REVIEWED BY MAGGIE ELEHWANY, J.D.
Rural Mental Health: Issues, Policies and Best Practices
Edited By K. Bryant Smalley, Ph.D., Psy.D., Jacob Warren, Ph.D. and Jackson P. Rainer, Ph.D.
Springer Publishing Company, 2012 392 pages; $65
Twenty percent of the population is scattered over 90 percent of the land mass. Geography, weather and cultural diversity can each negatively influence the delivery of health care. Accessing primary care in rural America can be exceedingly challenging; accessing mental health care can be prohibitively challenging.
Rural Mental Health: Issues, Policies, and Best Practices is a comprehensive delineation of the complex challenges of delivering mental health care in rural America. Moreover, it provides thoughtful insight on best practices for the unique specific populations of rural America as well as a practical guide to how to actually make a difference by engaging in policy advancement.
More than 85 percent of mental health professional shortage areas are in rural communities. The daunting shortage crisis can seem perpetual and hopeless, yet Rural Mental Health provides both commonsense and innovative guidance for finally tackling the severe provider shortages in rural areas, as well as overcoming the many cultural barriers also unique to rural areas. Its research-based data makes its policy recommendations powerful, timely and compelling to an audience that should be listening: federal policy makers.
Rural is not homogeneous; rural frontier is extraordinarily different from rural Kansas, which is different from rural Appalachia. The importance of this book is that it recognizes the extreme diversity among rural populations and that a one-size-fits-all approach to mental health care delivery is unworkable in rural American — even if we could fully provide such care. At the same time, the book unifies its approach to addressing the unique barriers of mental health delivery in rural communities because it recognizes the three re-occurring roadblocks in all of rural America: accessibility, availability and acceptability.
Rural Mental Health provides real solutions and best practices to overcome systemic shortages, engage communities and overcome the long-standing and pronounced stigmas of seeking mental health services in rural communities. Additionally, it confronts the issue of rural poverty, where uninsurance, underinsurance or lack of Medicaid acceptance further exacerbates mental health access. In the book's individual examination of the needs of sub-groups in rural populations, I found the focus on rural children and rural veterans especially poignant, offering clear solutions to some of our neediest and most vulnerable populations.
As a professional advocate for improved health delivery in rural areas, I found the book extraordinarily helpful in my Capitol Hill advocacy efforts. In a polarized political climate where legislation has been at a standstill for years, the recent severe tragedies of gun violence may provide a window of opportunity to finally gain a long overdue federal investment in mental health. If Congress does act, it is critical that rural areas not be left behind. It is critical that Congress draft legislation that addresses the many barriers to rural mental health delivery, as well as the great unmet needs of its diverse population. This book is an excellent resource and guide for Congress. I hope Congress heeds its advice.
MAGGIE ELEHWANY is vice president of government affairs and policy, National Rural Health Association, Washington, D.C.