Taking Care of Our Own

Taking Care of Our Own: A Good Mental Health Model

Michael Holton, Center for Rural Affairs, michaellh@cfra.org

A town successfully combines education, training, and new personnel to create a rapid, comprehensive system for mental health treatment.

The past few months I have concentrated on mental health in small rural communities and the inherent danger we face in the shortage of trained help and the lack of care available. Our situation is not unique. Powell River, a coastal town of less than 20,000 in British Columbia, came up with a creative solution to their lack of mental health care in the community.

Patients needing mental health care were handled by local family practitioners. Many were transferred to other facilities miles away or forgotten completely. Local practitioners and social workers were seeing outpatients of mental health facilities, yet they were not qualified to provide treatment.

The community and the local hospital teamed up to create the Acute Short-term Assessment Program (ASAP) in 1991. Specially trained psychiatric nurses were hired through the hospital, funded by Mental Health Services. They were available to assess patients needing mental health care Monday through Friday from 8:30 a.m. to 4:30 p.m.

Most of their skills were consistent with the Diagnostic and Statistical Manual, third edition (DSM III). Nurses were also trained, for a fraction of the cost, on basic biopsychosocial treatment models. And they studied drug and alcohol programs. The end result was uniformity in assessing mental health needs in their small rural community.

Once an assessment was complete, a referral to an area psychiatrist was made. A Triage Team consisting of the psychiatric specialist, the patient’s family physician, the assessment nurse, and sometimes the coordinator of mental health programs within the community was created.

Due to the program’s success, very few patients are seen outside ASAP. This process streamlines the patient to the appropriate care. An analysis is underway, but the main conclusion so far is that a single-entry system like this is rapid and, in most cases, correct. This is a far cry from the previous system in Powell River.

As we experience continued depopulation trends in the Midwest, it may be important to draw on this knowledge from our Canadian neighbors to help solidify a more comprehensive community-based mental health approach for our needs.

post a question or comment here or contact John Crabtree, johnc@cfra.org

Center for Rural Affairs

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