Unmet Need For Community-Based Mental Health and Substance Use Treatment Among Rural Adolescents

Abstract

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (12-18 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n = 177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care.

Utilization of Mental Health Services Among Adolescents in Community-Based Substance Abuse Outpatient Clinics

“…Although using a 3-month follow-up period for assessing receipt of mental health service is short, it is relevant because the median length of stay in outpatient treatment is Table 3 Estimated association of each mental health problem a with service receipt (service received relative to no service received) Five participants (0.4%) did not provide information on race-ethnicity and were not included in the analysis *pG0.05, **pG0.001 approximately 52 days. 38 Moreover, the Substance Abuse Treatment for Persons with Cooccurring Disorders, Treatment Improvement Protocols (TIPs) Series 42 (CSAT, 2005) 39 and evidence from prior studies 4,5,8,9,14 suggest that the effectiveness of substance abuse treatment can be advanced if integrated and effective substance abuse and mental health care can be provided to those with comorbid conditions soon after treatment admission. This study's findings are similar to several previous studies of the general population and clinical samples which revealed that only 20 to 50% of those in need of mental health care actually received needed services.…”

Anger Correlated with Psychosocial Variables in Rural Youth

“…Conger, Ge, Elder, Lorenz, and Simons (1994) found that adverse economic conditions in rural families led to marital conflict, parental depressed mood, increased risk of adolescent depression and aggression. The various problems evident in rural areas may be compounded by the lack of specialty health services, resulting in rural health disparities (Anderson & Gittler, 2005;USDHHS, 2000). Attempting to apply urban designed health promotion interventions in rural settings has been met with limited success (Stanton et al, 2006).…”

“…The assessment of adolescent mental health is a shared burden. The interactions between the primary care provider, pediatric school nurse, and the adolescent have been identified as key encounters appropriate for evaluation of the mental wellbeing and coping processes of rural youth (Flaspohler, Anderson-Butcher, Paternite, Weist, & Wandersman, 2006;Anderson & Gittler, 2005;Puskar et al, 2006).…”

“…The assessment of adolescent mental health is a shared burden. The interactions between the primary care provider, pediatric school nurse, and the adolescent have been identified as key encounters appropriate for evaluation of the mental wellbeing and coping processes of rural youth (Flaspohler, Anderson-Butcher, Paternite, Weist, & Wandersman, 2006;Anderson & Gittler, 2005;Puskar et al, 2006).State and federal funding is often based on population density, creating further healthcare disparities (USDHHS, 2000). Anderson and Doyle (2005) identified that when services are made available to the at-risk adolescent, there is an increase in help-seeking behaviors.…”

Mental Health of Rural Young Adults: Prevalence of Psychiatric Disorders, Comorbidity, and Service Utilization

“…A major cause of concern, however, is the high prevalence of alcohol use disorders in this sample in conjunction with the low rate of service utilization among participants with substance use disorders. Research indicates that services for rural adolescents with substance use disorders need to be improved (Anderson & Gittler, 2005), and specialized treatment programs for rural substance abusers are being developed (Clark et al, 2002).…”