Frontier ethics: Mental health care needs and ethical dilemmas in rural communities

Citation
Lw. Roberts et al., Frontier ethics: Mental health care needs and ethical dilemmas in rural communities, PSYCH SERV, 50(4), 1999, pp. 497-503
Citations number
50
Categorie Soggetti
Psychiatry,"Clinical Psycology & Psychiatry
Journal title
PSYCHIATRIC SERVICES
ISSN journal
10752730 → ACNP
Volume
50
Issue
4
Year of publication
1999
Pages
497 - 503
Database
ISI
SICI code
1075-2730(199904)50:4<497:FEMHCN>2.0.ZU;2-9
Abstract
Roughly 15 million of the 62 million rural U.S. residents struggle with men tal illness and substance abuse. These rural dwellers have significant heal th care needs but commonly experience obstacles to obtaining adequate psych iatric services. Important but little-recognized ethical dilemmas also affe ct rural mental health care delivery. Six attributes of isolated settings w ith limited resources appear to intensify these ethical dilemmas: overlappi ng relationships, conflicting roles, and altered therapeutic boundaries bet ween caregivers, patients, and families; challenges in preserving patient c onfidentiality; heightened cultural dimensions of mental health care; "gene ralist" care and multidisciplinary team issues; limited resources for consu ltation about clinical ethics; and greater stresses experienced by rural ca regivers. The authors describe these features of rural mental health care a nd provide vignettes illustrating dilemmas encountered in the predominantly rural and frontier states of Alaska and New Mexico. They also outline cons tructive approaches to rural ethical dilemmas in mental health care.