Management of mental disorders in rural primary care - A proposal for integrated psychosocial services

Mental health facilities and specialized providers are particularly lacking in rural areas. Even when these are available, poverty, negative attitudes toward mental health treatments, and traditional rural values of privacy a nd autonomy often result in low utilization rates. Consequently, most menta l health care in rural America is provided by primary care physicians who a re also faced with competing demands, including tensions among limited time and resources, the multiple and complex needs of patients, and economic fo rces determining reimbursements. We propose that in the best interest of ph ysicians and their patients, fully integrated psychosocial services in rura l primary care settings would reduce the burden of time-consuming mental he alth care, conform to patient preference for immediate on-site care, reduce non productive medical care use, and eliminate duplication of effort by ph ysicians and mental health professionals. The treatment model we propose wo uld provide multiple arenas for psychosocial intervention - with the indivi dual, the family, and the community - based on the patient's self-identifie d needs. The integration of psychosocial services within primary rural care is readily available, economically feasible, and urgently needed, but phys icians must take the lead to implement this collaborative treatment partner ship.