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Community Innovations
 


Frontier Communities:
Leading the Way With Innovative Approaches
to Behavioral Health

February 2003


Frontier Education Center

NATIONAL CLEARINGHOUSE FOR FRONTIER COMMUNITIES
723 Don Diego Avenue, Santa Fe, NM 87505
Phone: 505-820-6732 * Fax: 505-820-6783
E-mail: frontierus@frontierus.org
Website: http://www.frontierus.org/

Supported in part by the Federal Office of Rural Health Policy, HRSA, DHHS

For Complete Document:  MS Word  35pgs, 241K   or   PDF file  35 pgs, 598k

   
CONTENTS
  
Executive Summary   4
Introduction   5
Purpose   5
A Note About Terminology   6
Section I: Background   6
  The Frontier Population   7
  Estimated Extent of Behavioral Health Problems in the U.S.
  and in the Frontier   8
  Frontier Behavioral Health Issues 12
  Behavioral Health Issues Specific to Frontier Women 13
  Obstacles to Behavioral Health Care in Frontier Areas 14
  Building on the Strengths of the Frontier 14
Section II: Models that Work in Frontier Communities 14
  A Sampling of Innovative Approaches 14
  Integrated Behavioral Health and Primary Care:
  Plan de Salud del Valle 15
  Equine Assisted Psychotherapy: Reins of Change 17
  Behavioral Health Aides 19
  Telemental Health: Two Models in Use in New Mexico and Alaska 20
  Internet Peer Support 22
  Warm Lines 24
Section III: Five Policy Recommendations to Improve Behavioral
  Health Care in the Frontier 25
  Recognition of the Problem 25
  Training, Recruitment, and Retention of Providers 25
  Insurance Reform 26
  Recognition and Support for Dual Diagnosis 26
  Support for Drug and Alcohol Use Prevention Services and Research      27
Section IV: Obstacles to Behavioral Health Care in the Frontier 27
Section V: Behavioral Health Resources and Links 30
References 33
Appendix A 35
  Estimates of Children & Adolescents with Serious Emotional Disturbance by State
 
 
EXECUTIVE SUMMARY

Nearly 8 million people live in the enduring American frontier where they constantly struggle for access to health care. The majority of frontier counties have two or fewer services of any type, and as many as a quarter of a million people may be living in counties with no services at all. This struggle to reach and receive adequate health care service is exacerbated for the more than 2 million frontier adults and nearly 600,000 frontier children believed to have behavioral health problems.

Because little data has been gathered about frontier residents, the numbers of adults and children affected with behavioral health problems is based on the national estimation formula published in the Federal Register by the Center for Mental Health Services at the Substance Abuse and Mental Health Administration, DHHS (Center for Mental Health Services, 1999). People living in rural areas have the same incidence of mental illness or emotional problems as do people living in urban areas. In addition to severe or persistent mental illness and dual diagnosis, frontier residents, and especially frontier women and children, are at higher risk than their urban counterparts for depression, suicide, and alcohol, drug, and domestic abuse.

For frontier residents, the lack of health insurance and inadequate coverage is further compounded by a drastic shortage of behavioral health professionals, by great distances between home and services, by unstable or little funding for community support services, and by the lack of anonymity in small communities. They fear the societal stigma associated with behavioral health conditions and treatment. In an effort to lessen the impact of these problems, frontier behavioral health practitioners and community members have worked together to develop unique solutions to better meet the needs of those frontier residents requiring behavioral health services.

This paper, Frontier Communities: Leading the Way With Innovative Approaches to Behavioral Health, is devoted to furthering the knowledge about how behavioral health services can be improved in frontier communities, and is comprised of five sections. Section I briefly discusses the estimated extent of behavioral health problems both in the United States and in frontier communities, the obstacles to behavioral health care in frontier communities, and behavioral health issues unique to frontier women. Section II explores six models that highlight how community problem-solving can address behavioral health issues in frontier communities around the United States. Section III addresses policy recommendations for improving behavioral health care in frontier communities. Section IV expands on obstacles to behavioral health care in the frontier, and Section V contains references and Internet resources to behavioral health organizations and agencies, including several specific to frontier and rural communities.

As the National Clearinghouse for Frontier Communities, the Frontier Education Center believes that support for existing and new innovations to address behavioral health issues are essential to meeting the health and human services needs of the millions of people who live in Frontier America.

 
For Complete Document:  MS Word  35pgs, 241K   or   PDF file  35 pgs, 598k




National Center for Frontier Communities welcomes your comments and inquiries. Contact us:
National Center for Frontier Communities- HCR 65 Box 126 - Ojo Sarco NM 87521 - 505-820-6732 - frontierus@frontierus.org
     © 2009 National Center for Frontier Communities. All rights reserved