De Facto Mental Health Services in the Rural South

Abstract

Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.

Use of Psychotherapy by Rural and Urban Veterans

“…For example, rural culture may foster a perceived need for greater self-reliance, independence, and conformity to social norms (whether positive or negative toward mental health treatments) and thereby delay identification of mental health problems, discourage the use of formal services, and encourage the use of informal services such as ministers and traditional healers. 35 Stigma has also been found to be a significant barrier to treatment in rural areas. 12,36 To address these issues, dedicated educational efforts for patients and providers may facilitate a normalization of formal mental health treatments such as psychotherapy.…”

Empirically Supported Treatments in Rural Community Mental Health Centers: A Preliminary Report on Current Utilization and Attitudes Toward Adoption

“…There is no way of knowing whether the respondents' self-reports are completely accurate descriptions of clinic practices. We also note that private for-profit clinics seem to be underrepresented in the study, although this type of service is a rarity in rural areas (Fox et al 1995). As the study was meant to provide a broad-brush overview of current practices, generic labels for treatments (e.g., cognitive-behavioral therapy) were utilized rather than a finer delineation of treatment techniques (e.g., behavioral activation, cognitive restructuring).…”

Rurality and Mental Health Treatment

“…Rural areas present distinctive and substantial barriers to mental health treatment (Bischoff, Hollist, Smith, & Flack, 2004;Fortney, Thill, Zhang, Duan, & Rost, 2001;Fox, Blank, Rovnyak, & Barnett, 2001;Fox, Merwin, & Blank, 1995;Reschovsky & Staiti, 2005). While each rural community is unique, common barriers include distance and topographical challenges, insufficient population base to support services, population instability, limited number, training and isolation of rural providers, rural culture including attitudes such as individualism, the lack of anonymity afforded rural citizens who seek mental health care and stigma (Bachrach, 1983;Philo, Parr, & Burns, 2003).…”