Rural America makes up 90% of our nation's landmass and is home to approximately 25% of the U.S. population. Yet, the special mental health issues in rural communities are often minimized or not considered in the formation of national health policy. Although the highly diverse nature of rural populations makes global characterization difficult, there is significant research to indicate that many of these mental disorders have distinct characteristics or occur at a higher frequency in rural America. Poverty, a strong correlate of mental distress, is more prominent in rural areas than suburban areas. The rate of substance abuse is, also, often higher in rural America. Fatal injuries are 44% higher among rural than urban children. Importantly, rural adolescent males (ages 15-19) have a higher suicide rate than their urban counterparts. Despite the needs, access to mental health care is more limited in rural areas. Limited access particularly affects children, ethnic minority groups, the seriously mentally ill, and older rural residents who, due to their psychological/developmental state or economic deprivation, have limited ability to travel the necessary distances to receive qualified mental health care.
Aware of the critical needs of our rural populations, in 1992, the American Psychological Association instituted an APA Presidential and Board Rural Mental Health Initiative and an APA Task Force on Rural Health. The charge of the Task Force on Rural Health was to study and recommend means of improving behavioral health care of rural residents. In 1996, the Rural Task Force was formed into an eight-member Committee on Rural Health that reports to the Committee for the Advancement of Professional Practice (CAPP).
The Committee on Rural Health's mission shall be to address the full breadth of issues affecting the health of persons living in rural and frontier America. The APA Rural Health Committee shall consist of eight (8) members each of whom shall serve a staggered term of three (3) years. All members of the committee shall be APA members and reflect rural, gender, ethnic minority, sexual orientation and age diversity. The members shall be chosen by the APA Council of Representatives through the nomination process described in Association Rule 110-14. Committee members shall be limited to two successive terms of service and my not further succeed themselves without a break in service. The Committee shall meet twice a year. The activity of the Committee will encompass the interests of all APA Directorates and communication will be maintained with all Boards, Committees, and Divisions with an interest in these issues. The Committee will identify, study, and attempt to ameliorate health and mental health problems that may yield to the special knowledge and competence of psychologists. The Committee will identify and develop programs to meet the needs of residents in these areas. Linkages of psychologists with other health providers in these areas will be promoted to enhance the assessment and treatment of health problems with a behavioral component. The Committee on Rural Health shall report to the Council of Representatives and the Board of Directors through the Committee for the Advancement of Professional Practice.
Acknowledging and respecting traditional and non-traditional healing practices in rural areas.
MEMBERS OF THE COMMITTEE ON RURAL HEALTH IN 2004
Elaine LeVine, Ph.D. Chair (2002-2004)
Anne Cowardin-Bach, Ph.D. (2002-2004)
Kathy J. Harowski, Ph.D. (2003-2005)
Scott Meit, Psy.D. (2002-2004)
Richard M. McGraw, Ph.D. (2003-2005)
Jill Oliveira-Berry, Ph.D. (2004-2006)
Laura Schopp, Ph.D., ABPP (2004-2006)
Luis A. Vazquez, Ph.D. (2004-2006)
APA Staff Liaisons
Michael Sullivan, Ph.D.
Kristin Schelin
CRH MONITORS/LIAISONS
Barry Edelstein, Ph.D.
Bernice A. Marcopulos, Ph.D., ABPP
Richard G. Salamone, Ph.D.
Samuel S. Thomas, Ph.D.
SUMMARY OF ACTIVITIES, 2004
At the Spring meeting of 2004, the Committee on Rural Health worked diligently to learn about and bring together efforts of CRH. Members became familiar with the numerous papers and books, sponsored talks and conferences, and outreach efforts to members on the Hill, APA staff, and other APA committees in regards to rural health issues. Then, CRH members considered possible goals for the future. In brainstorming sessions many worthy projects were generated.
The CRH selected two primary projects for 2004. A first project was to update and expand the APA Rural Psychology website. This website is still evolving but is already much more user-friendly and helpful. We are now able to use it as the bank for the various efforts of the Committee on Rural Health, thereby bringing the issues of rural health to the awareness of the broad APA constituency. In addition, the website will meet the goals of facilitating access to good mental healthcare through its extensive bibliography and its inclusion of papers and power point presentations that are excellent guides for training and funding in rural areas. The numerous links to other rural health sites can facilitate psychologists' successful employment in rural areas.
The CRH decided that a second worthy project would be to complete a set of research articles that offer up-to-date review of critical aspects of rural mental health including: use of technology in rural areas, current efforts in training, financial resources, prescriptive authority in rural areas, and examples of successful rural program implementation. The Committee plans to complete this project and submit the articles for publication by January 2005.
Over the summer of 2004, the CRH Committee met for a telephone conference. In accord with requests from APA President Dr. Diane Halpern, the Committee identified three major goals for the CRH. These are:
1. Activities that facilitate access to and provide good mental health care in rural communities;
2. Facilitation of psychologists' successful employment in rural areas;
3. Bringing issues of rural mental health and means of addressing those issues to the awareness of the broad APA constituency.
It is interesting to review how the past projects of CRH have addressed these primary domains of interests. The attached Venn diagram summarizes CRH efforts that fall under each of these broad goals, as well as CRH efforts that cut across two or three of the goals. As can be seen, the 2004 goals of upgrading the rural health website and developing a series of research articles in rural mental health promise to address all three domains of focus.
In the Fall 2004 meeting, efforts to further refine our mission and future goals coalesced, and the Committee moved forward with much focus and energy. The vision, mission statement, and objectives listed at the beginning of this paper, were created during the Fall 2004 meeting. The Committee continued to work on its website and research projects.
In both the Spring and Fall meetings, CRH met with a number of individuals with critical knowledge and valuable links within the field of rural health. These meaningful dialogues with others included:
Norman B. Anderson, Ph.D.
CEO of APA
Diane Halpern, Ph.D.
2004 APA President
Russ Newman, Ph.D., J.D.
APA Executive Director of Professional Practice
Paul Craig, Ph.D.
APA Board of Directors, and former member of the APA Rural Task Force
Nina Levitt, Ph.D.
APA Director of Education Policy
Peter Newbould, Ph.D.
APA Director of Congressional and Political Affairs
Ruth Paige, Ph.D.
APA Board of Directors
Jack Wiggins, Ph.D.
Past President of APA
Craig Kennedy
National Association of Community Health Centers
Chris McLaughlin
HRSA/National Health Services Corporation
Jennifer Riggle, J.D.
Office of Rural Health Policy of the Health Resources and
Services Administration
Steve Wilhide, MSW
National Rural Health Association
These dialogues have been very helpful in that they inform CRH members of national efforts in rural health as well as providing links for our working more directly with other agencies.
Finally, in the Fall of 2004 Consolidated Meeting, the CRH outlined its goals for the next year. One goal is to reach out more broadly to other APA committees through the liaison and conference committee process at the consolidated meetings. Committee members will hope to provide information on rural health to other committees as well as to request some specific information from those committees on how rural issues impact their domains of focus. The Committee will, then, develop a report as well as further requests for information to be presented to the APA Council. It is believed that this project will help facilitate the goal of increasing awareness of the APA constituency of the needs and accomplishments in rural psychology and may also help generate energy among the rural caucus of the APA Council.
CRH also will follow up on work with the APA Research Office under Jessica Kohout's guidance to better tease out relevant information about APA members in rural areas.
There are plans to work more closely with Chris McLaughlin at the National Health Service Corps and with Craig Kennedy from the National Association of Community Health Centers. CRH hopes to develop closer working relationships with other agencies that address rural health care and broaden our connection with national networks through visits to Capitol Hill.
The Committee on Rural Health is deeply appreciative of the leadership and steadfast support provided by Michael Sullivan, Ph.D., Assistant Executive Director, State Advocacy, of the Practice Directorate, and Kristin Schelin, Director of Committee Operations of the Practice Directorate. Their wise guidance on many conference calls with this Chair was invaluable in enabling her to successfully conduct the meetings during the Spring and Fall Consolidated Meetings and summer conference calls. Their knowledge and support brought out “the best of each of the members” so that CRH looks forward to its 2005 projects with refined focus and renewed vigor.
