New APA Resource Addresses Psychiatry in Underserved Areas

In many areas of the United States, people with mental illness must travel long distances to receive treatment or, worse still, go without treatment altogether because they lack local access to psychiatric care.

APA leaders who formed a task force to explore the issue, along with APA's Office of Healthcare Systems and Financing, have created an online clearinghouse of information on psychiatric services in underserved areas. The goal of this initiative is to increase access to care in underserved areas, alert APA members about a number of programs that extend psychiatric care to these communities, and help them develop similar programs in their own areas.

“Psychiatrists—and other mental health professionals—tend to be relatively scarce in rural and inner-city areas,” said APA President-elect Nada Stotland, M.D., M.P.H., in an interview with Psychiatric News. Stotland chaired the Presidential Task Force to Develop a Strategic Plan to Address Psychiatric Needs in Underserved Areas, which was created in 2005 by then-president Steven Sharfstein, M.D.

“We see it as the responsibility of our profession to address the psychiatric needs of patients and their families who are located in those areas,” she noted.

Stotland said that task force members first polled APA district branches to learn more about how they dealt with the need for psychiatrists in rural areas and then investigated a number of programs across the country designed to ameliorate them. Examples include psychiatrists traveling to rural areas to see patients, clinics using telemedicine to treat patients, and health insurance companies in certain states covering psychiatric consults in primary care settings.

The Web site contains different sections on psychiatric needs in underserved areas, including federally designated criteria used to determine the need for psychiatrists in rural areas, government programs that place medical professionals in underserved areas, and innovative programs to increase the number of psychiatrists in certain areas.

Defining Mental Health Shortage Areas

According to the Web site, for a geographic area to be designated as a mental health professional shortage area by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Resources, the ratio of population to psychiatrists and/or nonphysician mental health professionals must be disproportionate according to HRSA-defined standards.

For instance, a mental health shortage area must have a population-to-mental-health-professional ratio greater than or equal to 6,000 to 1 and a population-to-psychiatrist ratio of greater than or equal to 30,000 to 1; the qualifying population-to-psychiatrist ratio in areas with unusually high mental health needs must be greater than or equal to 20,000 to 1.

Certain facilities such as federal and state correctional institutions and state and county psychiatric hospitals also can be designated mental health shortage areas.

Technology Bridges the Gap

In the past couple of decades, medical professionals have used technology to reach patients who would otherwise go untreated. Various telemedicine and telepsychiatry programs listed on the Web site include the Rural Health Care Program of the Universal Service Fund, which provides discounts to eligible rural health care professionals for telecommunication services, and the University of Colorado Health Sciences Center's American Indian and Alaskan Native Program, which provides telemedicine and telepsychiatry services to American Indian and Alaskan Native communities in Colorado. Other telepsychiatry programs include those at the Medical College of Georgia and the Southern Illinois School of Medicine.

The clearinghouse also lists dozens of links to other Web sites that provide information on many different aspects of telepsychiatry, including payment of services, training for psychiatrists, and laws regarding the practice of telemedicine.

The site also addresses government programs developed to increase the number of mental health professionals in rural and inner-cities areas (see Original article: Rural Mental Health Resources).

For instance, the J-1 visa waiver program is a mechanism through which international medical graduates can apply to government agencies to stay in the United States after completing psychiatry residencies and serve patients in mental health professional shortage areas for a certain period of time.

In addition, the National Health Service Corps, which falls under the umbrella of HRSA, recruits dentists, primary care physicians, and psychiatrists to work in health professional shortage areas.

Clearinghouse Highlights Model Programs

APA's clearinghouse also includes links to innovative programs in which APA members participate. For instance, the site includes information about the Maine Consultation Project, a collaboration between the Maine Academy of Family Practice and the Maine Association of Psychiatric Practice, and links volunteer psychiatrists with primary care physicians throughout the state.

There is also information listed about the New Mexico Rural Psychiatry Outreach Project, an APA-funded grant program that is a collaborative effort among New Mexico Health Resources, the University of New Mexico Department of Psychiatry, and the Psychiatric Medical Association of New Mexico.

The program seeks to recruit and identify psychiatrists to provide monthly clinical services to underserved communities, matches the communities with specific providers, and establishes a database for this purpose.

Programs that link primary care practitioners with psychiatrists include the home-based Depression Care Improvement Study, a collaboration of APA, the American Academy of Family Physicians, and the American College of Physicians. The program trains primary care and family practice physicians to screen for depression in their offices using the nine-question Patient Health Questionnaire and assists them with treating depressed patients.

By creating the clearinghouse on APA's Web site, “we wanted to create a place that would emphasize some of the wonderful opportunities and rewards that come from practicing psychiatry in rural communities,” said Anita Everett, M.D., in an interview.

Everett served on the APA task force and helped write its report, which was issued in December 2006.

“Additionally, we wanted to provide supports that would reduce some of the barriers to practice in rural areas. This is why we have focused so much on telepsychiatry, which can reduce the burden of geographic distances between patient and healer,” Everett said. Task force members“ felt strongly that APA could play a strong role in pooling resources that might engage and support practice in these areas.”

APA's Clearinghouse for Information on Psychiatric Services in Underserved Areas can be accessed at<www.psych.org/SpecialGroups/Clearinghouse.aspx>. More information is available by contacting Laurie Emmer-Martin in APA's Office of Healthcare Systems and Financing at [email protected].▪