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To date, there are few assessment measures available to assess physician wellness and no evidence-based treatments to address wellness deficits in rural physicians' medical or psychological health. Such resources would have the potential to benefit individual rural physicians and the quality of healthcare they deliver to rural communities. Future research should focus upon the assessment and promotion of rural physician well being, which may improve recruitment and retention of quality physicians to provide optimal care in rural communities.

Current and developing models of integrated behavioral health service delivery have proven successful for the general population; however, these approaches may not sufficiently address the unique needs of individuals living in rural and remote areas. For all communities to benefit from the opportunities that the current trend toward integration has provided, it is imperative that cultural and contextual factors be considered determining features in care delivery. Rural integrated primary care practice requires specific training, expertise, and adjustments to service delivery and intervention to best meet the needs of rural and underserved communities. In this commentary, the authors present trends in integrated behavioral health service delivery in rural integrated primary care settings. Flexible and creative strategies are proposed to promote increased access to integrated behavioral health services, while simultaneously addressing patient care needs that arise as a result of the barriers to treatment that are prevalent in rural communities. (PsycINFO Database Record

The “problem of the poor” is typically discussed as a client/patient problem. However, interviews of poor people, and those with whom they work, consistently reveal the role of the environment in maintaining the intractability of this status, as well as the role of the mental health professional who unknowingly contributes to the cycle. The barriers to mental health services for the poor are complex and interdependent; a domino effect ensues that results in ongoing stressors. Classism and the failure of our standards of care to include class competency in cultural competency training, research, and practice are profound. These omissions and the models available for evidence-based practice through continuing education and graduate training are described. Empirically supported treatments and qualitative research are reviewed, demonstrating more effective outcome expectations than were possible with traditional approaches. Settings and systems that hold promise for a path toward the future are identified.

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