Provided by the National Institute of Mental Health
The nearly 60 million Americans living in rural
and frontier areas have the same kinds of mental health problems and needs for
services as individuals who live in urban and suburban areas. Among rural
populations, the prevalence of mental illness, substance abuse and disability
due to these problems is equal to or greater than in urban populations.
Yet, rural areas have unique characteristics that present barriers to mental
health care. Access to and availability of mental health specialists, such as
psychiatrists, psychologists, psychiatric nurses and social workers, are
seriously lacking. Poverty, geographic isolation and cultural differences
further hinder the amount and quality of mental health care available to people
in rural areas.
More than 800 rural counties have high poverty rates, but only 25 percent of
people living in rural areas qualify for Medicaid—compared to 43 percent in
urban areas. Women head 46 percent of rural households, and of these families,
27 percent are living below the poverty level, compared to 9 percent of
male-headed rural families. The elderly are disproportionately represented in
rural areas. Many residents of remote rural areas who suffer from mental
illnesses do not seek care. As in urban areas, people do not seek care in part
because of the stigma associated with mental illness, lack of understanding
about mental illnesses and their treatments, lack of information about where to
go for treatment, and the inability to pay for care.
Of those people living in rural areas who do seek mental health services, a
large percentage go to primary care physicians who may lack the training, time,
and resources to diagnose and treat mental illnesses effectively.
Cost of services is a major barrier. Many of the newer psychoactive medications
are very expensive. Although rural residents have comparable rates of insurance,
they have less comprehensive coverage. Thus, of those people who have medical
insurance, many lack insurance coverage for psychotherapy—even if they can find
a therapist in their area. And treatment combining medication and psychotherapy
is usually not an option for people in rural areas.
Lack of quality inpatient care for severely mentally ill people is another
serious problem in rural areas. These patients often must obtain care in
hospitals that are located far from family and friends, or they are hospitalized
in general medical settings where no psychiatric consultation is available. Once
discharged back into the community, there are limited psychosocial
rehabilitation services available and thus patients are often re-hospitalized at
a very high cost compared to outpatient care.
NIMH is funding research on how to improve access to quality mental health
services for people living in rural and frontier areas. Projects include
research to determine whether the use of interactive electronic
communications—telemedicine—to diagnose and treat mental disorders is as
effective as face-to-face encounters in diagnosing and treating mental
illnesses, and studies on how to enhance the quality of mental health care
provided by/through rural primary care physicians.
NIMH-funded studies are also currently assessing how best to approach the
longstanding and well-documented problem of access to culturally sensitive,
high-quality mental health care on Indian reservations. Additional avenues of
research are being proposed through NIMH-sponsored meetings of rural and
frontier mental health experts.
Meeting in Alaska
The NIMH convened a meeting entitled "Mental Health at the Frontier: Alaska" on
August 10-11, 1999, in Anchorage, Alaska. The meeting was preceded by meetings
and consultations, and by trips of researchers. Among the towns and villages
visited were Kotzebue and Selawik above the Arctic Circle, and Bethel and
Kwethluk in the Yukon-Kuskokwim Peninsula. "We wanted our meeting to reflect the
real lives of people who live in frontier Alaska," noted NIMH Director, Dr.
Steven Hyman. The trips provided a first hand look at the provision of mental
health services in the Alaskan frontier and the living conditions of these
areas. Providers of health services are dependent on diverse modes of
transportation such as boats and bush planes to reach people who live in
sparsely settled areas of Alaska.
This conference was the fourth in an NIMH series on rural mental health research
and offered a grant-writing workshop, seminars on current mental health
research, breakout discussion groups and a town meeting designed for Alaskans to
give NIMH the benefit of their views as the Institute sets priorities for future
research efforts. It gave an opportunity for Alaskans to learn about recent NIMH
supported research findings and ways to access NIMH resources. Over 200 people
from a variety of backgrounds including consumers, family members, providers,
civic and state officials, and researchers attended the conference.
Dr. Grayson Norquist, Director of the NIMH Office of Rural Mental Health
Research, has noted that Alaskans have responded to the meeting by continuing to
build a research infrastructure and to assess their needs and develop
appropriate services. Many of the problems identified in Alaska are similar to
those found in the lower 48 States.
Rural Mental Health Meeting
The 26th Annual Conference of the National Association for Rural Mental Health (NARMH),
was held August 3-6, 2000, in Portland, Oregon with NIMH in active attendance.
Over 200 providers, consumers, researchers, and mental health administrators
attended the conference. The mission of NARMH is to develop, enhance, and
support mental health services and providers in rural and frontier areas. NIMH
co-sponsored a day-long session on telemedicine for rural and frontier
populations. NIMH also sponsored two focus groups of rural mental health
providers to discuss issues facing rural practitioners, including barriers to
delivering high-quality, effective care, what might be done to address such
barriers, and how the NIMH can be responsive to the needs and concerns of rural
mental health professionals.
The Broad NIMH Research Program
In addition to rural mental health, NIMH supports and conducts a broad based,
multi-disciplinary program of scientific inquiry aimed at improving the
diagnosis, prevention, and treatment of other mental disorders. These illnesses
include schizophrenia, bipolar disorder, clinical depression, panic disorder,
and obsessive-compulsive disorder.
Increasingly, the public as well as health care professionals are recognizing
these disorders as real and treatable medical illnesses of the brain. Still,
more research is needed to examine in greater depth the relationships among
genetic, behavioral, developmental, social, and other factors to find the causes
of these illnesses. NIMH is meeting this need through a series of research
initiatives.
NIMH Human Genetics Initiative
This project has compiled the world's largest registry of families affected by
schizophrenia, bipolar disorder, and Alzheimer's disease. Scientists are able to
examine the genetic material of these family members with the aim of pinpointing
genes involved in the diseases.
Human Brain Project
This multi-agency effort is using state-of-the-art computer science technologies
to organize the immense amount of data being generated through neuroscience and
related disciplines, and to make this information readily accessible for
simultaneous study by interested researchers.
Prevention Research Initiative
Prevention efforts seek to understand the development and expression of mental
illness throughout life so that appropriate interventions can be found and
applied at multiple points during the course of illness. Recent advances in
biomedical, behavioral, and cognitive sciences have led NIMH to formulate a new
plan that joins these sciences to prevention efforts.
While the definition of prevention will broaden, the aims of research will
become more precise and targeted.
More Than 2,000 Grants and Contracts
In total, NIMH supports more than 2,000 research grants and contracts at
universities and other institutions across the nation and overseas. It also
conducts basic research and clinical studies involving 9,000 patient visits per
year at its own facilities on the National Institutes of Health campus in
Bethesda, MD, and elsewhere. NIMH research projects focus on:
basic research on behavior, emotion, and cognition to provide a knowledge base
for a better understanding of mental illnesses
basic sciences, including cellular and molecular biology, developmental neuro-biology,
neurochemistry, neurogenetics, and neuropharmacology, to provide essential
information about the anatomical and chemical basis of brain function and brain
disorders
neuroscience and behavioral aspects of acquired immune deficiency syndrome
(AIDS) and behavioral strategies to reduce the spread of HIV (human
immunodeficiency virus)
interventions to treat, prevent, and reduce the frequency of mental disorders
and their disabling consequences
mental health services research, including mental health economics and improved
methods of services delivery
comorbidity among mental disorders and with substance abuse and other medical
conditions, such as depression and heart disease
the prevalence of mental disorders
risk factors for mental disorders
differences in mental health and mental illness among special populations
children and adolescents who suffer from or who are at risk for serious mental
disorders and learning disabilities
psychotherapies and pharmacotherapies for specific disorders
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NIMH Intramural Research Program
The NIMH Division of Intramural Research Programs (DIRP) encompasses a broad
array of research activities that range from clinical investigation into the
diagnosis, treatment and prevention of mental illness to basic neuroscience
studies conducted at the behavioral, systems, cellular, and molecular levels.
DIRP is composed of more than 500 scientists working in 22 clinical branches and
basic research laboratories, as well as four free-standing specialized research
groups. Intramural research is conducted under the leadership of the Office of
the Scientific Director.
NIMH Research Divisions
Division of Neuroscience and Basic Behavioral Science
Division of Services and Intervention Research
Division of Mental Disorders, Behavioral Research and AIDS
Division of Intramural Research Programs
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At the beginning of the 21st century, NIMH stands poised to surmount the burden,
loss, and tragedy of mental illnesses that afflict millions of Americans.
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