Rural Mental Health and ACI’s Efforts to Serve
By James Kwasneski, MSW
Case Manager Supervisor
Gadsden County Outpatient
The provision of outpatient services to rural populations is a significant challenge and area of opportunity for Apalachee Center. Since the passage of the Community Mental Health Act of 1963 (CMHA), federal funds have been allocated for development of outpatient clinics in rural areas of the United States (National Association for Rural Mental Health, 1997 [NARMH]). Often, outpatient clinics are satellites of a larger community mental health provider such as our agency and are funded by Medicaid and other forms of payment (1997).
In many rural areas, there is a gap between client treatment needs and availability of mental health services. Even when services are available, stigma and lack of mental health education/awareness are problematic. In small communities, most people know each other and may ostracize individuals who suffer from psychiatric and/or substance abuse problems. People who are diagnosed may be labeled as “crazy” or “dangerous” and made to feel isolated from their community. In addition, issues such as lack of financial resources, racism, lack of public and commercial health resources, lack of insurance coverage, transportation deficits, and other psychosocial problems limit participation in outpatient attendance. According to the NARMH (2006), “Rural areas (areas characterized by low population density, limited and fragile economic base, cultural diversity, high level of poverty, limited access to cities) have incidents of serious mental and behavioral health problems(depression, suicide, alcohol and substance abuse) equal to or greater than urban areas.”
Solutions to barriers in rural mental health have been put into practice by Apalachee for the past few decades. Apalachee originated with services in Leon County but now provides outpatient services to the surrounding counties (Gadsden, Madison, Wakulla, Jefferson, Taylor, Liberty, and Franklin) that are predominantly rural. Every day, our agency provides case management, psychiatric services, therapy, day treatment, and other valuable services to rural populations. Currently, Apalachee plans to expand on these services through integrated health to address physical health concerns within rural communities. In addition to service provision, it has been crucial for Apalachee to earn the trust of community leaders, local governments, and law enforcement in order to enhance our ability to serve clients in rural areas. Although we face many challenges, the compassion and efforts of our staff and leadership will continue to work towards improving rural mental health.