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Nportno DHEW-HSM-73-9035 PUB DATE Aug 73 NOTE 184P DOCUMENT RESUME ED 086 421 RC 007 572 AUTHOR Yahraes Herbert; And Others TITLE The Mental Health of Rural America: The Rural Programs of the National Institute of Mental Health. INSTITUTION Nation41 Inst. of Mental Health (DREW), 'Rockville, Md. nPORTNO DHEW-HSM-73-9035 PUB DATE Aug 73 NOTE 184p. AVAILABLE FROM Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 (Stock No. 1724-00297; $1.85) EDRS PRICE MF-$0.65 HC-$6.58 DESCRIPTORS Alcoholism; American Indians; Attitudes; Community Programs; Experimental Programs; *Federal Programs; Hospitals; Manpower Development; *Mental Health; Mental Health Clinics; *Mental Illness; Minority Groups; *Reports; Rpsearch; *Rural Population; Services; State Programs; Suicide; Urbanization ABSTRACT Prepared by the National Institute of Mental Health staff and grantees, this report gives not only the quantitative research data, but also demonstrations of community .mental health efforts that serve as excellent models for other communities to follow. Chapter I presents An Introduction: The Setting and an Overview; Chapter II, Studies of Rural Life and Mental Health: epidemiological and demographic studies, the attitudes of rural delinquents and rural suicide rates. Chapter III, New Approaches to Rural Mental Health Service, covers closing the gap between hospital and community, and mobilizing and strengthening community resonrccs, while Chapter IV, Community Mental Health Centers in Rural America, details these centers, staffing, financing, transportation, and regional differences. Chapter V, Rural Mental Health Centers: Five Case Histories, centers on Appalachia, the Northeast Kingdom (Vermont), Aroostook County (Maine), Down East (Maine), and Prarie View (Kansas). Chapter VI, State Hospitals with Rural Patients, presents the Hospital Improvement Program and grants for Hospital Staff Development; Chapter VII, Supplying the Manpower, discusses continuing education and experimental and special training programs. Chapter VIII presents the summary and "a quick look ahead". (KM) I (NJ U S DEPARTMENT OF HEALTH. EDUCAT:ON & WELFARE NATIONAL INSTITUTE OF EDUCATION 1 4-.0 THIS DOCUMENT HAS BEEN REPRO DUCE° EXACTLY AS RECEIVED FROM . co THE PERSON OR ORGANIZATION ORIGIN ATING IT POINTS OF VIEW OR OPINIONS C.) STATED DO NOT NECESSARILY REPRE SENT OFFICIAL NATIONAL INSTITUTE OF w EDUCATION POSITION OR POLICY THE MENTAL HEALTH OFRURAL AMERICA The Rural Programs of The National Institute of Mental Health Julius Segal, Ph.D., Editor Author: Herbert Yahraes with Emily Barron Mary Camp Helen Fussell Program Analysis and Reports Branch Office of Program Planning and Evaluation Alcohol, Drug Abuse, and Mental Health Administration r`d) 5600 Fishers Lane 1.r) Rockville, Maryland 20852 August 1973 C) DHEW Publication No. (HSM) 73-9035 Printed 1973 For sale by the Superintendent of Documents, U.S. Government Printing Office. Washington. D.C. 20402Price: $1.85(paper) Stock Number 1724-00297 t FOREWORD In 1969, the National Institute of Mental Health published a report on The Mental Health of Urban America, describing the major programs of the Institute focusing on urban populations. That report served its purposes well. They were to proilide an overview of the Institute's aims and efforts in dealing with the mental health problems of our cities ; to make clear the Institute's role in the broad collaborative effort necessary to improve the quality of our urban life ; and to demonstrate through examples how agencies and communities can move to meet problems of urban mental health. This companion report stares the same aims with respect to the NIMH's rural programs. The beauty of the countryside and the satisfactions of rural life have been sung with good reason, as one can see even today when many farmers have been forced off the land, when dirt lanes have become asphalt roads, and when the livelihood of many rural families depends upon the encroaching factory. Almost anywhere in America a person who goes into a rural county with mind open and senses alert will perceive a different and deeper kind of beauty than that to be experienced in the city. But the longer a visitor remains, the more he is likely to be impressed not only by the loveliness of the surroundings but also by the misery of many of those living among them. He may find that rural regions are afflicted with numerous problems usually associated in the public mind with life in the inner cities. He may come to know, firsthand, families crow:ed into shanties, old trail- ers, or other inadequate quarters, without plumbing and perhaps without even a water supply; families who have to make long trips to the welfare office ; homeless, in-and-out-of-jail alcoholics as well as alcoholics with good homes they seem bent on trying to destroy ; anguished parents of children who are retarded, or disturbed, or delinquent; and the troubled faces or unreasonable behavior of other persons in need of psychiatric help. For the truth is that the troubles of our urban population get a preponderance of attention from journalists and sociologists rightly so in view of the number of people involvedbut the troubles of our rural population are generally similar and in some cases proportionately worse. For example, poverty, often a factor iii in both physical and mental illness, is significantly more exten- sive in rural than in urban America. An even greater disparity between city and country lies in the ability of these areas to handle problems of mental health ; while the shortage of mental health personnel and facilities is nationwide, it is particularly severe in our rural arms. In a great many rural communities, nevertheless, the interested visitor will also find a growing awareness of mental health prob- lems, a widening realization that they are both treatable and, often, preventable, and an increas" lg determination to develop the needed services. By describing the pioneering efforts in a number of these communities made with NIMH encouragement and support, in collaboration with local or State groups and often with other Federal agenciesthis report not only demonstrates what is being done but also suggests what can and should be done to meet the mental health problems of rural America. BERTRAM S. BROWN, M.D. Director National Institute of Mental Health iv PREFACE This report draws upon the work of a sizeable number of NIMH staff members and grantees working in behalf of the Institute's research, training, and service r..rograms. The report demonstes how the varied activities of the Institute are brought to bear on a single pressing problem involving a broad segment of American society. Reported here are not only quantitative research data but also demonstrations of community mental health efforts that serve as excellent models for other communities to follow. Because the report was developed over a period of many months, some of the work presented nere as in process may in fact have been completed, and newer projects in the area of rural mental health started. But the original purpose of the report continues to be served: to demonstrate the kind and the range of rural mental health activities in which the Institute is involved. This retort was prepared by NIMH's Program Analysis and Reports Branch, collaborating with those segments of the Institute whose specific programs are described. In the preparation of this volume, Dorothea L. Dolan, Special Assistant for Rural Mental Health, Division of Mental Health Services Programs, provided invaluable guidance. JULIUS SEGAL, Ph.D. Chief, Program Analysis and Reports Branch CONTENTS Page FOREWORD iii PREFACE CHAPTER I. INTRODUCTION: THE SETTING AND AN OVERVIEW 1 CHAPTER II. STUDIES OF RURAL LIFE AND MEN- TAL HEALTH 9 EPIDEMIOLOGICAL AND DEMOGRAPHIC STUDIES. 9 Mental Health in Three North Carolina Counties 10 Surveys in Florida and Illinois . ... 11 State Hospital Patients in a Great Plains State 12 The Road to the Hospital 14 Social Stress and Mental Illness. 14 THE ATTITUDES OF RTJRAL PEOPLE . 14 People of Two Counties Ask for Services . 15 An Accepting AttitudeAnd Also Prejudice 16 Guides for Mental Health Programs 18 Differences Between Generations. 19 Rural vs. Urban Day Hospital Patients 19 Progress and a Continuing Need. 21 STUDIES OF URBANIZATION . .. 22 Sudden Industrialization of a Rural Area 22 Rural-to-Urban Migrants 23 STUDIES OF AMERICAN INDIANS 24 Educational Problems 24 Prescription for the Schools 26 Th Decisionmaking Process 27 Understanding Indian Medical Concepts 27 Indians and Alcohol . .. STUDIES OF RURAL DELINQUENTS . 29 School Failure Linked to Lawbreaking . 30 STUDIES OF RURAL SUICIDE RATES . 31 vii Page CHAPTER III. NEW APPROACHES TO RURAL MEN- TAL HEALTH SERVICE.. 35 CLOSING THE GAP BETWEEN HOSPITAL AND COMMUNITY 35 Providing Aftercare Services 36 Improving the Attitudes of Family and Community 37 Reaching Remote Areas Through a Team From the Hospital 38 MOBILIZING AND STRENGTHENING COMMUNITY RESOURCES 41 Testing a New Pattern of Service 41 Developing Services With the Help of Consultants 43 Psychiatric Consultation by TV.. 44 Nurses as Crisis Counselors . 45 Using Other "Natural Helpers" 47 Mobilizing Indian Resources Against Alcoholism. 48 CHAPTER IV. COMMUNITY MENTAL HEALTH CEN- TERS IN RURAL AMERICA . 49 Historical Roots of the Program 49 Rural Mental Health Centers . 50 Meeting Problems of Money. 51 Building a Staff . 52 The Problem of Distance 54 Serving the Community's Caregivers 55 Special Services 56 County, State, and Regional Differences 56 Evidence of Success CHAPTER V. RURAL MENTAL liEALTH CENTERS: FIVE CASE HISTORIES 61 APPALACHIA: MAKING MENTAL HEALTH MANPOWER Go AROUND 62 Services Through Area Teams . 63 The Use of Paraprofessionals . 64 Why the Mobile Team Approach Failed . 65 Making Do With a Part-Time Psychiatrist 65 Services for Children 66 Helping Mentally Retarded Personsand the Elderly 67 Alcoholism Program 67 The Eastern Kentucky Syndrome 68 People Served and Money Raised 69 NORTHEAST KINGDOM: A RICH VARIETY OF SERVICES. 70 Summary of Programs 71 History and Staff 73 Caring for Patients 74 viii Page Social Groups Volunteers and Citizen Participants .
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