Providing mental health services to older people living in rural communities

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional wellbeing and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.     

Chapter 17. Rural Mental Health

SUMMARY

Mental health services available in many rural communities are too limited in scope and availability to meet the needs of rural citizens. The future of mental health services for the rural poor will be impacted by state government decisions about Medicaid funding priorities. It is important that rural practitioners, especially those that work in the fields of mental health, health, and aging services, engage in advocacy for better coverage of the rural poor and low-income elderly persons. This chapter discusses issues of advocacy related to improving the provision of mental health services to older rural citizens as an important goal in the larger effort to expand and improve rural mental health service delivery throughout the nation.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

Intimate Partner Violence Survivors’ Unmet Social Service Needs

ABSTRACT

Women who have experienced intimate partner violence (IPV) victimization are at risk for physical and mental health problems, as well as social and economic challenges. In this cross-sectional study, 173 adult, English-speaking women who had experienced police response to IPV completed a self-report questionnaire about their use of, interest in, and need for various social services and whether or not each type of service helped (or would help) them to feel safer. More than three quarters of the participants reported a current need for health and economic support services. There was less interest in traditional IPV resources: law enforcement and domestic violence counseling or shelter. Expanding services to meet survivors’ needs for health care and economic independence may facilitate long-term safety. Recommendations for further research in this area are provided.     

Mental Health Service Utilization Among Frail,Low-Income Elders

Abstract

This study was conducted to determine the extent to which service providers in a community-based care program accurately identified and referred elders with symptoms of depression. Interviews were conducted with 79 frail, low-income elders, with the CES-D used to gauge depressive symptomatology. Reviews of their case files were then conducted to determine first, the extent to which case managers recognized depressive symptoms and second, the extent to which respondents who screened with significant symptoms were referred for mental health services. Results suggest an imperfect association between CES-D scores and case managers' perceptions and referrals. Less than 1/3 (31%) of those who screened for depression received counseling.     

Chapter 13. Rural Older Adults at Home

SUMMARY

In this chapter, we discuss circumstances that affect rural seniors living in their own homes. The strengths perspective informs this discussion, allowing the reader to consider several alternatives to the deficit-focused mentality that often pervades those who work with elders who are, sometimes, and perhaps stereotypically, regarded as frail. Issues unique to rural areas are addressed, programs that serve rural seniors are reviewed, and suggestions are made for the service provider working with this population.     

Revitalizing the Vision in Supervision: Supporting the Supervisor in Home-Based Therapy Programs

Home-based programs provide a growing number of mental health and case-management services to high-risk children, adolescents, and their families. The clinical service providers who work directly with these children and families have varying degrees of education and practice experience as well as a range of different supervisory needs. Because of the daily challenges service providers face, they require support from competent, available supervisors. The professionals who supervise them often assume that responsibility with limited, if any, training in providing supervision. New and experienced supervisors alike often find themselves in positions for which they are ill prepared, without suitable training or administrative support. This article describes a supervision seminar developed for supervisors who supervise the clinicians who provide home-based services. The seminar provides training, support, consultation, and other forms of assistance to help supervisors adapt their clinical skills for use in their supervisory roles.     

Rural African American Clergy: An Exploration of Their Attitudes and Knowledge of Alzheimer's Disease

Rural African American clergy's ability to recognize Alzheimer's Disease (AD) and their capacity to provide support to elders with this illness has been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore rural African American clergy knowledge and beliefs of AD. In-depth interviews were conducted with 9 African American clergy who oversaw churches in central Kentucky. Although few had direct experience with providing pastoral care to elders with AD, all clergy were literate and aware of the need for additional training. This study seeks to further clarify the role of African American clergy and their understanding of AD to inform the future development of appropriate interventions and establish better collaborative community treatment relationships.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Comfort and Confidence Levels of Health Care Professionals Providing Pediatric Palliative Care in the Intensive Care Unit

ABSTRACT

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

Experiencing breast cancer in the context of mental illness in New Zealand

ABSTRACT

This study aimed to explore the experiences of women with mental illness who had also experienced breast cancer diagnosis and treatment, in particular, to identify barriers and facilitators to cancer treatment. Semi-structured interviews were conducted with ten breast cancer survivors who had had contact with secondary mental health services prior to their cancer diagnosis. Thematic analysis was used to identify key themes. Participants described positive experiences of cancer treatment, expressing surprise at both how well they coped with diagnosis and treatment and how well they were treated by services. Many contrasted this with their less positive experience of mental illness and mental health services. The women interviewed were active participants in their cancer treatment and did not report feeling stigmatised because of their mental health experiences. A lack of connection between cancer and mental health services was described, but this was not regarded as necessarily a bad thing. This study begins to counter the stereotypes of the difficult patient or the person unable to understand and cooperate in their own care which are prevalent in the literature. Further work is needed to understand the reasons for disparities in cancer outcomes.     

Chapter 16. Future Training and Education Recommendations for Rural Gerontological Social Workers

SUMMARY

With the increasing number of older adults, social work students need to be prepared to work with this population in a variety of settings. Rural areas may have high concentrations of older adults including those who age-in-place, and those who relocate to retirement areas in small towns and rural communities. Within the curriculum, content on health care, economics, and leadership/decision making need to be included to prepare students for practice in these areas. In addition, programs need to actively seek students who have an interest in working within more rural practice settings.     

Navigating Housing Instability and Substance Use: Hidden Tensions Facing Youth in Small Town America

Abstract

Recent scholarship indicates that youth homelessness is a significant problem outside urban areas. However, previous studies have not examined how local contexts shape the experiences of youth who are homeless in rural areas and small towns with high rates of poverty and epidemic drug use. To address this gap, this analysis draws from two components of a large national study of homelessness among youth, using data collected in a small non-urban setting in the Northwest including (1) a subset of 41 (out of 215 nationally) in-depth interviews with youth and (2) a subset of 16 surveys (out of 523 nationally) with service providers. We explored availability of services and how youth navigate housing instability and the service landscape in small communities. We discovered that current or prior addictions sometimes posed risks to the safety of youth and compromised their ability to rely on family supports – a support proving critical in the absence of a formal service infrastructure. Our results suggest that youth experiencing housing instability in the context of high rates of drug use and limited formal services must often choose between meeting competing needs: a place to stay versus sobriety. We discuss the implications for policy, practice, and research.     

Poverty,Partner Abuse,and Women's Mental Health: New Knowledge for Better Practice

ABSTRACT.

To better understand how poverty and poor mental health impact women who are abused by intimate partners, a convenience sample of 300 abused women using shelters or justice services for the 1st time were interviewed. The 300 women were categorized as having no income, being above poverty, and being below poverty according to U.S. Poverty Guidelines. Results indicated that no direct effect of income on poor mental health was noted; however, an interaction between type and severity of abuse and income level had an impact on poor mental health. Abused women who were above poverty with the highest incomes reported the highest levels of depression in the presence of high physical and sexual abuse. In contrast, women reporting no income reported no significant effect of severity or type of abuse on depression scores. Women just above the poverty level who experienced severe abuse were at highest risk for mental health problems. Poverty impacts the mental health of abused women according to the degree of poverty and type and severity of abuse. More research is needed to specify programs to maximize the mental health functioning and economic solvency of abused women.     

Conceptualizing Age-Friendly Community Characteristics in a Sample of Urban Elders: An Exploratory Factor Analysis

Accurate conceptualization and measurement of age-friendly community characteristics would help to reduce barriers to documenting the effects on elders of interventions to create such communities. This article contributes to the measurement of age-friendly communities through an exploratory factor analysis of items reflecting an existing US Environmental Protection Agency policy framework. From a sample of urban elders (n?=?1,376), we identified 6 factors associated with demographic and health characteristics: access to business and leisure, social interaction, access to health care, neighborhood problems, social support, and community engagement. Future research should explore the effects of these factors across contexts and populations.     

The Elder Latino Population in Holyoke,MA

Abstract

Holyoke's elderly Latino population's needs, as well as their patterns of service utilization, were explored through detailed interviews of 13 individual elders and a focus group of an additional 10 participants. The research uncovered a gap in the web of resources available, with some services, such as medical care, functioning well. However, there continue to be unmet needs, particularly in the areas of transportation, social and recreational activities, and sense of safety. Negative perceptions of aging and complaints of anxiety, depression, and boredom are also an area of concern.

The barriers to use of services were also explored. Recommendations for the enhanced provision and utilization of services, many suggested by the elders themselves, are offered. Implications for social work research and policy on, and practice with, Latino elders are discussed.