Stemming the mental health crisis in rural America
With rural psychiatrists in short supply, new program is geared to primary care providers
It’s estimated that more than half of all U.S. mental health care takes place at the primary care level and that percentage jumps considerably in rural areas where there often are no mental health practitioners for hundreds of miles.
New online training modules have been designed by the Behavioral Health Education Center of Nebraska (BHECN) to help primary care providers better treat patients with mental health issues.
“Our primary care practitioners are on the front lines in the battle for mental health and in many ways they are overwhelmed,” said Howard Liu, M.D., a child and adolescent psychiatrist for the University of Nebraska Medical Center and interprofessional education director for BHECN. “With these training modules, we hope to help arm primary care practitioners with the tools to help them treat patients with mental health issues.”
BHECN – a UNMC program that aims to improve behavioral health training and education throughout the state – has created the training modules to help family physicians, pediatricians, physician assistants, nurse practitioners, pharmacists, and other primary care providers treat depression in adolescents, adults and geriatric patients.
UNMC’s work in primary care has been nationally recognized. UNMC’s primary care program is ranked No. 6 in the country in the 2013 rankings of the nation's top graduate schools by U.S.News & World Report.
The adolescent module was released last fall and has been viewed by hundreds of practitioners from around the world. The adult and geriatric modules will be released this spring.
The goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists.
This is particularly timely in adolescents as black box warnings on antidepressants about increased suicidal thoughts being related to their use have made many primary care physicians leery when it comes time to prescribe the medications.
In the modules, practitioners watch video, review text and graphs and take quizzes designed to teach them more about depression treatment. Primary care providers can receive continuing education credits for the training.
The modules will be particularly helpful in rural areas where the need for mental health care is overwhelming, said Angie Brennan, M.D., a primary care physician at Howard County Medical Center in St. Paul – a town of 2,200 people in central Nebraska.
She estimated that 35 percent of all primary care visits have some mental health component.
In rural areas, she said, typical challenges of the treatment of psychiatric disorders – reluctance to see a counselor and a lack of lack of mental health insurance coverage – combine with an intensified fear that someone in the community will find out a patient has mental health issues.
“Many patients in small towns have anxiety that someone may see them walk into the counselor’s office on Main Street,” said Paul Paulman, M.D., assistant dean for clinical skills, education and quality in the UNMC College of Medicine, who helped create the modules. “The stigma of mental illness is definitely exacerbated in rural areas.”
This contributes to more untreated conditions, he said. And often, when treatment is finally sought, the conditions have progressed to the point that the primary care professionals aren’t equipped to treat them, said Dr. Paulman, who treated patients in rural Nebraska for several years before he came to UNMC.
“Primary care providers receive psychiatric training in medical school, but we’re finding it’s not sufficient to handle the amount of mental health-related cases they encounter in their clinics,” Dr. Paulman said.
In that regard, the BHECN training modules are much needed munitions on the front lines of mental health, said Dr. Liu, who noted that the Adolescent Depression Module was recently featured in a national campaign to educate pediatricians about mental health. The modules also are likely to be used in medical student education across the country.
“The challenges in mental health are significant and the consequences for not meeting these challenges are great,” Dr. Liu said. “We want our training modules to provide the skills and insight needed to help address this great need.”
Visit http://www.unmc.edu/bhecn/adolescent_depression_module.htm to view the online training modules.
Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.
Video of training modules
Here's a video featuring Dr. Howard Liu of UNMC talking about the behavioral health training modules that are now being used in 40 states and 20 countries.