This article reports on a workshop in which the major focus was a review of the barriers that prevent access to the array of community-based services available to the rural elderly. The demographics of the elderly were outlined and key components of the service system described. Attention was given to access hospital-based care, the closing of hospitals and the reasons for bypassing rural hospitals for those in large towns or cities. Special emphasis also was given to mental health services and their uneven accessibility. A review of the policy implications closed the workshop.
In the face of geographic isolation, economic deprivation, the lack of a well-defined human infrastructure, and limited economies of scale, innovation and flexibility must be the catchwords to ensure the adequate development of mental health services and programs in rural areas. The adaptation of urban models is possible, especially if rural cultural values are taken into account. The major components that should be part of a rural model of mental health service delivery are reviewed, focusing on the barriers of distance, individuals' privacy, the coordination and use of the present but often weak human infrastructure, and coordination between agencies and across political boundaries.
This paper describes rural mental-health service delivery models identified in a 1995 yearlong search by the National Resource Center for Rural Elderly for innovative programs. Programs are classified into those providing direct service and those with an education and training focus. The leadership role of a single individual, palatibility to a rural elderly clientele, and flexibility are found to be shared characteristics of successful direct service models. Successful educationally oriented models are characterized by ongoing involvement of community leaders, development of specialized rurally specific curricula, and marketing that enabled programs to survive beyond their initial demonstration project funding. It is concluded that successful rural models of mental health care must be based on information that is germane to rural community life, specific training of mental health professionals to work in rural settings, engagement of rural elders as peer counselors in outreach, and strong linkages with existing services and programs.
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