ABSTRACT
This paper presents findings from a study designed to identify and describe models for integrating primary care and mental health services in rural communities. Data were obtained from telephone interviews with staff at rural primary care sites around the country. Findings are based on the responses of 53 primary care organizations in 22 states. The authors identify four integration models--diversification, linkage, referral and enhancement--which appear to exist in combination, rather than as pure types. The proposed analytic framework outlines aspects of integration that are readily amenable to study.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Mental Health Services/organization & administration , Models, Organizational , Primary Health Care/organization & administration , Rural Health Services/organization & administration , Attitude of Health Personnel , Continuity of Patient Care/organization & administration , Contract Services/organization & administration , Humans , Referral and Consultation/organization & administration , Surveys and Questionnaires , United StatesABSTRACT
A case study of the community mental health work force in Nebraska over a seven-year period beginning in 1981 examined changes in the professional makeup, overall staffing levels, extent of professional training, and number of medical staff in both metropolitan and nonmetropolitan agencies. The study found significantly more bachelor's-level staff in metropolitan agencies and more master's-level staff in nonmetropolitan agencies. The proportions of doctoral-, master's-, and bachelor's-level staff did not change significantly in metropolitan or nonmetropolitan agencies during the study period. However, beginning in fiscal year 1982, nonmetropolitan agencies had significantly fewer full-time-equivalent positions than metropolitan agencies, and metropolitan agencies experienced significant decreases in medical personnel. The loss of positions in rural agencies portends a crisis in their ability to respond effectively to the needs of rural residents. Special approaches may be needed to facilitate the recruitment and retention of quality mental health professionals in nonmetropolitan areas.
Subject(s)
Community Mental Health Centers , Mental Disorders/rehabilitation , Rural Health/trends , Clinical Competence , Humans , Nebraska , Patient Care Team/trends , Personnel Selection/trends , Personnel Staffing and Scheduling/trends , WorkforceABSTRACT
In an effort to address the complex realities of mental health service delivery in the 1980s, a systems model for planning and policy making has been developed. The model, called "the Nebraska Mental Health Desired Service System," can serve as a template for future service delivery system design. The development of the model and issues attendant to it are presented. Application of the model to planning, fiscal management, system management, politics, human resources development, and services coordination is presented.
