Rural communities face the twin burden of higher need and lower resources. Rural residents are more likely to be poor, uninsured, unemployed, have lower education, experience more chronic health conditions, engage in high-risk health behaviors, and live shorter lives than their urban counterparts. And yet, many of the rural counties in the US have extremely limited access to mental health care. When rural residents do find care, they are more likely to be treated in primary care settings that oftentimes struggle to provide effective mental health care and rarely offer treatments other than medication.
The AIMS Center recently completed a five year initiative designed to increase access and quality of depression treatment in rural community clinics by implementing Collaborative Care, an evidence-based approach to mental health treatment in primary care pioneered by our department nearly twenty five years ago. Collaborative Care adds two mental health professionals to the rural primary care team – a care manager (onsite in this study) and a psychiatric expert (remote in this study). This approach efficiently uses scarce mental health professionals, and allows most patients to receive expert-informed care even though they do not see the psychiatric expert directly. The project was primarily funded through a public-private partnership between The John A. Hartford Foundation and the federal Corporation for National and Community Service (Social Innovation Fund). Additional philanthropic and government funders included the Margaret A. Cargill Foundation, Helmsley Charitable Trust, Rasmussen Foundation and Lewis County Commissioners.
The first goal of the initiative was to increase access to care by providing Collaborative Care to 3,250 patients at eight rural community clinics over two and a half years. The clinics surpassed this goal and provided depression treatment to 5,392 patients. In rural areas this represents a significant group of depressed patients who otherwise were unlikely to receive care. One patient said, “It was amazing because I didn’t know how sick I was.”
The second goal of the initiative was to increase quality of depression care at participating clinics. This was measured, in part, as the proportion of patients achieving a response to treatment (50% or greater reduction in depression symptoms). On average, nearly 50% of patients treated with Collaborative Care at participating clinics had a response to treatment. This is more than double the number who respond to usual treatment in primary care (20%).
“The effects have been much more widespread than simply improving care of our behavioral health patients,” said a primary care provider at one of the clinics. I feel like it has benefited the entire organization, made us more effective in teams, more focused on measurement, and more interested in improving quality.”
Department faculty and staff who made significant contributions to the success of this initiative include Heather Wilcox, Julianne Salisbury, and Tess Grover (program support), Pam Collins (finance and administration), Mary Pyper (program support and travel), Mindy Vredevoogd and Mary Ann Barnard (evaluation), Anna Ratzliff, MD, PhD, and Alan Gojdics, MEd (training), and Jürgen Unützer, MD, MPH, MA, and Diane Powers, MA, MBA (program leadership).
