The treatment of persons with dual diagnoses in a rural community

Mental Health Care Provision for Rural Elders

Rural mental health service resources and intervention approaches to meet the needs of rural elders are in a state of flux. Even within this fluctuation, some relatively stable and beneficial resources are available to rural elders and their families. This article identifies those resources within the context of the growing influence of managed behavioral health care. Systems of managed care are directing the types of mental health services available and their patterns of coordination with other health and social service resources used by rural elders.

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service.

Rural and urban similarities and differences in private substance abuse treatment centers

Although previous research has considered the unique treatment needs of rural residents, little research has investigated the potential differences in the availability of treatment services in rural and urban areas. Using three waves of longitudinal data from a nationally representative sample of privately-funded substance abuse treatment centers, this research compared rural and urban treatment centers with regard to the availability of clinical levels of care, the offering of specialty treatment tracks, the adoption of treatment innovations, and the average costs of care. Results indicate that rural and urban centers were similar in their increasing provision of inpatient psychiatric levels of care and their decreasing offering of more intensive levels of chemical dependency services between 1995 and 2001. Rural and urban centers were increasingly likely to offer specialty treatment tracks for women, adolescents, clients with HIV/AIDS, and relapsing clients over time, but rural centers were less likely to offer a treatment track tailored to substance-abusing women. The use of treatment innovations was similar at rural and urban treatment centers with the exception of lesser use of acupuncture at rural centers. Rural and urban centers did not differ in their average charges for treatment services.

Metropolitan-nonmetropolitan differences in amount and type of mental health treatment

This article examines the extent to which, conditional on receiving treatment, the type of care differs across metropolitan and nonmetropolitan areas. Using data from the Medical Expenditure Panel Survey (MEPS), the findings indicate that nonmetro residents who obtained mental health care (n = 2,381) have fewer mental health visits in a calendar year than their metro counterparts after adjusting for individual-level characteristics. Although observed rates of hospitalization and contact with physicians are higher in nonmetro areas than metro areas, this difference is attributable primarily to compositional differences between metro and nonmetro residents.

Gender-related concerns of rural women with severe and persistent mental illnesses

This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI.

Drug treatment experiences: rural and urban comparisons

This study sought to investigate treatment-seeking behaviors among drug users in rural populations and how they compare to their urban counterparts. Data for this analysis were drawn from the Miami and Immokalee sites of the National Institute on Drug Abuse's Cooperative Agreement Program for AIDS outreach/intervention research study targeting high-risk out-of-treatment injection drug users and crack smokers. Findings indicate that Miami subjects were 2.57 times more likely to have been in drug treatment compared to their rural counterparts. This differential may be explained in terms of the availability, accessibility, and acceptability of health care services.

Substance Abuse in Hawaii: Perspectives of Key Local Human Service Organizations

Available evidence suggests that substance abuse in Hawaii is a substantial problem. The three major objectives of this study were to determine qualitatively Hawaii's human service organizations' perspective regarding (1) the magnitude of the statewide substance abuse problem, (2) the unmet needs of the state's substance abuse treatment system, and (3) the features of the problem unique to Hawaii's many ethnic and other subgroups. The study targeted those human service organizations most burdened by the substance abuse problem. Respondents from 55 human service organizations were interviewed using a series of 21 open-ended questions. Respondents perceived the magnitude of the Hawaii substance abuse problem to be at least comparable to that of the mainland United States. Although most respondents viewed the problem using a medical model, the problem was generally thought to be exacerbated by a community context in which substance abuse is accepted, excused, or denied. Increasing use of crystal methamphetamine and heroin were cited as the most worrisome trends. Systems issues identified were unstable funding, insufficient detoxification services, and limited availability of residential treatment and supportive services following treatment, such as housing and aftercare. Service delivery problems frequently associated with rural areas were identified, such as transportation, staff development, outreach, and difficulty providing a full range of services, particularly on neighbor islands. Cultural alienation, exacerbated by the state's prevailing multiculturalism, was thought to contribute to the substance abuse problem among all ethnic groups, but especially among Native Hawaiians. Cultural factors were thought to have a major impact on seeking care and subsequent acceptance of such care. Further study is needed to understand better the content of care, therapeutic elements, and efficacy of culturally specific treatment and prevention programs. To initiate change, concerted efforts are needed to inform Hawaii residents about the statewide substance abuse problem and local treatment system needs. Future studies should compare human service organization perceptions to those of individuals abusing substances and using these services.