Mental Health in Rural America and How to Utilize Patient Engagement Technology
With recent cultural shifts there has thankfully been a gradual increase in mental health awareness across the United States. The awareness sheds light on the need for better mental health care and access to behavioral health services like counseling, therapy, psychiatry, social services etc.
Recent data shows:
- Sixty-eight percent of adults with mental health disorders also struggle with medical conditions. Some of these conditions are chronic, and the cost of managing these conditions is high.
- Estimates suggest that at least 1 in 4 people experience significant behavioral illness at some point in life
- One recent study in the United States, for example, found that the share of people reporting negative behavioral health impacts from COVID-19 rose from 32% to 53% between March and July 2020.9
- 1 in 5 U.S. adults experience mental illness each year
- 1 in 20 U.S. adults experience serious mental illness each year
- Suicide is the 2nd leading cause of death among people aged 10-14
These stats apply to data gathered across the entirety of the U.S., but rural mental health care can be a completely different ballgame.
Rural Mental Health
In the United States, one fifth of the population lives in a rural area (defined by low density or geographically isolated areas and can range from 2,500 to 50,000 people), of those rural residents 7.7 million individuals struggle with mental illness. According to a recent 2020 study, “1.8 million, or 4.8%, of adults in nonmetropolitan areas reported having serious thoughts of suicide during the year.” While the urban counterpart has similar data, the access to care and services available to rural residents is significantly different. The top few reasons are:
- Accessibility: Patients must travel long distances to receive any kind of care, in general- and they might not even be insured for mental health care when they get there.
- Availability: Staffing shortages are prevalent in healthcare facilities, and lack of mental health professionals is common in rural communities.
- Affordability: Many patients might not be able to pay the out of pocket costs for mental health care
- Acceptability: In the rural community, there is a lot of stigma around receiving mental health services. Some find it unnecessary, embarrassing, or worry about the confidentiality between doctor and patient.
Behavioral Health Clinic Vs. Behavioral Services
Behavioral health clinics/mental health clinics/mental health facilities are separate clinics/facilities than integrated behavioral health services. Any Rural Health Clinic or hospital can integrate services like: psychologist services, clinical social worker services, and services and supplies furnished as incident to a clinical psychologist or social worker. Depending on state to state regulations and guidelines, RHCs will have to submit forms or a formal request to add these services by reaching out to CMS, or in some cases the State Comptroller’s office.
According to 2020 data, there are around 12,275 mental health treatment facilities in the U.S. Out of those, 9,634 are 24-hour outpatient facilities and of those 1,806 facilities are 24 hour inpatient.
In rural areas, more than 60% of residents live in mental health professional shortage areas. Around 65% of rural Americans receive care from their primary care provider, and the mental health crisis responder is usually a law enforcement officer.
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Opportunities for Improvement and Future Predictions
- A ‘positive’ that came out of the COVID-19 pandemic was the utilization and integration and rapid popularity of telehealth software. Telehealth spiked during Covid. For example, less than 1% of Medicare services were telehealth pre-pandemic. At the pandemic’s peak, more than 32% of all Medicare claims were telehealth services. 44% continuously had a telehealth visit, accounting for more than 45 million visits! Now in 2022, telehealth usage certainly has leveled off and gone down from the spike, but it will never be the same as pre-Covid numbers
- Chronic Care Management
- Chronic care management research links higher costs to patients with chronic care disease and a mental health disorder, suggesting that organizations should loop mental healthcare into the chronic care management program. It’s already well documented that most patients suffering from comorbidities, (and therefore receiving chronic care management), have depression as a byproduct of their illnesses or physical impairments
- Data Sharing
- The more data that can be shared safely and securely, through heightened interoperability the better. With interoperable data, patients receive care quicker and lots of redundancy would be eliminated on the provider’s side. Thankfully with the new CURES act that goes into effect on December 31st, EHRs will have to comply with new minimum standards that allow for providers and patients to have better access to patient information
Telehealth and Patient Engagement as Means for Change
As mentioned earlier, telehealth adoption has risen quickly in the past 2 years- and for good reason. Through the quarantine, patients were still able to have access to doctors and receive care and medical advice. Now, the additional benefits have been made more abundantly clear- telehealth is a true way to reach patients that otherwise would not have been able to reach a doctor previously.
Telehealth opens up a door of opportunities for patients. If their primary care doesn’t have the ‘furnished’ mental health services, telehealth provides ways to reach other mental health professionals. Even primary cares, RHCs, that have services use telehealth as a means to keep their doors open (this was essential during covid), currently telehealth has been helpful to increase patient visits.
Telehealth not only helps patients, but provides reimbursement opportunities for rural clinics. For RHCs telehealth can be a revenue lifeline. However, installing functional telehealth in communities can be costly, and broadband can be limited.
Thankfully, there are grants available. The U.S. Department of Agriculture has three:
- The Rural Broadband Access Loan and Loan Guarnatee Program provides money for construction costs, improvement or acquisition of facilities and equipment needed for broadband services in rural areas
- USDA Distance Learning and Telemedicine Loan and Grant Program offers grants to support and improve telehealth
- USDA Community Facilities Direct Loan and Grant Program awards direct loans and/or grants for essential community facilities in rural areas
- The USAC, universal service administrative company, offers the rural health care telecommunications program. This program assists providers with expenses for broadband/telecommunications access
The HRSA has a program called the evidence based telehealth network program that helps existing telehealth programs.
Patient and Provider Portals
Patient engagement software, like patient or provider portals additionally bring added benefits to the patient experience. Through patient engagement software:
- The patients can download test results and discharge details
- Patients can book their appointments
- Update allergy or medication information
- Receive reminders so that no appointments are missed
- Bill payments can be done online and also the receipts can be downloaded
- Patients can more easily engage and be more proactive with their health
- Quicker diagnosis, treatments & results
Alternatively, a provider portal can give providers the ability to:
- Establish trust with patients through online messaging
- The customizability of patient engagement and personalization of care plans
- Capture data in real-time
- Mobile charge capture
- Access patient records easily and securely to apply subsequent visit charges, switch between different patient accounts without logging into multiple accounts
As an aid for mental health, patient and provider portals allow for both patient and provider to have more control over the patient’s health. Better access to health information can lead to a higher interest in ones health and therefore better patient outcomes. Additionally, secure messaging can establish trust between the patient doctor relationship. Through portals, telehealth calls can be conducted, and in fact many new forms of therapy are all conducted online.