Substance Abuse. Among current drinkers, men in nonmetro areas consume 5 or more drinks in one day than those in metro areas (56% vs.

Transcription

1 Framing the Issue

2 Substance Abuse Among current drinkers, men in nonmetro areas consume 5 or more drinks in one day than those in metro areas (56% vs %) Periodic heavy drinking more common among non-hispanic white, Hispanic, and American Indian persons Rural admissions were younger and less racially and ethnically diverse than urban admissions Rural admissions were more likely than urban admissions to report primary abuse of alcohol (49.5 vs percent) or non-heroin opiates (10.6 vs. 4.0 percent) Rural admissions were more likely than urban admissions to be referred by the criminal justice system (51.6 vs percent) and less likely to be self- or individually referred (22.8 vs percent) Rural regions also saw a greater number of male clients seeking treatment: 68% of rehab clients were male, while only 32% were female.

3 Opioid Use Nonmedical use of opioid pain relievers and heroin is higher among rural adolescents, young adults, and in states with large rural populations such as Kentucky, West Virginia, Alaska, and Oklahoma. Southern and Appalachian states had the highest rates of opioid prescriptions per person. In 2012, northeastern providers wrote the most prescriptions for long acting and high dose painkillers per person Rural communities suffer from greater naloxone restrictions than urban communities. EMS providers are less likely than urban providers to administer naloxone in the case of opioid overdose.

4 Suicide A JAMA Pediatrics study analyzed suicides among people aged 10 to 24 between 1996 and 2010, and found that rates were nearly doubled in rural areas, compared to urban areas For males 15 years and older, rates of suicide were per 100,000 people in metro areas and 31 per 100,000 in rural areas Higher rates of suicide and suicide attempts in rural areas Elderly residents in some rural regions had suicide rates 3 times higher than national average in non-rural settings

5 Smoking (CDC Urban and Rural Health Chartbook, 2001) (American Lung Association: Tobacco Use in Rural Communities) Adults living in rural counties most likely to smoke (27% of women and 31% of men) versus metro areas (20% of women and 24-25% of men) 27.8 % of rural residents smoke, compared to 22.7% of urban Rural young adults ages 18 to 34 smoke at especially high rates, and are 27% more likely to smoke than their urban counterparts 27.4% of pregnant women in rural communities smoke throughout their pregnancy, compared to 11.2 %of their urban counterparts

6 Behavioral Health Workforce (NRHA Workforce Series: Rural Behavioral Health) (US Department of Health & Human Services HRSA) 20% of non-metro counties lack mental health services compared to 5% of metro areas 85% of 1,669 federally mandated health professional shortage areas are rural Provider to patient ratio in rural areas 1:3, % of physicians practice in rural America Over 85% of psychologists work in urban areas, with just 11% working in rural areas 14.5% of social workers are in rural areas 15% of counselors work in rural areas Higher scores/darker red indicate greater priority and need for mental health clinicians

7 Behavioral Health Workforce

8 Behavioral Health Workforce For MHPSAs in rural counties, nearly three quarters lack a psychiatrist and 95% lack a child psychiatrist.

9 Rural Health Clinics

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12 Telehealth Telemental Health in Today s Rural Health System A 2013 study found that rural telemental health systems were providing more and different types of services than in the past. Consultations between Providers 72% / Care Management/Coordination 46% / Staff Supervision 36% / Quality Improvement Activities 32% Direct Care Services Provided in Telemental Health Programs: Medication Management 82% / Initial Diagnostic Evaluation 80% / Psychotherapy 62% / Crisis Stabilization 44% / Involuntary commitment assessment 28% / Substance Abuse Treatment 26% / Crisis Management 26% Mental Health Professionals Providing Telemental Health Services: Psychiatrists 88% / Clinical Psychologists 44% / Clinical Social Workers 38% / Psychiatric Nurse Practitioners 30%

13 Insurance Coverage Individuals living with an SMI (serious mental illness) in rural areas were more likely to have public insurance but also more likely to pay out of pocket. Rural adults who are privately insured have a lower rate of office-based mental health services but a higher rate of prescription medicines than do their urban counterparts. Lower quality mental health care was offered to individuals living in rural areas compared to those in urban areas, partially due to a lack of mental healthcare specialists and also lower rates of insurance coverage. Individuals living with an SMI (serious mental illness) in rural areas were more likely to have public insurance more likely to pay out of pocket. Rural adults who are privately insured have a lower rate of office-based mental health services but a higher rate of prescription medicines. Children from rural settings are less likely to be diagnosed with mental health issues other than ADHD and are less likely to receive counseling. As of 2014, 22% of rural residents were enrolled in Medicaid while 20% were enrolled in Medicare, (Medicaid has surpassed Medicare as the largest source of public health coverage in rural areas, second only to employer sponsored insurance plans.)

14 Rural System of Care Gaps in the availability of substance use and mental health treatment services, particularly related to medication assisted therapies. Rural EMS delivery systems are plagued by long travel distances; lower population density; longer response times, and staffing patterns which rely on volunteers and/or lower skilled staff Rural communities suffer from greater naloxone restrictions than urban communities.

15 Frontier Innovators Observations Assets: Capability to recognize interconnectedness and develop partnerships that provide value to patients and the organizations they serve, familiarity with patients and families that allows innovators to more readily provide support and connections to services, and Small size and remote location offer a unique capacity to be a petri dish for experimentation and innovation. Value of working at a regional level not only to coordinate efforts and share resources, but also to amplify the frontier voice. Challenges: Themes, challenges, and strategies for rural and frontier are similar. However, frontier challenges were magnified particularly issues related to distance, transportation, and evaluation.

16 Frontier Innovators Observations Community-derived solutions have the most impact. Trust is essential in rural innovation efforts. Workforce training must reflect the cultural dynamic of the community being served and the context of the program services. There is a need for metrics, especially related to costs, that better serve the evaluation and assessment of rural innovations.