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
"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
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.
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
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
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
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.
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