Implications of health care reform for rural mental health services

New York State case manager survey: urban and rural differences in job activities, job stress, and job satisfaction

The impact of stress in the workplace on employees' well-being and effectiveness has been increasingly recognized in recent years. The purpose of this research was to study the quality of working life of case managers in urban and rural community mental health programs in New York State. The objectives were to describe specific job activities and examine differences in the perceptions of job stress and job satisfaction. Urban case managers attributed greater job stress intensity and frequency than did rural workers to stressors relating to collaborating and coordinating services. Urban case managers reported higher levels of perceived job stress due to organizational support deficits than did rural workers. No differences were found for the 2 groups on job pressure stressors. The significance of the findings for mental health agencies is discussed.

Rural mental health coverage under health care reform

Efforts to integrate services and financing under health care reform hold benefits for provision of services to rural mentally ill persons. Remote areas pose a particular challenge as the unique characteristics of rural America are even more evident. The model for managed care in remote rural areas will differ from those used in urban and their adjacent rural areas. Universal coverage would remove the barriers to accessing care for this population, but does not assure availability of adequate mental health services are or providers in rural areas. Characteristics of currently available rural mental health services are presented and obstacles to expanded delivery under health care reform are outlined.