1. Rural Mental Health and Primary Care Lessons learned from a statewide workgroup.

2. Primary care is not the safety net system for mental health care in rural Minnesota. It is the system. ~Jack Gellar, rural health researcher

3. Challenges Shortage of rural providers in both mental health and primary care Lack of provider training Inadequate reimbursement structure Stigma and need for better public information

4. What Did We Do? Created an overview of services and needs Explored promising practices and examples of collaborative models for primary care Developed recommendations for Commissioner of Health and other policymakers

5. Challenges: Breadth of the topic Defining mental health and primary care Broad workgroup membership with individual areas of interest Surveys—content and implementation

6. Keys to Success Engagement of workgroup Balancing large and small group work Meeting results packets Need, nice and nuts rule

7. What did we find out? Too often help is a car ride away—without gasoline. ~physician in northeastern Minnesota

8. Minnesota Mental Health Landscape An estimated 950,060 Minnesotans have some type of mental health problem 25% increase in rural hospital mental health inpatient days Suicide fatality rates are higher in rural Minnesota (11.1/100,000 compared to 8.7/100,000 urban)

9. Mental Health Workforce 7.3 psychiatrists for every 100,000 people in rural Minnesota (national average is 16/100,000) Only 19 child psychiatrists practice outside the 7-county metro area 13 rural counties had no psychologists

10. Workforce Training Data Three psychiatric residency training programs in Minnesota, none with a rural site component Two advanced practice psychiatric nurse training programs. One has a rural component

11. Primary Care Survey Increase in mental/behavioral issues among patients in past 2-3 years Most do not routinely screen for mental/behavioral issues Majority would like more training and education Substance abuse biggest issue of concern

12. Snapshot:Primary Care

14. Critical Access Hospital Survey We have become adept at jumping through many administrative and other barriers to find care for our mental health patients. Sometimes we fail… our regional support system fails us every day. ~ Survey Respondent

15. Snapshot: Emergency Rooms 40% are seeing an increase in ER visits for mental and behavioral health issues 32% of visits are for anxiety and depression 29% of visits are for substance abuse

16. Snapshot: Emergency Rooms

17. Promising Practices: Collaboration is Key Community Assessment: Fond du Lac Abuse Counseling Program Community Collaboration: Shared Care, Detroit Lakes Telehealth psychology in Big Fork Psychologist in primary care clinic in Detroit Lakes

18. We can no longer do business as usual. We must screen, identify and treat in primary care clinics. To do this, collaboration if required, and rural providers must be trained and supported. In addition, funding streams must be redesigned to reimburse and support collaborative models of care. ~Rural mental Health and Primary Care Workgroup

19. Recommendation Areas Health Professionals Health Systems Public Policy

20. Health Professionals Enhanced mental health training for primary care students (MDs, RNs, PAs) Rural site experiences for mental health and primary care students Mental health related continuing education for primary care practitioners

21. Health Systems Promote collaborative care models Develop common set of mental health benefits Promote and expand telehealth Improve delivery of mental health crisis services in rural hospital ERs Create an understandable guide to payment system

22. Public Policy Rural mental health voice in development of electronic medical records Support rural mental health crisis response team development Promote CAH mental health emergency QA projects

23. Public Policy Create coordinated data collection and analysis system for mental health incidence, prevalence and treatment Improve Medicare coverage for mental illness

24. We don’t want this to be a report that gathers dust on someone’s shelf. ~Work group member New Connections for Community Mental Health— Statewide Telehealth Crisis Intervention Minnesota Psychiatric Society— Rural Education Initiatives

25. Rural Mental Health and Primary Care Linda Norlander RN MS Linda.norlander@health.state.mn.us 651-282-6317 C.J. Peek PhD cjpeek@visi.com 612-827-8109 Rhonda Wiering RN Rhonda@tylerhealthcare.org 507-247-2242 Report Available at : http://www.health.state.mn.us/divs/chs/rhpcrpts.htm