A Surveyof RuralCommunityMentalHealth NeedsandResources BORIS GERTZ, PH.D. Project Director
JILL MEIDER, R,N., M.S. Senior Instructor
MARGARET L. PLUCKHAN, R.N., PH.D. Senior Instructor Continuing Education in Mental Health Project Department of Staff Development Fort Logan Mental Health Center Denver, Colorado The authors conducted a survey of 215 rural commu nity mental health centers across the country to deter mine their unique problems, needs, and resources. From the 92 responses they received, they formulated a composite description of the rural mental health scene. Their description focuses on services offered, skills re quired to operate effective rural programs, and prob lems in the delivery of care and of evaluation. From the responses they also analyzed the extent of inservice training available to rural practitioners, the support sys tems needed, and the functions a proposed national task force on rural mental health could perform. •¿Inorder to get a clear picture of the mental health cane system in rural areas and to identify the problems mental health practitioners face in those areas, we de veloped a questionnaire to be sent to rural mental health centers across the country. The questionnaires were mailed in 1974 to representatives of the 215 agencies listed in the Directory of Rural Mental Health Centers and Their Satellites.' We received 92 nespon ses, a return nate of 42 pen cent, from 88 agencies in 37 states. From those responses, we formulated a compos ite description of the mental health picture in rural America. In answer to a question about what programs the various agencies offered, the majority of respondents identified the five required activities of community mental health centers: inpatient services, outpatient Dr. Gertzs mailing address at the center is 3520 West Oxford Ave nue, Denver, Colorado 80326. 1 D.
L.
Dolan,
ville, Maryland,
816
editor,
Nationa,l
Institute
of
Mental
Health,
Rock.
1973.
HOSPITAL
& COMM UNITY
PSYCHIATRY
services, partial hospitalization, consultation and educa tion, and emergency services. Drug and alcoholism pro grams were most frequently mentioned as special serv ices offered . Children' s services, marital counseling, and mental retardation programs were often cited. A few of the more novel programs listed were pre natal specialty services, learning-community work shops, training sessions in mental health for new police officers, training programs for Native Americans that included the use of medicine men as consultants, and juvenile court consultation. One agency utilized the services of three educators to help teachers in 12 local schools deal with problem children through behavior modification techniques. Outpatient programs were mentioned frequently as the most effective pnogram& and as the ones that reached the greatest number of clients. The prefenence for outpatient care was exemplified by one Wisconsin respondent who reported that he derived great pleasure from keeping people out of the hospital. In ten years his agency had gone from using 250 hospital beds to using 20 beds, and he anticipated eliminating the last 20 beds within the next few years. Outreach on satellite pro grams for aftercane in outlying areas were acknowl edged as effective means of reducing neadmissions to inpatient facilities. Providing consultation and educa tion programs to welfare departments, health agencies, and schools were identified as effective programs. Almost all agencies reported serving a wide geogra phic area, often with very limited staff. For example, at one clinic 11 paraprofessionals are responsible for main taming crisis stations in an 8600-square-mile territory; another clinic covers a 6104-square-mile area with 30 satellite locations in ten counties.
SKILLS REQUIRED BY STAFF The questionnaire recipients were asked what staff skills were required to operate effective programs. That par ticulan question was intended to provide insight into the training and continuing-education needs of pnofes sionals and parapnofessionals. The responses were cate gorized into four sections: academic qualifications and preparation, personal qualities, general abilities, and requirements unique to a rural setting.
Academic preparation in the disciplines of psychol ogy, psychiatry, nursing, social work, and anthropology were listed. Skills in individual and group counseling and psychotherapy, together with a knowledge of corn munity resources, were considered beneficial. Expe rience in child psychology, family therapy, testing, be havioral-management techniques, together with diagnostic, medical, and bilingual skills, were also re garded as important. The personal qualities most frequently listed as desir able were good communications skills and the ability to function independently and to have good interpersonal relationships. Other qualities listed were the ability to relate to minority groups and youths; to work with community organizations such as churches, schools, and granges; to tolerate isolation while still remaining visible to the community; and to develop trust and a sense of helpfulness. Also considered to be necessary staff attributes were the potential for creativity, innovation, and flexibility in order to function effectively with limited resources. Desirable general abilities included skills in teaching, consultation, public relations, management, and prob lem-solving. Sensitivity to signs of social change and the ability to understand networks of social interaction in the community were also cited. It was also consid ered important for staff to be able to do social planning and community organizing and to work with advisory councils from the community. It is apparent from the responses that the uniqueness of the rural setting requires special skills and qualities of staff members. A number of respondents identified a knowledge of rural politics and power structures and the ability to develop informal patterns of commu nication with key community officials as essential to effective staff functioning. The importance of recogniz ing informal pressure groups that exert control in the community was also listed. Other necessary special skills and qualities included familiarity and empathy with the particular cultures, socioeconomic levels, val ues, and mores of the rural residents. Sensitivity to the community process and flexibility in adjusting program schedules to accommodate competing activities were also important. Acceptance of the conservative rural ethic was consid ered to be another desirable staff attribute. Essentially, the staff are expected to become integrated into small town cultural patterns. In light of that requirement, it is interesting to speculate whether a staff member reared in a small community or a rural setting might have a greater chance of success than one who has had little or no prior exposure to a rural area. Staff were also expected to have a grasp of the de mographic characteristics of the area they serve. State and local surveys can provide information on employ ment rates, extent of poverty, income levels, occupa tional diversity, and the distribution of minority and elderly populations. Such data are essential in estab lishing a mental health program that is truly responsive to community needs, and they play a central role in the
Mostrespondents
identifieda lackof adequate resources
specificallymanpower andmoney—as the majorproblem in the delivery of servicesto a ruralcommunity. development of a state master plan for mental health care. For example, in Colorado the projected industrial and population growth resulting from impending oil shale development may very well dictate changes in life styles that could affect the mental health of the resi dents. Since alleviating local suspicions about mental health programs is an essential part of effective service deliv ery, it was not surprising to find respondents suggesting that partnership models between professionals and the public be established. It was also frequently suggested that mental health terminology be translated into lan guage understandable to the local population and that programs be advertised in a nonjudgmental and non threatening manner. DELIVERY OF SERVICE Most respondents identified a lack of adequate re sources as the major problem in delivery of services to a rural community. That lack was specified either as a shortage of manpower, particularly young professionals willing to work in rural areas, or as a lack of sufficient money, especially funds needed to operate costly out reach programs. A few respondents mentioned the need for additional referral sources and physical facilities. The next most frequently mentioned problem was geography. Distance and population dispersal were identified as major impediments to maintaining conti nuity of care and adequate distribution of services through outreach efforts. Both the energy crisis and weather were cited as critical variables in delivery of services. Also, lack of adequate public transportation systems was often listed as causing difficulties in getting clients to the centers. The third most frequently identified problem was entry of the mental health system into the community. The respondents indicated that community acceptance was inhibited by general public attitudes toward men tal illness, superstitions, labeling, and the stigma associ ated with being a patient. The difficulty of maintaining confidentiality in a small-town setting was also listed. One respondent reported that when his patients walk into the mental health center, they feel as though every one in town sees them.
VOLUME 26 NUMBER 12 DECEMBER 1975
817
One previous survey of community attitudes toward mental health resources indicates that some staff pen ceptions may be false. Bentz, Edgerton, and Hollisten surveyed the attitudes of 418 leaders in two counties in rural North Carolina and found little or no stnong nega tive feelings toward mental hospitals and psychiatrists, in contrast to the findings of an earlier national survey of public attitudes. In fact, the leaders showed an ac cepting attitude toward medical and psychiatric re sources. The results further indicated that attitudes of defeatism and pessimism about the potential for an eventual cure for mental illness appear to be dimin ishing.' More positive attitudes and a greaten commu nity understanding of the role of mental health centers could be fostered by community education pnognams, which are now nonexistent in many areas. Such educa tion programs could communicate the centers' role, pro gram, and services to the public and, in general, make the center more visible to the community. Staff resistance to agency changes was also cited as a problem area. A lack of effective planning and priority setting, along with conflicting expectations of state and local agencies, was also listed as a problem.
EVALUATION AND TRAINING Program objectives and goals can usually be developed with relative ease, but identifying appropriate criteria for evaluation of programs is far more difficult. Only a few respondents reported no particular problems with evaluation. Most said they needed to find a corn pnehensive, measurable, and easy evaluation system. Inadequate clinical staff to do careful evaluation was a major concern. In several instances, lack of interest, poor cooperation, and inertia were cited as reasons for a lack
of evaluation
efforts.
One respondent reported that his staff were either unwilling on unable to be objective and often resisted measuring their own effectiveness. Another problem cited was that of securing consumer participation in evaluation. When consumer participation was enlisted, conflicts often arose between consumer and profes sional expectations of effectiveness. Responses indicated that most centers provide contin uing-education programs for their staff. Although 17 respondents said their agencies had no organized pro grams, 75 described a variety of training activities. Training sessions generally focus on clinically oriented treatment techniques, with emphasis on family and marital therapy, gestalt training, transactional analysis, suicide and crisis intervention, treatment of alcoholism and drug problems, child management, and group training techniques. Some centers use professionals from their own staffs to conduct the training, while others use outside consultants. Eleven of the 88 agencies sent staff out of state to attend conferences, 2 W.
K.
Bentz,
J.
W.
Edgerton,
and
W.
G.
Hollister,
ers' Perceptions of Mental Illness,― Hospital chiatry, Vol. 22, May 1971, pp. 143-145.
818
while 50 agencies relied on local resources for training through the use of inservice programs, specialized work shops, seminars, and staff meetings. Ten agencies con ducted weekly inservice training programs; five main tamed a monthly schedule. Most respondents said that additional staff training needs centered around learning specific therapies and clinical treatment skills. Also cited was the need to learn how to teach mental health skills to and utilize the services of volunteers and non-mental-health pnofes sionals such as physicians. The need to train staff in community organizing techniques was also frequently mentioned. Some respondents recommended ‘¿ ‘¿ the rural community' ‘¿ as a topic for training, indicating the need for staff to know about rural culture, customs, life styles, and attitudes. Another suggested “¿ how to cope with provincialism' ‘¿ as a topic. Other training needs mentioned were in the areas of program management and systems development, in cluding organization and education of advisory boards, dealing with state governments, and securing local funding. It was also suggested that rural practitioners hold a convention to share program-development ideas and to work out common problems. A surprising number of respondents recommended changes within professional education systems to allow for greater clinical experience in rural areas. Field place ment in rural mental health centers was viewed as a valuable prerequisite to eventual employment in a rural area. Holding education programs at specified rural mental health centers was also strongly recommended, with local colleges and universities as second-choice locations. Urban centers and annual meetings of mental health associations were listed as the least desirable sites for staff training purposes.
HOSPITAL
“¿Rural
& Community
& COMMUNITY
Lead
Psy
PSYCHIATRY
SUPPORT
SYSTEMS
We proposed in our questionnaire that a national task force on rural mental health be established, then asked respondents to suggest functions such a task fonce could perform. Forty per cent suggested training, 39 per cent evaluation, and 26 pen cent clearinghouse functions, such as disseminating information about pertinent pro grams and training opportunities. Representatives from several agencies indicated a desire for technical assist ance and said the proposed task force could work in legislative and funding areas. There is no doubt that governmental support for rural mental health services must be strengthened. Participants in a 1974 University of Wisconsin Sum men Study Program in Rural Mental Health Services adopted the following recommendations to be sent to the Secretary of Health, Education, and Welfare: “¿ That
the
functional
statement
for
the
Office
of
Rural
Development should include an emphasis on the devel opment of rural mental health services; that staff assist ance on rural mental health services in the federal office and the regional offices of the Alcohol, Drug Abuse, and Mental Health Administration should be significantly
increased; services
that the development
should
receive
of rural mental health
concentrated
attention
by state
governments as part of the development of state-sup ported programs in the human service field; that
ADAMHA should provide for the development of a National Center on Rural Mental Health for leadership, research, and education.―
A NEED FOR CHANGE The modest return nate in this survey precludes any extensive generalizations. However, the qualitative depth and richly detailed responses, often in the form of lengthy addenda, indicate that those who took the time to reply did so because they seriously wanted to
communicate runal mental health issues and problems. It is imperative that changes be made in our mental health care delivery system to more realistically meet the needs of rural clients. New and creative means for coping with the geographic distances and resulting transportation problems must be explored. Ways must be found to strengthen resources, which a,re now often limited, and to attract staff who have sufficient technical and social skills to work with unique cultures and cus toms of clients in rural communities. Expanded in service and continuing-education programs must be de veloped for isolated professionals, as well as educational programs in mental health for the general public. Rural residents must be allowed to claim their fain share of mental health services.U
The FirstYear of a ChildAdvocacyProject WILLIAM M. WOMACK, M,D. Executive Director Harborview Community
Mental
tam community services and in increasing between parents and the schools.
contact
Health Center
LINDBERGH S. SATA, M.D. Chief of Psychiatric Services Harborview Medical Center University of Washington School of Medicine Seattle, Washington In a child advocacy projectfunded through a communi ty mental health center, five area residents were trained as advocates and assigned to two elementary schools. The advocates spent much of theirfirst year in training, and in trying to establish themselves as resource per sons for children and families, in setting up parent school councils, and in developing recreational programs. They found it easier to be activists and caregivers than coordinators of services, and they met some resistance from the schools and the community. But by the end of the first year the advocates had made significant progress in helping children andfamllies ob Dr. Womack's mailing address at the center is 326 9th Avenue, Seat tie, Washington 98104. Dr. Sata formerly was executive director of the Harborview Community Mental Health Center; he currently is also an associate professor in the department of psychiatry of the Uni versity of Washington Medical School, and Dr. Womack is an assistant professor there.
UThe term child advocacy became popularized over night following the publication of the report of the Joint Commission on Mental Health of Children in 1970.' The commission was unanimous in its recommendation that child health care in the United States required improved coordination and greater use of existing services, and it recommended the develop ment of an advocacy system at every level of society, neighborhood through national. To develop viable methods of child advocacy, the federal government allocated funds for about 12 demonstration projects throughout the nation. The Holly Park child advocacy project, serving a community in Seattle, was one such project. It was a three-year program funded in 1971 by a grant from the Office of Child Development to the University of Washington; the grant was made through the Harbor view Community Mental Health Center, a comprehen sive center operated by the university's department of psychiatry. A description of the project's design and its first year of operation gives some indication of the effec 1 Joint
Commission
on
Mental
Health
of
Children,
Crisis
in
Child
Mental Health: Challenge for the 1970's, Harper & Row, New York City, 1970.
VOLUME
26 NUMBER
12 DECEMBER
1975
819
JILL MEIDER, R,N., M.S. Senior Instructor
MARGARET L. PLUCKHAN, R.N., PH.D. Senior Instructor Continuing Education in Mental Health Project Department of Staff Development Fort Logan Mental Health Center Denver, Colorado The authors conducted a survey of 215 rural commu nity mental health centers across the country to deter mine their unique problems, needs, and resources. From the 92 responses they received, they formulated a composite description of the rural mental health scene. Their description focuses on services offered, skills re quired to operate effective rural programs, and prob lems in the delivery of care and of evaluation. From the responses they also analyzed the extent of inservice training available to rural practitioners, the support sys tems needed, and the functions a proposed national task force on rural mental health could perform. •¿Inorder to get a clear picture of the mental health cane system in rural areas and to identify the problems mental health practitioners face in those areas, we de veloped a questionnaire to be sent to rural mental health centers across the country. The questionnaires were mailed in 1974 to representatives of the 215 agencies listed in the Directory of Rural Mental Health Centers and Their Satellites.' We received 92 nespon ses, a return nate of 42 pen cent, from 88 agencies in 37 states. From those responses, we formulated a compos ite description of the mental health picture in rural America. In answer to a question about what programs the various agencies offered, the majority of respondents identified the five required activities of community mental health centers: inpatient services, outpatient Dr. Gertzs mailing address at the center is 3520 West Oxford Ave nue, Denver, Colorado 80326. 1 D.
L.
Dolan,
ville, Maryland,
816
editor,
Nationa,l
Institute
of
Mental
Health,
Rock.
1973.
HOSPITAL
& COMM UNITY
PSYCHIATRY
services, partial hospitalization, consultation and educa tion, and emergency services. Drug and alcoholism pro grams were most frequently mentioned as special serv ices offered . Children' s services, marital counseling, and mental retardation programs were often cited. A few of the more novel programs listed were pre natal specialty services, learning-community work shops, training sessions in mental health for new police officers, training programs for Native Americans that included the use of medicine men as consultants, and juvenile court consultation. One agency utilized the services of three educators to help teachers in 12 local schools deal with problem children through behavior modification techniques. Outpatient programs were mentioned frequently as the most effective pnogram& and as the ones that reached the greatest number of clients. The prefenence for outpatient care was exemplified by one Wisconsin respondent who reported that he derived great pleasure from keeping people out of the hospital. In ten years his agency had gone from using 250 hospital beds to using 20 beds, and he anticipated eliminating the last 20 beds within the next few years. Outreach on satellite pro grams for aftercane in outlying areas were acknowl edged as effective means of reducing neadmissions to inpatient facilities. Providing consultation and educa tion programs to welfare departments, health agencies, and schools were identified as effective programs. Almost all agencies reported serving a wide geogra phic area, often with very limited staff. For example, at one clinic 11 paraprofessionals are responsible for main taming crisis stations in an 8600-square-mile territory; another clinic covers a 6104-square-mile area with 30 satellite locations in ten counties.
SKILLS REQUIRED BY STAFF The questionnaire recipients were asked what staff skills were required to operate effective programs. That par ticulan question was intended to provide insight into the training and continuing-education needs of pnofes sionals and parapnofessionals. The responses were cate gorized into four sections: academic qualifications and preparation, personal qualities, general abilities, and requirements unique to a rural setting.
Academic preparation in the disciplines of psychol ogy, psychiatry, nursing, social work, and anthropology were listed. Skills in individual and group counseling and psychotherapy, together with a knowledge of corn munity resources, were considered beneficial. Expe rience in child psychology, family therapy, testing, be havioral-management techniques, together with diagnostic, medical, and bilingual skills, were also re garded as important. The personal qualities most frequently listed as desir able were good communications skills and the ability to function independently and to have good interpersonal relationships. Other qualities listed were the ability to relate to minority groups and youths; to work with community organizations such as churches, schools, and granges; to tolerate isolation while still remaining visible to the community; and to develop trust and a sense of helpfulness. Also considered to be necessary staff attributes were the potential for creativity, innovation, and flexibility in order to function effectively with limited resources. Desirable general abilities included skills in teaching, consultation, public relations, management, and prob lem-solving. Sensitivity to signs of social change and the ability to understand networks of social interaction in the community were also cited. It was also consid ered important for staff to be able to do social planning and community organizing and to work with advisory councils from the community. It is apparent from the responses that the uniqueness of the rural setting requires special skills and qualities of staff members. A number of respondents identified a knowledge of rural politics and power structures and the ability to develop informal patterns of commu nication with key community officials as essential to effective staff functioning. The importance of recogniz ing informal pressure groups that exert control in the community was also listed. Other necessary special skills and qualities included familiarity and empathy with the particular cultures, socioeconomic levels, val ues, and mores of the rural residents. Sensitivity to the community process and flexibility in adjusting program schedules to accommodate competing activities were also important. Acceptance of the conservative rural ethic was consid ered to be another desirable staff attribute. Essentially, the staff are expected to become integrated into small town cultural patterns. In light of that requirement, it is interesting to speculate whether a staff member reared in a small community or a rural setting might have a greater chance of success than one who has had little or no prior exposure to a rural area. Staff were also expected to have a grasp of the de mographic characteristics of the area they serve. State and local surveys can provide information on employ ment rates, extent of poverty, income levels, occupa tional diversity, and the distribution of minority and elderly populations. Such data are essential in estab lishing a mental health program that is truly responsive to community needs, and they play a central role in the
Mostrespondents
identifieda lackof adequate resources
specificallymanpower andmoney—as the majorproblem in the delivery of servicesto a ruralcommunity. development of a state master plan for mental health care. For example, in Colorado the projected industrial and population growth resulting from impending oil shale development may very well dictate changes in life styles that could affect the mental health of the resi dents. Since alleviating local suspicions about mental health programs is an essential part of effective service deliv ery, it was not surprising to find respondents suggesting that partnership models between professionals and the public be established. It was also frequently suggested that mental health terminology be translated into lan guage understandable to the local population and that programs be advertised in a nonjudgmental and non threatening manner. DELIVERY OF SERVICE Most respondents identified a lack of adequate re sources as the major problem in delivery of services to a rural community. That lack was specified either as a shortage of manpower, particularly young professionals willing to work in rural areas, or as a lack of sufficient money, especially funds needed to operate costly out reach programs. A few respondents mentioned the need for additional referral sources and physical facilities. The next most frequently mentioned problem was geography. Distance and population dispersal were identified as major impediments to maintaining conti nuity of care and adequate distribution of services through outreach efforts. Both the energy crisis and weather were cited as critical variables in delivery of services. Also, lack of adequate public transportation systems was often listed as causing difficulties in getting clients to the centers. The third most frequently identified problem was entry of the mental health system into the community. The respondents indicated that community acceptance was inhibited by general public attitudes toward men tal illness, superstitions, labeling, and the stigma associ ated with being a patient. The difficulty of maintaining confidentiality in a small-town setting was also listed. One respondent reported that when his patients walk into the mental health center, they feel as though every one in town sees them.
VOLUME 26 NUMBER 12 DECEMBER 1975
817
One previous survey of community attitudes toward mental health resources indicates that some staff pen ceptions may be false. Bentz, Edgerton, and Hollisten surveyed the attitudes of 418 leaders in two counties in rural North Carolina and found little or no stnong nega tive feelings toward mental hospitals and psychiatrists, in contrast to the findings of an earlier national survey of public attitudes. In fact, the leaders showed an ac cepting attitude toward medical and psychiatric re sources. The results further indicated that attitudes of defeatism and pessimism about the potential for an eventual cure for mental illness appear to be dimin ishing.' More positive attitudes and a greaten commu nity understanding of the role of mental health centers could be fostered by community education pnognams, which are now nonexistent in many areas. Such educa tion programs could communicate the centers' role, pro gram, and services to the public and, in general, make the center more visible to the community. Staff resistance to agency changes was also cited as a problem area. A lack of effective planning and priority setting, along with conflicting expectations of state and local agencies, was also listed as a problem.
EVALUATION AND TRAINING Program objectives and goals can usually be developed with relative ease, but identifying appropriate criteria for evaluation of programs is far more difficult. Only a few respondents reported no particular problems with evaluation. Most said they needed to find a corn pnehensive, measurable, and easy evaluation system. Inadequate clinical staff to do careful evaluation was a major concern. In several instances, lack of interest, poor cooperation, and inertia were cited as reasons for a lack
of evaluation
efforts.
One respondent reported that his staff were either unwilling on unable to be objective and often resisted measuring their own effectiveness. Another problem cited was that of securing consumer participation in evaluation. When consumer participation was enlisted, conflicts often arose between consumer and profes sional expectations of effectiveness. Responses indicated that most centers provide contin uing-education programs for their staff. Although 17 respondents said their agencies had no organized pro grams, 75 described a variety of training activities. Training sessions generally focus on clinically oriented treatment techniques, with emphasis on family and marital therapy, gestalt training, transactional analysis, suicide and crisis intervention, treatment of alcoholism and drug problems, child management, and group training techniques. Some centers use professionals from their own staffs to conduct the training, while others use outside consultants. Eleven of the 88 agencies sent staff out of state to attend conferences, 2 W.
K.
Bentz,
J.
W.
Edgerton,
and
W.
G.
Hollister,
ers' Perceptions of Mental Illness,― Hospital chiatry, Vol. 22, May 1971, pp. 143-145.
818
while 50 agencies relied on local resources for training through the use of inservice programs, specialized work shops, seminars, and staff meetings. Ten agencies con ducted weekly inservice training programs; five main tamed a monthly schedule. Most respondents said that additional staff training needs centered around learning specific therapies and clinical treatment skills. Also cited was the need to learn how to teach mental health skills to and utilize the services of volunteers and non-mental-health pnofes sionals such as physicians. The need to train staff in community organizing techniques was also frequently mentioned. Some respondents recommended ‘¿ ‘¿ the rural community' ‘¿ as a topic for training, indicating the need for staff to know about rural culture, customs, life styles, and attitudes. Another suggested “¿ how to cope with provincialism' ‘¿ as a topic. Other training needs mentioned were in the areas of program management and systems development, in cluding organization and education of advisory boards, dealing with state governments, and securing local funding. It was also suggested that rural practitioners hold a convention to share program-development ideas and to work out common problems. A surprising number of respondents recommended changes within professional education systems to allow for greater clinical experience in rural areas. Field place ment in rural mental health centers was viewed as a valuable prerequisite to eventual employment in a rural area. Holding education programs at specified rural mental health centers was also strongly recommended, with local colleges and universities as second-choice locations. Urban centers and annual meetings of mental health associations were listed as the least desirable sites for staff training purposes.
HOSPITAL
“¿Rural
& Community
& COMMUNITY
Lead
Psy
PSYCHIATRY
SUPPORT
SYSTEMS
We proposed in our questionnaire that a national task force on rural mental health be established, then asked respondents to suggest functions such a task fonce could perform. Forty per cent suggested training, 39 per cent evaluation, and 26 pen cent clearinghouse functions, such as disseminating information about pertinent pro grams and training opportunities. Representatives from several agencies indicated a desire for technical assist ance and said the proposed task force could work in legislative and funding areas. There is no doubt that governmental support for rural mental health services must be strengthened. Participants in a 1974 University of Wisconsin Sum men Study Program in Rural Mental Health Services adopted the following recommendations to be sent to the Secretary of Health, Education, and Welfare: “¿ That
the
functional
statement
for
the
Office
of
Rural
Development should include an emphasis on the devel opment of rural mental health services; that staff assist ance on rural mental health services in the federal office and the regional offices of the Alcohol, Drug Abuse, and Mental Health Administration should be significantly
increased; services
that the development
should
receive
of rural mental health
concentrated
attention
by state
governments as part of the development of state-sup ported programs in the human service field; that
ADAMHA should provide for the development of a National Center on Rural Mental Health for leadership, research, and education.―
A NEED FOR CHANGE The modest return nate in this survey precludes any extensive generalizations. However, the qualitative depth and richly detailed responses, often in the form of lengthy addenda, indicate that those who took the time to reply did so because they seriously wanted to
communicate runal mental health issues and problems. It is imperative that changes be made in our mental health care delivery system to more realistically meet the needs of rural clients. New and creative means for coping with the geographic distances and resulting transportation problems must be explored. Ways must be found to strengthen resources, which a,re now often limited, and to attract staff who have sufficient technical and social skills to work with unique cultures and cus toms of clients in rural communities. Expanded in service and continuing-education programs must be de veloped for isolated professionals, as well as educational programs in mental health for the general public. Rural residents must be allowed to claim their fain share of mental health services.U
The FirstYear of a ChildAdvocacyProject WILLIAM M. WOMACK, M,D. Executive Director Harborview Community
Mental
tam community services and in increasing between parents and the schools.
contact
Health Center
LINDBERGH S. SATA, M.D. Chief of Psychiatric Services Harborview Medical Center University of Washington School of Medicine Seattle, Washington In a child advocacy projectfunded through a communi ty mental health center, five area residents were trained as advocates and assigned to two elementary schools. The advocates spent much of theirfirst year in training, and in trying to establish themselves as resource per sons for children and families, in setting up parent school councils, and in developing recreational programs. They found it easier to be activists and caregivers than coordinators of services, and they met some resistance from the schools and the community. But by the end of the first year the advocates had made significant progress in helping children andfamllies ob Dr. Womack's mailing address at the center is 326 9th Avenue, Seat tie, Washington 98104. Dr. Sata formerly was executive director of the Harborview Community Mental Health Center; he currently is also an associate professor in the department of psychiatry of the Uni versity of Washington Medical School, and Dr. Womack is an assistant professor there.
UThe term child advocacy became popularized over night following the publication of the report of the Joint Commission on Mental Health of Children in 1970.' The commission was unanimous in its recommendation that child health care in the United States required improved coordination and greater use of existing services, and it recommended the develop ment of an advocacy system at every level of society, neighborhood through national. To develop viable methods of child advocacy, the federal government allocated funds for about 12 demonstration projects throughout the nation. The Holly Park child advocacy project, serving a community in Seattle, was one such project. It was a three-year program funded in 1971 by a grant from the Office of Child Development to the University of Washington; the grant was made through the Harbor view Community Mental Health Center, a comprehen sive center operated by the university's department of psychiatry. A description of the project's design and its first year of operation gives some indication of the effec 1 Joint
Commission
on
Mental
Health
of
Children,
Crisis
in
Child
Mental Health: Challenge for the 1970's, Harper & Row, New York City, 1970.
VOLUME
26 NUMBER
12 DECEMBER
1975
819
