural workforce strategies involve two primary aspects: 1) development of the existing workforce and 2) expansion of the workforce through recruitment and retention activities. The Institute of Medicine Report Crossing the Quality Chasm (2005) identifies a third strategy which is to enhance the “health readiness” of rural residents. This involves educating rural residents about the symptoms of mental illness so they can be more proactive in seeking care for possible mental health issues. Promising Initiatives In March, 2005, the Western Interstate Commission on Higher Education (WICHE) Mental Health Program facilitated a conference on rural workforce development ( Bridging the Gap: Bringing Higher Education and Mental Health Practice Together ) in Mesa, Arizona. This conference built on gains made during a previous workforce development conference in 2003. The stakeholders at the conference developed recommendations on how to link higher education programs with mental health disciplines to meet the growing need for mental health services in rural areas. Recommendations from this conference will be used to inform a national strategic plan for rural behavioral health workforce development for the Annapolis Coalition project. That plan, with support from SAMHSA, will hopefully give rise to new initiatives at the federal, state and local levels that will begin to solve what is quickly becoming a behavioral health care workforce crisis in rural areas. States such as Alaska, Arizona, and Montana have been undertaking processes through which higher education, public mental health, and provider agencies work together to identify shared goals and activities to better integrate their systems, train existing providers, and attract students into the mental or behavioral health field. Specific activities have included creating “career ladders” in mental health, articulation of coursework across disciplines or from one degree level to the next, and distance learning for providers in remote areas. ( Note other promising initiatives listed in the “Links” section on this webpage.) References for this Overview are available here. Links WICHE Mental Health Program http://www.wiche.edu/mentalhealth/WorkforceDevelopment.asp http://www.wiche.edu/mentalhealth/conference/meetingminutes.asp Alaska’s Behavioral Health Workforce Initiative http://www.alaska.edu/health/downloads/BHP%20Init%20Final.pdf The Health Profession Tracking Program (HPTP) at the Center for Rural Health, University of North Dakota School of Medicine and Health Sciences http://www.med.und.nodak.edu/depts/rural/rhw/tracking/ National Association of Rural Mental Health Website http://narmh.org/ The Office of Rural Health Policy http://ruralhealth.hrsa.gov/ Rural Community College Initiative http://http://www.mdcinc.org/rcci/philosophy.htm Idaho State University Rural Institute of Rural Health http://www.isu.edu/irh/ Texas Rural Community College Network http://www.trccn.org/ Texas Tech University Health Sciences Center http://www.ttuhsc.edu/ruralhealth/ Arizona Rural Recruitment and Retention Resources http://www.rho.arizona.edu/WorkForce/RecruitRetain/ Rural Assistance Center http://www.raconline.org/info_guides/hc_providers/ Senior Advisor Information Dennis Mohatt, Senior Advisor on Rural Workforce Issues Director, WICHE Mental Health Program PO Box 9752 Boulder, CO 80301 303-541-0256 dmohatt@wiche.edu Resources Quality Through Collaboration: The Future of Rural HealthCare Institute of Medicine (November, 2004). Examines the quality of health care in rural America. Includes recommendations to improve health care quality and safety in rural communities. Addresses workforce, information technology, finance and other factors that impact rural health care quality. Muskie School of Public Service, Maine Rural Health Research Center Are Advanced Practice Psychiatric Nurses a Solution to Rural Mental Health Workforce Shortages? State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce The President’s New Freedom Commission on Mental Health Subcommittee on Rural Issues Background Paper http://www.samhsa.gov/samhsa_news/VolumeXII_6/article4.htm The Workforce Crisis: SAMHSA's Response The Rural Monitor Volume 11 Number 3 Winter 2005 Implications for the Rural Mental Health Workforce 2004 Report to the Secretary: Rural Health and Human Service Issues National Advisory Committee on Rural Health and Human Services University of North Dakota Center for Rural Health BACK