24 Aug Delivering Better Behavioral Healthcare in Rural Communities

Rural, isolated regions have historically lacked resources and infrastructure to adequately address the behavioral healthcare needs of its population. People living in remote areas have limited access to specialty services for mental health and substance use disorders, creating a rural-urban divide. Fortunately, technological innovation and government-sponsored programs have expanded opportunities in sparsely-populated, remote regions of the United States. 

Barriers to Treatment in Rural Communities 

For many years, young adults have left small towns to live in urban environments. Those left behind—many elderly and impoverished—tend to lack the resources to move and often rely on Medicare and Medicaid for health coverage. The precarious nature of these publicly funded insurance programs, coupled with restrictive reimbursement requirements, equates to lower income for providers in remote locations. In addition to that, a relatively low volume of patients corresponds with higher costs of service delivery. In the past ten years, 80 rural hospitals have closed. Of those still operating, 41% run at a negative margin. This uncertainty of funding streams makes providers hesitant to open practices in rural communities. 

The lack of specialists and trained clinicians means rural residents must travel long distances to seek treatment. There may be excessive wait times before services become available, leaving many people to rely on a general practitioner for all of their healthcare needs. Oftentimes, there is limited or no integration of mental health within primary care, and many rural providers have outdated software or inadequate infrastructure for teletherapy connections. 

Building a Behavioral Healthcare Workforce

The lack of behavioral healthcare in remote regions has historically been addressed by sending workers to underserved areas. For example, the National Health Services Corps uses federal funds to repay academic loans to professionals who serve two years in a qualified community. While helpful in the short term, a significant limitation of this approach is that it focuses on time-limited commitments because it takes time for outside providers to establish trust in small, close-knit communities.  

An isolated area might benefit from training local residents who want to improve their own community. The Alaska Training Cooperative offers a model for training an indigenous workforce. The University of Alaska provides courses toward a degree in mental health while local cooperatives supply supervisors and clinical practicums. These “home-grown” graduates can then apply for jobs in the regions where they already have established relationships.

Expanded Access Through Integrated Care

Integration with existing facilities can bring much-needed mental health services to rural regions. Integrated care offers easier referrals between the primary care provider and the behavioral healthcare clinician. Levels of integration can vary from minimal to complete collaboration. Basic integration involves communication about patients. For example, residents who know and trust their primary care provider may be more willing to enter mental health treatment when their doctor provides a warm handoff to a specialist. 

In a fully-merged practice, mental health and primary care providers share the same systems and buildings where they work together as a single entity, making the continuity of care even greater. One example of full collaboration is the Veterans Administration Home-based Primary Care. Care is delivered in the veteran’s home by a multidisciplinary team. The team includes both physical and mental services to address the comorbidities that often accompany disabling medical conditions. The model is well-suited for rural residents who have complex conditions where transportation and mobility put an undue burden on clients and their caregivers. 

Benefits of Teletherapy and EHRs

Teletherapy is another approach that increases access to mental health specialists for isolated populations. Mounting evidence suggests that distance counseling can deliver effective care while reducing costs. Communication technologies support behavioral healthcare services with adaptable solutions for a variety of situations. When compared to in-person sessions, teletherapy is particularly beneficial in terms of cost and burden reduction for rural populations. A teletherapy option allows clients to have increased access to specialty services at lower prices. Virtual appointments are more convenient for residents who may otherwise need to drive long distances for mental healthcare, and clients are more likely to continue services that are easier to access. 

Health Information Technology (IT) is non negotiable in modern practices. However, many rural organizations work with a hodgepodge of platforms—one for billing, a different one for notes, another for client intake. Some still rely on paper documentation for portions of their workflow. These disparate systems are not sustainable and may lead to inconsistent care for patients and confusion among the staff.

Rural behavioral health clinics deserve reliable, unified health IT. The rise of cloud-based services is a boon for remote providers. Web-based systems allow for easier integration and collaboration. Mental health clinics can leverage the expertise of a seasoned EHR company to maintain client records and promote collaboration among a diverse team of healthcare specialists, while ensuring data security and HIPAA compliance. Technology designed explicitly for behavioral healthcare has everything needed in one system, eliminating the need for piecemeal platforms. A complete mental health EHR solution will result in better documentation for behavioral health providers and better treatment outcomes for clients.

Closing Thoughts

Rural behavioral healthcare clinics face unique barriers when it comes to providing the best care possible. Long distances, workforce shortages, and shaky funding make accessing mental health services difficult for isolated populations. Training local residents and integrating behavioral and primary healthcare increases the availability of specialists to these remote areas. With the rise in video telehealth technology, therapists reach their clients more easily. Moving forward, rural organizations should rely more on cloud-based behavioral health-specific EHRs to streamline their practice, leaving clinicians to do what they do best—care for their clients.