Patterns of rural mental health care. An exploratory study

In rural areas, it is important to clarify our understanding of how primary care and specialty mental health professionals organize care for those with mental disorders, and the role that linkages between specialty mental health and primary health care providers can play in the effectiveness of such care. Although these are issues that must be generally addressed, in rural areas fewer institutional and individual providers per capita accentuate problems of health care organization and delivery. This paper reports findings from an exploratory study of service use in two primary care sites in a rural, group-model HMO (Site A enrollment = 2,625; Site B = 6,019). We found that patients in the primary care site who had weaker mental health consultative linkages, higher rurality, and less availability of mental health specialty care used more mental health services by primary care providers (RR = 5.19 (3.78,6.61)), received more ambulatory care from joint mental health/ primary care providers (RR = 1.68 (1.02,2.78)), and had more mental health hospital utilization (adjusted OR = 1.84 (0.54,6.23)). These findings point to the need for further study of primary care providers and their linkage relationships in rural areas, in this large and currently often underserved population.