MENTAL HEALTH AND MENTAL DISORDERS - A RURAL CHALLENGE
by Larry Gamm, Sarah Stone, and Stephanie Pittman
GOALS AND OBJECTIVES
Mental disorders affect approximately one-half of the population over a lifetime1 and are among the most impairing of chronic diseases.2, 3 In a recent survey of state and local rural health leaders, mental health was the fourth most often selected topic as a high rural health priority. Mental health was rated a priority most frequently by rural health centers and clinics and by state organizations associated with rural health. It was among the top five most frequently selected rural health priorities in all four regions of the country.4
This summary addresses the Healthy People 2010 mental health and mental illness goal - improve mental health and ensure access to appropriate, quality mental health services5 emphasizing access to treatment by mental health providers in rural areas. This overall goal encompasses three of the 467 specific Healthy People 2010 objectives. These include:
Mental disorders are widespread in urban and rural areas alike and affect approximately 20 percent of the population in a given year.6, 7 Moreover, mental illness is distributed across all age groups. An estimated 20 percent of children and adolescents age 9 to 17,8 and as many as 25 percent of those 65 years and older9 suffer from mental illness each year. Of those who experience a mental disorder, only a minority report treatment in the preceding year.10
The prevalence of mental disorders appears to be similar in rural and urban areas;6, 11, 12 however, there are some noteworthy exceptions. Poverty, age, being African American, and living in a rural area have been associated with a low, or a lower, likelihood of receiving mental health care.13 African Americans and rural residents underutilize mental health services and seek help later in the course of the disease.14, 15 Rural areas are especially disadvantaged in meeting the needs of children with serious mental health problems because of the relative lack of psychiatrists, and especially child psychiatrists, in rural areas.16 The elderly are also at risk. While as many as a quarter of elderly people may suffer from mental disorders, less than 5 percent of mental health professional’s practice time is spent with elderly.17
Among all illnesses and health behaviors, mental disorders have been identified as one of the leading contributors to disability and associated disease burden, defined as years of life lost to premature death and weakened by disability.3, 18 Also, mental illness is often a contributor to and/or a consequence of disabilities or other serious health-related conditions among the nation's most vulnerable populations such as the homeless, alcohol or substance abusers, and abusing families.19
The impact of mental health and mental disorders on mortality in rural areas appears in several forms. Suicide rates, a standard indicator of mental illness, are higher in rural areas, particularly among adult males and children.12, 20 More suicide attempts, too, occur among depressed adults in rural areas than in urban areas.21
Depression is an important cause of morbidity and a frequent co-morbidity for other illnesses. According to a report from the U.S. Surgeon General,18 depression is the second leading cause of years lost because of premature death or disability among established market economies. More specifically, there is evidence that depression, anxiety, and other psychosocial factors contribute to progression and outcomes associated with chronic illnesses, such as heart disease.22
Morbidity differences associated with mental illness among rural versus urban residents are not consistent. No differences in one-year symptom outcomes are observed in studies comparing rural and urban people with depression.23 Worse symptom outcomes in rural areas, however, are observed among those with more serious mental illness, especially with co-occurring substance abuse.24
Although relatively little is known about the causes of mental illness, a number of factors have been identified that may contribute to mental disorders, to their consequences, or to failure to adequately treat the disorders. Stress is frequently associated with the appearance of mental disorders such as anxiety and depression. Stresses associated with economic hardship, e.g., the farm crisis of the 1980s or loss of a major employer, can affect the mental health of rural populations.25, 26 Stressful life events along with mental disorders and substance abuse disorders are among the risk factors for suicide.27
Rural areas suffer shortages in mental health infrastructure and supply of mental health professionals. Twenty percent of non-metro counties lack mental health services; the same is true in only 5 percent of metro counties. Non-metro counties have on average less than two specialty mental health organizations, while metro counties report an average in excess of 13 mental health organizations.12, 28 In 1999, 87 percent of the 1,669 Mental Health Professional Shortage Areas (MHPSAs) in the United States were in non-metropolitan counties.29
Greater travel distance to outpatient services is common in rural settings. It is associated with fewer mental health visits by patients and with a lesser likelihood of receiving care in accordance with treatment guidelines.30 This and other barriers may account for findings that use of outpatient mental health services is lower in rural areas than in urban areas.13, 21, 31-34 However, according to one recent national study, rural residents are less likely to report unmet treatment needs for serious mental illness than young adults and those residing in nonrural areas.35
Primary care physicians who practice in rural and frontier areas play an even larger role in mental health care than their urban counterparts.36 This may be attributed both to the scarcity of mental health professionals11 and to the stigma-associated reluctance among rural residents to see a mental health professional.37, 38
Treatment of mental illness by primary care practitioners, however, faces a number of practice and professional constraints including insufficient training and skills, heavy patient case load,32, 36 lack of time,36 and lack of specialized backup.39 Some researchers find that primary care physicians deliberately underdiagnose mental illness because of stigma, doubts about the patient’s acceptance of a mental disorder diagnosis, or a concern for the patient’s future insurability.40, 41
Finally, recognition and perception of mental illness may reduce utilization of mental health care in rural areas. Evidence indicates rural persons suffering from mental disorders may be less likely than their urban counterparts to perceive a need for mental health care.13 A lack of anonymity in rural communities and the perceived social stigma associated with mental illness may also prevent treatment-seeking behavior.26, 42 In one recent national study, however, rural residents with serious mental illness were less likely than nonrural residents to report stigma as a reason for not seeking treatment.35
A number of solutions to the rural undersupply of mental health professionals have been proposed and attempted. Among these are:
· identification of MHPSAs,
· improved training and recruitment of rural mental health professionals,
· greater reliance upon primary care practitioners for mental health care,
· improving linkages between primary care physicians and mental health specialists, and
· dependence on managed behavioral health care programs to attract mental health professionals.
Mental health and mental disorders are serious problems in rural areas. These problems arise because of the frequent failure to identify such conditions early on, lack of access to mental health professionals to treat such conditions, and the tremendous consequences of mental illness for treatment of physical illnesses and for day-to-day life. Mental health needs occur among men, women, and children of all ages, ethnic groups, and social backgrounds. Some of these groups appear particularly disadvantaged in rural areas in gaining necessary treatment. Among these groups experiencing rural disparities are children, the poor, the elderly, and African Americans and other minority groups.
Concerns regarding anonymity in treatment and associated stigma may be more pronounced among rural populations. These factors, combined with the existence of stressful occupations, and the lack of knowledge of mental illness symptoms or treatments may reduce utilization of mental health care. The continuing shortage of mental health professionals in rural areas creates serious access problems. It is all the more important, therefore, that rural primary care practitioners receive continuing training in mental health diagnosis and treatment. Similarly, ongoing attention to coordination between physicians, mental health specialists, and other formal and informal sources of mental health support is all the more critical to rural areas.
The following models for practice are examples of programs utilized to address this rural health issue.
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Chapter Suggested Citation
Gamm, L.G.; Stone, S.; and Pittman, S. (2003). Mental Health and Mental
Disorders—A Rural Challenge. Rural Healthy People 2010: A companion document to
Healthy People 2010. Volume 1.
MODELS FOR PRACTICE
FOCUS AREA: MENTAL HEALTH AND MENTAL DISORDERS
Program Name: Pro Bono Counseling Program, Mental Health Association of the New River Valley, Inc.
Location:
Problem Addressed: Access to Mental Health Services for the Uninsured
Healthy People 2010 Objective: 18
Web Address: http://www.mhanrv.org
The Pro Bono Counseling Program is designed to provide mental health services to those who are low to moderate income, uninsured, and ineligible for Medicaid. Through partnerships with local mental health providers, the program provides free mental health services to eligible adults, children, and families. The program also provides free prescription services. Currently, the program serves 280 persons per year and provides nearly $45,000 in free psychiatric medications. Each patient receives an average of seven units of counseling or medication-related services.
Blueprint: The Pro Bono Counseling Program provides mental health counseling and psychiatric services to low to moderate-income individuals up to 200 percent of the federal poverty level (FPL). The program’s clients are uninsured and/or ineligible for assistance programs such as Medicaid. It delivers free mental health services, short-term solution-focused counseling, and medication evaluations. The program currently partners with 35 mental health providers throughout the 1,400 square mile region, with nearly 40 percent of the mental health providers donating their time. To expand their pool of service providers, the program also partners with local universities. Unlicensed graduates of masters and Ph.D. programs in mental health related fields see four clients per week; the program pays a qualified supervisor to provide the required clinical supervision once a week. Services are delivered in the provider offices as well as during special clinic nights and at nonprofit locations such as libraries in the more rural areas.
Additionally, the program coordinates medication evaluations. While pharmaceutical companies provide free samples, the program also uses a voucher system to pay for medications when free samples are not available. The program also benefits from The Pharmacy Connection software, which expedites applications to pharmaceutical companies’ indigent drug programs.
Making a Difference: To measure the program’s effectiveness, an outcome and satisfaction survey is annually administered to randomly selected clients. All responding clients report they would refer a friend to the program. On a scale of 1 to 10 (10 being the highest satisfaction rating), the program has received a rating of nine. Outcome measurement finds that nearly 60 percent of clients complete their treatment, and there is a no-show rate of only 10 percent. Severity of symptoms and difficulties in work life and personal life were cut in half.
Beginnings: The
Pro Bono Counseling Program is a collaborative initiative of the New River
Valley Partnership for Access to Healthcare (PATH). PATH is a community-focused
alliance comprised of over 40 health and human services organizations,
community organizations, and businesses. PATH was created to address the health
concerns of the New River Health District, which consists of 1,400 square miles
encompassing rural and suburban regions in southwest
The Mental Health Association of New River Valley serves as the coordinating agency for the Pro Bono Counseling Program. The program began with receipt of a four-year grant from a local hospital foundation. Using the grant money, the Pro Bono Counseling Program has grown and currently has three part-time paid staff who coordinate the clinical services provided by the volunteer and trainee providers.
Challenges and Solutions: One of the foremost challenges encountered by the Pro Bono
Counseling Program is the pursuit of funding sources. While a local hospital
foundation provided initial funding, the Pro Bono Counseling Program sought and
received additional funding from a statewide health care foundation. In
addition, the program faced challenges in recruiting mental health provider
volunteers. By partnering with local universities, post-graduate,
license-eligible trainees are utilized to provide direct services to clients
and also gain valuable experience. Medicaid requirements in the state of
The majority of the program’s clients are referred by word of mouth; however, the program does utilize a variety of other marketing tools to publicize their program. The program advertises through program brochures and ads in the newspaper. It recently initiated an anti-stigma campaign to address societal barriers to seeking mental health care.
The program has received a number of awards. It won the 2000 Innovation in Programming Award by the National Mental Health Association. It was also a semifinalist for the American Psychiatric Association’s Golden Community Award and the Premier Cares Award.
Finally, to offer the opportunity for other areas of the country to replicate the program, the program offers a Program Development Guide, which includes a program handbook and all the forms and documents (including the original grant) needed for other sites to create their own Pro Bono Counseling Program. The guide may be purchased from the program.
Amy Forsyth-Stephens, Executive Director
Mental Health Association of the New River Valley, Inc.
Pro Bono Counseling Program
Phone: (540) 951-4990
Fax: (540) 951-5015
E-mail: mhainfo@mhanrv.org
MODELS FOR PRACTICE
FOCUS AREA: MENTAL HEALTH AND MENTAL DISORDERS
Program Name: Thomas E. Langley Medical Center¾Behavioral Health Department
Location:
Problem Addressed: Mental Health and Mental Disorders
Healthy People 2010 Objective: 18
Web Address: thomaselangleymedical.com
Blueprint: The
Behavioral Health Department serves all residents of
The services are delivered on-site at TELMC, in a building designated for Behavioral Health Services. The department provides psychological evaluation services, traditional therapeutic services, specialized programs, and services for attorneys and courts. The psychological evaluation services include psychological testing, intellectual testing, psycho-educational testing, and alcohol and drug addiction evaluations. The traditional therapeutic services include child, adolescent, and geriatric therapy; employee assistance programs; and coping/life management skill development. Specialized programs address attention deficit hyperactivity disorder (ADHD), pain management, loss and grief issues, stress management, domestic violence, and sexual abuse. It also provides social skills training, addictions education and counseling, cognitive assistance programs, random drug screening, and rapid saliva alcohol testing. Additionally, the program provides services for attorneys and courts including competency determinations, diversion programs, custody evaluations, identifying substance abuse, and making treatment recommendations. Group therapy, marital counseling, family therapy, conjoint therapy, pain management group, parenting and educational seminars, couples counseling, teen group, and children’s group round out the complement of behavioral health services offered by TELMC.
The department coordinates the center’s participation in the National Health Disparities Depression Collaborative. The Collaborative allows the center to share data and exchange best practices with other centers throughout the country. The Collaborative is an ongoing endeavor to ensure the highest quality of patient care.
Also, there are
many outreach endeavors that are ongoing to serve the entire
Making a Difference: To measure the success of the program, the following indicators are monitored: psychologists’ productivity, decrease in the number of “no-shows” from baseline data, number of network panels in which staff are accepted for third-party payment, and patient satisfaction. Other quality-related indicators include quality assurance chart reviews, physician review for medical necessity as appropriate, and annual internal quality council review accessing progress on the above measures and developing new goals.
Beginnings: Behavioral Health began in August 2000 and was fully implemented in February 2001. It started in response to several primary care physicians’ recognition of mental health problems in many of their established patients. Before it was established, these mental health needs had to be addressed by outside referrals, which limited access to care and follow-up and resulted in inadequate treatment of behavioral health problems.
Challenges and Solutions: Behavioral Health has been successful in its endeavors to integrate
primary health care and mental health, and to sustain itself financially. Lack
of funds, however, has prevented expansion of the program to meet all of the
needs of the community. Behavioral Health’s pursuit of increased access is
complicated in part by the fact that
William J. Kuzbyt, Psy.D.
Behavioral Health
1489 W. Hwy 301
Phone: (352) 793-5900 ext. 3046
Fax: (352) 793-3959
E-mail: bkuzbyt@hotmail.com
MODELS FOR PRACTICE
Program Name: Turning Point Counseling Services, Inc.
Location:
Problem Addressed: Mental Health and Mental Disorders
Healthy People 2010 Objective: 18
Web Address: None
Turning Point
Counseling Services, Inc. (TPCS) is an independent agency that collaborates
with other agencies to build a network of support and services for the
Blueprint: TPCS
is organized as a 501(c)(3) not-for-profit agency. It utilizes volunteer
services provided by
TPCS has three main programs: Victims of Crime, Outreach Services, and Familias Unidas. Victims of Crime serves individuals, children, and families from Aransas, Nueces, and San Patricio Counties who are child victims of physical and sexual abuse, domestic violence victims, adult survivors of abuse, and victims of sexual and physical assault. The majority of this group is uninsured, and the services to them are free. The Outreach Services Program serves children 5-17 and their families from Nueces and Aransas Counties who have been identified in some manner (self-report, referral from a collaborating agency) as at risk. This group also has limited access to mental health care due to the lack of adequate insurance. The Familias Unidas Program targets families and children in San Patricio County and focuses on prevention and intervention for “at risk” youth.
TPCS provides individual, couple, family, and group counseling. TPCS also uses play therapy with children and goes to the schools to provide counseling as needed. If transportation is a problem, home visits for counseling are available. TPCS provides referral services, follow-up services, and collaborations with other area agencies. TPCS also provides educational/informational group presentations to agencies and groups who request this service.
The main office
for TPCS is located in downtown
Making a Difference: TPCS utilizes a variety of measures to determine the elements of each program. The Victims of Crime Program uses a client case tracking system. Each client is placed in this system and tracked according to seven important categories: number of sessions utilized, type of victimization, age, ethnicity, county served, referral source, and disability.
To measure the level of activity, TPCS looks at the number of new victims as well as the number of sessions provided. Current data for the Victims of Crime Program are shown in the following table.
Tracking Categories |
Reporting Year 1999-2000 |
Reporting Year 2000-2001 |
|
Number of Sessions* |
1,128 |
1,868 |
|
Number of New Victims |
379 |
646 |
|
Average Number of Sessions per Victim |
2.97 |
2.89 |
*“Session” refers to direct service and group presentation.
Through the use of these outcome measures, TPCS is better able to determine the approximate length of treatment needed for each specific referral, the services most utilized by clients, the category of victimization group that needs services in the Tri-County area, and the referral sources that most utilize the agency for referrals/services to their clients. TPCS uses a mental health outcomes questionnaire and discharge follow-up as two measurement devices to ensure that clients are receiving therapeutic services. The same methods and categories for tracking clients used in the Victims of Crime Program are used in the Outreach Services Program.
For the “Familias Unidas” Program, TPCS developed a tracking system for all clients that identifies six important categories: referral source, county/city served, number of sessions/groups attended, age group, ethnicity, and disability.
Historically, although parents of youth involved in Familias Unidas participate in initial sessions, they frequently drop out and do not actively participate in ongoing services. The percentage of parents who stay in treatment after the initial session will be monitored as an indicator of effectiveness.
Beginnings: TPCS was started in 1997 by a group of licensed professionals as a clinical internship and was fully implemented in 1999. The program began in response to increasing violence and neglect identified in the community. These problems were identified in the Nueces County Community Plan as well as in the Community Plan for Aransas, Bee, Live Oak, McMullen, and San Patricio Counties. Of these counties, Aransas, Bee, Live Oak, and McMullen are non-metropolitan. The statistics for this area support that these problems are on the rise.
Challenges and Solutions: The program has been awarded several grants that will fund positions and programs for a minimum of one year and up to three years. The first funding source came from the Criminal Justice Division/421 fund in 1999. A Victims of Crime Act (VOCA) grant was received that same year. These two grants funded the executive director position, administrative assistant position, and one counselor position. A series of grants since January 2001 have enabled the organization to launch the Familias Unidas Program and to hire staff members to support the program efforts.
TPCS expanded at a rapid rate. While this expansion was beneficial, adequate time is needed to implement effective tracking systems to keep up with the expansion.
Christine Gullett
Turning Point Counseling Services, Inc.
Phone: (361) 888-5924
Fax: (361) 882-4347
E-mail: tpoint@birch.net
MODELS FOR PRACTICE
FOCUS AREA: MENTAL HEALTH AND MENTAL DISORDERS
Program Name: Sowing the Seeds of Hope
Location:
Problem Addressed: Mental Health Access for Rural Farm Families
Healthy People 2010 Objective: 18-7, 18-9
Web Address: http://www.agriwellness.org
Sowing the Seeds of
Hope: Responding to the Mental Health Needs of Farm Families is a collaborative
effort of project leaders in seven predominantly rural states:
Blueprint: Sowing the Seeds of Hope provides behavioral health assistance in participating states to those involved in the agricultural business and their families. The project in the seven states addresses the underserved rural agricultural population without regard to age, income, availability of insurance, racial/ethnic group, or location.
The program provides services to individuals and families who do not have health insurance or adequate behavioral health coverage, and others who are unable to pay for necessary care. Often, these individuals and families experience an accumulation of stresses that result in the breakdown of coping mechanisms. Common associated behavioral health problems include interpersonal distress, depression, anxiety, substance misuse, and loss of hope. Negative stigma about mental health services, geographic barriers, and a perception that providers do not understand their agricultural issues often deters some families from seeking necessary assistance. Additionally, there is a scarcity of qualified professional service providers in rural areas, necessitating the training and utilization of informal networks of support, such as clergy, Extension staff, trained natural helpers who reside in the farm community, and primary care providers (e.g., physicians, nurse practitioners, and physician assistants).
Sowing the Seeds of Hope was designed and initiated in 1999 by the Wisconsin Office of Rural Health and Wisconsin Primary Health Care Association. It was supported by grants from the U.S. Department of Health and Human Services Office of Rural Health Policy and Bureau of Primary Health Care. Administrative support for Sowing the Seeds of Hope is now coordinated by AgriWellness, Inc., a 501(c)(3) nonprofit corporation that assists project leaders in the seven states, provides proposal and grant writing, and explores funding opportunities.
Many individuals and organizations serve voluntarily in their specific states to carry out portions of the work. A central aim of each state project is the formation of a coalition of individuals (both paid staff members and volunteers), agencies, and organizations to maximize information about access and cost of services, options for additional funding, and continuation of the state projects.
Project leaders identified 11 core services for the underserved rural agricultural community:
· outreach;
· training and education of traditional and non-traditional behavioral health care providers;
· education of the community on agricultural behavioral health issues;
· information clearinghouses;
· crisis hotlines;
· direct services through vouchers, contracts with approved providers, and other means to ensure access to necessary services;
· prevention of more serious difficulties through early intervention;
· coalition building with organizations, agencies, and communities;
· advocacy for behavioral health of the underserved;
· social marketing through publications, press releases, and other media activities; and
· retreats and support group activities for farm couples and families.
Making a Difference: To evaluate the core activities of the program, the following evaluation measures are used:
Since the outcome criteria were not established until December 10, 2001, not all the reported data are usable. Thus, the outcomes/results reported here for 2001 are probably underestimates.
More than 14,000 farm residents were reached in 420+ outreach events. More than 400 providers were documented as having received professional training in 40+ documented training programs. At least 5,850 farm residents received community education. The crisis hotlines in the seven states reported more than 20,000 callers during the first two years of the project. At least 3,811 farm residents received direct services, which were partially or completely funded by Sowing the Seeds of Hope. Project personnel were successful in generating an additional $3,150,000 of federal, state, and private funds to augment $1,035,000 received from the Federal Office of Rural Health Policy, $90,000 from the Federal Bureau of Primary Health Care, and $28,000 from the Land O’ Lakes Foundation. At least 556 persons participated in 95 support group meetings or farm couple/farm family retreats.
Beginnings: The Sowing the Seeds of Hope project was developed to respond to the mental health needs of farm families in the seven-state region. Behavioral health threats increase among the rural agricultural population during eras of economic stress. The suicide rate among farmers rose three to four times the national average during episodes of financial distress in several of the states in the Sowing the Seeds of Hope region.
The program began in May 1999 and was fully implemented in September 2000. The first three years of funding were considered the pilot phase. The Sowing the Seeds of Hope project leaders are now ready at the next level¾implementing the basic services on an ongoing basis.
Challenges and Solutions: Insufficient funding is the greatest challenge to the projects in each state. Although project leaders in each state have been very successful leveraging additional state, private, and federal resources to augment their projects, the needs of the population surpass available resources. The program is working very actively with federal, state, and private organizations to both secure additional funds and to maximize pursuit of the program’s objectives.
Michael R. Rosmann, Ph.D., Executive Director,
AgriWellness, Inc.
Phone: (712) 235-6100
Fax: (712) 235-6105
E-mail: info@agriwellness.org
MODELS FOR PRACTICE
FOCUS AREA: SUBSTANCE ABUSE
Location:
Problem Addressed: Substance Abuse and Mental Health
Healthy People 2010 Objective: 18
Web Address: http://www.searhc.org
Blueprint: The
Community Family Services Program is part of SEARHC (Southeast Alaska
Regional Health Consortium), the third largest Native health organization in
The program is staffed by 18 paid employees including nine village providers, four licensed mental health clinicians, one clinical director, two administrative personnel, one health systems technician, and one health systems specialist. The village providers are cross-trained to work with both mental health issues and substance abuse disorders. Professional staff supervise the village providers by visiting each community every six to eight weeks and by providing day-to-day support via telephone.
The program’s clientele is mostly Native Alaskan with substance abuse disorders. Specifically, the program provides outreach, prevention, assessment services, early intervention, education, emergency and crisis intervention, outpatient counseling, aftercare/continuing care, relapse prevention, community development, and telepsychiatry/telehealth for individuals with substance use disorders, mental illness, or co-occurring disorders.
The services are delivered in a variety of ways. Village-based counselors and itinerant clinicians offer services to individuals, couples, families, and groups. The services are offered primarily in counseling offices but can be offered in homes, schools, and medical offices. These services employ various technologies including telephones, fax, e-mail, computers, polycom units, and palm pilots.
SEARHC developed its own program to combat substance abuse and suicide. The program assesses individual needs and tailors treatment to the individual. All counselors are cross-trained in the treatment of substance use disorders and mental health disorders, such as motivational interviewing and culturally relevant interventions such as the Red Road to Recovery curricula. A key element of the program’s success is the philosophy of identifying natural helpers from the villages and training them as counselors, which: 1) increases the odds of provider longevity, 2) promotes culturally competent providers for this unique underserved population, and 3) provides career development in isolated economically depressed areas.
Making a Difference: Since the program began, information has been gathered and assessed based on the number of people served. Factors considered in the follow-up include client satisfaction, improvement in productive activity for clients, decrease in the use of alcohol, and increase in support from others. The program expanded its focus to include more prevention and early intervention and training concerning these issues. Initially, this may be more difficult to evaluate, but it is thought that in the long run, longitudinal studies will prove the efficacy of this direction. Additionally, prevention and early intervention are more cost-effective than treatment.
In 2000, 71 percent of the clients were treated for substance use disorders, 20 percent for mental health disorders, and 9 percent for co-occurring disorders. In 2001, 51 percent of the clients were treated for substance use disorders, 16 percent for mental health disorders, and 33 percent for co-occurring disorders. In 2001, of the 222 discharged clients, 155 completed their treatment plans compared to 104 of the 144 discharged clients in 2000. The substance abuse program does pre- and post-assessments to determine program effectiveness, as well. In 2000, 65 percent of program clients contacted for follow-up reported they had not relapsed at the six-month mark, and 59 percent of the contacted clients had not relapsed at the 12-month mark. In 2000, 90 percent of follow-up contacts rated their relationships as good or above average at the six-month mark and 97 percent as good or above average at the 12-month mark. In 2000, 83 percent of respondents rated family support as above average at the six-month mark and 88 percent as above average at the 12-month mark. In 2001, 81 percent of respondents rated family support as above average at the six-month mark and 81 percent above average at the 12-month mark.
The program
received accreditation for its work, including CARF (Commission on
Accreditation of Rehabilitation Facilities) accreditation for outpatient
services for children and adolescents; and State of
Beginnings: The program began in 1989 in response to the need to address suicide and alcohol problems. Seven years later, in 1996, the program was fully implemented. The program began with the cooperation of the Native villages of Klukwan, Haines, Kake, Angoon, Pelican, Hydaburg, Hoonah, and Yakutat. Since the program began, Hoonah and Yakutat have withdrawn, and a new village, Klawock, joined. These villages range in size from 160 in Klukwan to 1,429 in Haines.
Challenges and Solutions: The funding for sustaining this program is through grants;
the depressed economy in southeast
Geographical and
cultural barriers present major challenges in accessing and delivering mental
health services in this part of
Community Family Services Program
Phone: (907) 966-8776
Fax: (907) 966-2489
E-mail: ivag@searhc.org