Specialty mental health services in metropolitan and nonmetropolitan areas: 1983 and 1990.

This paper provides information about the changes between 1983 and 1990 in the availability and volume of specialty mental health services in counties with different levels of metropolitanization and urbanization. The analysis uses the 1983 county metropolitan and urbanization designations for both 1983 and 1990 in order to obtain an accurate determination of the changes that occurred in the 7-year period. The results indicate that during the study period, metropolitan counties experienced increasing availability of specialty mental health services, while nonmetropolitan counties did not. Implications for future rural mental health policy are discussed.

The demographics of disability in the south.

A major issue for health reform is the equitable distribution of health services. Equity in the use of services depends in large part on the distribution of need for services, in addition to availability, accessibility, affordability, and acceptability of the services. The present paper focuses on one set of indicators of need, the disability data reported in the 1990 U.S. Census of Population and Housing for 14 southern states. The Census data on work limitation, inability to work, physical mobility, and ability to perform routine personal care show differentials for subpopulations defined by rural versus urban areas within levels of poverty, age, sex, education, and ethnic group. Highest rates of work disability are found for rural, female, elderly, less educated, African-American, and below poverty level populations. The implications of such findings for health care reform suggest that there should be greater access to services by populations of greater identified need. Historically, the opposite has been true, perhaps exacerbating the observed differentials in need.

Human resource issues in rural mental health services.

Human resource issues related to the provision of mental health care in rural areas under the proposed health care reform are addressed. Rural areas continue to utilize more non-specialty providers in the provision of mental health care. First, issues surrounding the training, recruitment, and retention of specialty mental health providers differ between urban and rural areas. Next, innovative strategies currently being used to attract and retain specialty providers to rural practice are presented. Finally, implications for expanding the knowledge base related to rural providers are explored.

Projections of inpatient admissions to specialty mental health organizations: 1990 to 2010.

OBJECTIVE: To help predict changes in patterns of service delivery, the total number of inpatient admissions to specialty mental health organizations and the number of elderly persons (over age 65) admitted were projected in five-year intervals between 1990 and 2010. METHODS: One set of projections is based on 1986 rates of use and their coefficients of variation. A second, more accurate, set is based on 1990 rates derived from logarithmic projections of trends from 1980 to 1986 and the coefficients of variation for the 1986 rates. RESULTS: Projections based on 1990 rates show an increase of more than 25 percent in the total number of inpatient admissions to all specialty mental health organizations between 1986 and 2010 and an increase of more than 40 percent in elderly admissions. Nonfederal general hospitals are expected to have the largest increases in the number of total admissions, and state and county mental hospitals the smallest. The greatest percentage growth in total admissions will occur in private psychiatric hospitals. For elderly persons, inpatient admissions to Veterans Affairs medical centers will show the largest percentage increase, and admissions to state and county mental hospitals the smallest. By 2010 the majority of elderly admissions (67.6 percent) will be to nonfederal general hospitals. CONCLUSIONS: Plans to cope with increased demand for inpatient services should take into account the potential economic consequences of the forecasted changes as well as their effects on allocation of and access to services.

Racial congruity as a contextual correlate of mental disorder.

The effects of exposure to racially dissonant residential environments on depressive psychopathology are explored. Epidemiological survey data are shown to support the hypothesis that an inverse relationship exists between racial congruity and depression. Limitations of the analysis are discussed, as are the social implications of the findings.