Dr. Herbert Coard: The crisis in rural and frontier mental health

Dr. Herbert F. Coard III

Dr. Herbert F. Coard III

People outside of the metropolitan area feel more isolated and unsupported while dealing with mental illness and have less resources to effectively treat and manage their mental illness.
People who live in the rural and frontier areas experience mental illness at the same rate as those who live in cities, but they experience significantly more challenges because of the difficulty in accessing professional mental health services, including psychiatry, psychology, social work, counseling and substance abuse providers.
Typically when available, the services provided are from the professionals with the least amount of training in behavioral health (social workers, counselors, and a licensed marriage family therapist) and frequently pharmacological therapy is not available from a psychiatrist or psychiatric nurse resulting in patients relying on their primary care providers (family medicine physicians, nurse practitioners, and physician assistants) who have limited training experience in treating and managing mental illness.
Telehealth services have shown promise in alleviating the lack of mental health services for nearly 7.3 million or 21.2% of adults who live in rural and frontiers with mental illness based on the 2019 National Survey of Drug Use and Health. This also includes approximately 1.6 million or 4.8% of adults who had serious thoughts of suicide during the year.
Telehealth seems like an attractive solution; however, there are many functional limitations including decreased access to the reliable Internet services in rural areas and no access in frontier areas, requiring patients to travel to larger communities with better Internet access. In addition, the Centers for Medicare and Medicaid Services recently announced a 3.89% reduction in the reimbursement for telehealth behavioral health services after the pandemic and/or fiscal year 2022 making it less attractive for individuals to provide patient care.
The reimbursement from Medicaid, Medicare, and private insurers has a significant impact on the ability of rural providers to offer mental health services.
The publication “Encouraging Rural Health Clinics to Provide Mental Health Services: What are the Options?” notes that rural health clinics and provider may be reluctant to start providing mental health services when reimbursement rates are low. In addition, high no-show rates among mental health clients in the Medicaid population tends to be as high as 30% and high numbers of uninsured patients further exacerbate the issue of low reimbursement rates paid by Medicaid and others.
As of Sept. 30, 2020, Health Resources and Services Administration had designated 3,363 Mental Health Professional Shortage Areas in rural areas. It is estimated that it would take 1,676 practitioners to remove the designation; however, with the lack of financial incentive, little will change for the patients in rural and frontier Northern Nevada.
Community leaders, politicians, and mental health professionals need to come together to increase accessibility for patients in rural and frontier areas to receive quality mental health services without the need to travel a great distance, by addressing the financial aspects of delivering mental health care to patients in Northern Nevada.
Dr. Herbert F. Coard III is a psychologist and managing partner at Sapience Practice. Sapience Practice provides behavioral health and forensic psychological services in Reno, Carson City and rural Nevada. Coard can be reached at info@sapiencepractice.com.

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