Jeanne C. Fox

Alternative Mental Health Services: The Role of the Black Church in the South

OBJECTIVES This study determined the extent to which churches in the South were providing mental health and social services to congregations and had established linkages with formal systems of care. METHODS A computer-assisted telephone interview (CATI) survey was conducted with pastors from 269 Southern churches. RESULTS Black churches reported providing many more services than did White churches, regardless of urban or rural location. Few links between churches and formal provider systems were found, irrespective of the location--urban or rural--or racial composition of the churches. CONCLUSIONS Results are discussed in terms of the potential for linking faith communities and formal systems of care, given the centrality of the Black church in historical context.

DE FACTO MENTAL HEALTH SERVICES IN THE RURAL SOUTH

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.

Barriers to Help Seeking for Mental Disorders in a Rural Impoverished Population

This study examined barriers to seeking mental health care reported by individuals in a rural impoverished population, by screening 646 randomly selected adults for depression, anxiety, and alcohol abuse. Respondents who screened positive were randomly assigned to one of three groups: (1) no intervention, (2) an educational intervention alone, or (3) the educational intervention in the presence of a significant other. Those who screened positive for disorders cited barriers to care at significantly higher rates than respondents who screened negative. Respondents who received the educational intervention endorsed several barriers at significantly lower rates in the follow-up telephone call (subsequent to the intervention) than in the original interview (prior to the intervention). Virtually all respondents in a subsample of 142 subjects (99.3%) said they would seek mental health care if they thought mental health services would help them.

Critical issues in reforming rural mental health service delivery

Critical issues in reforming rural mental health service delivery systems under health care reform are outlined. It is argued that the exclusive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural areas, which should focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural areas are delineated and three assumptions about the structure of rural communities which are shaping the dialogue on rural health and mental health service delivery are examined. These assumptions include the notion that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and that rural dwellers represent a low risk population which can be effectively served through existing facilities and by extending existing services.

Mental disorders and help seeking in a rural impoverished population.

Objective: This study examined the impact of an in-home screening and educational intervention on help seeking among rural impoverished individuals with untreated mental disorders. The effect of including a significant other in the intervention and reasons for not seeking help were explored. Method: The sample was randomly selected from households in nine rural counties in Virginia. The short form of the CIDI was used to screen 646 adult residents. Respondents who screened positive were randomly assigned to one of three groups: 1) no intervention, 2) an educational intervention, or 3) the educational intervention with a significant other. A list of local sources of health and mental health care was distributed. At one-month post interview, respondents were telephoned to inquire about help seeking. Results: Almost one-third (32.4%) of these respondents screened positive for at least one disorder. Five hundred and sixty-six (87.6%) were successfully followed up, and thirty-three of the 566 (5.8%) reported that they had sought professional help since the interview. Eighty-four subjects who screened positive and received the educational intervention reported in follow up that they had discussed the interview with a friend or family member, but only eleven (13.1%) received encouragement to seek treatment. The predominant reason endorsed for not seeking help was “felt there was no need,” even among respondents who were informed that they had a disorder. Conclusions: A significant proportion of this rural impoverished sample screened positive for a mental disorder. Few individuals sought professional help and significant others did not encourage them to seek treatment. The implication of these results for investigators and service providers is that motivating individuals to seek mental health services is a complex process; more attention must be devoted to the development of culturally relevant methods for facilitating help seeking.

Case manager follow-up to failed appointments and subsequent service utilization

Case manager responses to failed appointments were monitored for 83 seriously mentally ill persons in a rural community mental health center. Case manager actions taken were grouped into four categories of follow-up from most intensive to least intensive: home visit, phone call, letter, and no follow-up. On the whole, case managers most frequently did not follow-up missed appointments (56.7%), followed up by letters (21.3%), and telephone calls (18.7%), and home visits (3.3%). Analyses revealed that home visits were most intensive and all clients who were visited following failed appointments did not fail the subsequent appointment. Clients who received telephone calls or letters were about equally likely to fail the subsequent appointment, but were much more likely to attend the subsequent appointment than were clients who received no follow-up to the failed appointment. Interestingly, clients who failed appointments and received no follow-up were much more likely to need emergency services rather than a regular appointment as their next contact with the clinic.

Balance theory as a model for coordinating delivery of rural mental health services

Abstract The chaotic nature of rural mental health services is due, at least in part, to a lack of consistent theory guiding their purpose and structure. The failure to plan mental health care systematically for rural areas is a result of diverse opinions and policies grounded in changing social, political, and economic conditions. The Balance Theory of Coordination ( Litwak & Meyer, 1966 ) offers a viable perspective to guide service system development and evaluation. This article identifies current difficulties in the rural mental health systems, offers balance theory as a basis for further work, and posits a model for case management rooted in balance theory. The intent is to stimulate research and theory development for rural mental health systems.

Mental Health of Rural Elderly: A Research Agenda for Nursing

Only recently have the health sciences, including nursing, begun to focus on the dynamics of mental health and aging. Reports on rural initiatives, are beginning to appear; these developments have occurred without the benefit of context and direction, however, especially in terms of how these issues apply in rural areas. The article reviews selected issues in the interface of aging and mental health in rural areas. It offers a research agenda comprising descriptive, intervention, and utilization studies as a context to guide research and knowledge development in mental health nursing of rural elderly.

Recruitment, motivation, and reinforcement of preprofessionals for public sector mental health careers

The labor intensive public mental health system needs to encourage trainees in mental health professions to consider careers in the public sector. Recent evidence is that younger professionals are choosing other carrer paths following their training. This paper suggests that the availability of relevant training opportunities, positive role models, financial support while in training, and a supportive group of peers are important components of training for public sector careers.

Relationship of Clinical Case Management to Hospitalization and Service Deliy for Seriously Mentally Ill Clients

This article describes the use of a clinical case management team approach in the care of severely mentally ill individuals and the organization of the service. Patient characteristics and use of community services are evaluated as predictors of the use of inpatient care. Findings suggest that hospitalized clients use more community services than nonhospitalized clients and that the use of certain community services--such as medical, legal, and housing services--affects hospital use. Clients who had assistance in obtaining medical services were less likely to be hospitalized, and those needing legal and housing assistance were more likely to be hospitalized.