HJLR Mar/Apr 2019

Healthcare Journal of LITTLE ROCK  I  MAR / APR 2019 55 Bruce Trimble, MA, APR Director Business Development The BridgeWay Hospital Bruce Trimble, MA, APR, is the director of business development for The BridgeWay Hospital, a psychiatric facility for children, adolescents, and adults in North Little Rock, Arkansas. An avid mental health advocate, Trimble was appointed by the governor of Arkansas to the Arkansas Suicide Prevention Council in 2015 and served as co-chair from 2015 to 2017. In 2018, he was instrumental in establishing a call center for the Arkansas Suicide Prevention Hotline. area. And the challenges faced by people in rural areas are quite different from those in urban areas. Rural populations are often un- derserved and possess health and behavioral health disparities. Rural communities have a chronic shortage of behavioral health provid- ers and limited access to services. Some of those challenges increase the risk for suicide. Risk Factors The Centers for Disease Control and Pre- vention identified these important risk fac- tors for suicide in rural areas: • Difficulty obtaining mental and behavioral health services due to high cost, lack of transportation and other distance-related issues, and shortage of providers. • Living in an isolated location, which may reduce one’s sense of connectedness and increase feeling of isolation and loneliness, and cause substance use and abuse. • Socioeconomic factors, such as unemploy- ment and being in persistent poverty. • Influence of firearms and suicide; the rate of suicide with a firearm is almost two times higher among rural than urban res- idents. Also, providing life-saving medi- cal care after an attempted suicide can be more challenging because of the isolated residences of some people and the limited number of rural trauma centers, hospitals, and emergency medical services. • Sociocultural factors that increase mental illness stigma and prevent help-seeking, including a culture of indifference. In order to improve the mental wellness of Arkansans, we need to eliminate these risk factors, beginning with access to care. Improve Access to Mental and Behavioral Health Services According toMental HealthAmerica, there are over 4,000 areas in the US (including 110 million people) that are considered mental health professional shortage areas. In order to access care, people living in these areas must travel hours or across state lines. While the Affordable Care Act expanded the op- portunities for millions to access care, these people are now facing a shortage of mental health providers (psychiatrists, psycholo- gists, licensed clinical social workers, coun- selors, marriage and family therapists, and advanced practitioner nurses specializing in mental health care). For example, in 2018 according to Mental Health America, in Al- abama, there was only one mental health professional per 1,260 people, and that state ranked 51st in the nation for mental health workforce availability whileArkansas ranked 26th. So, how do we eliminate this barrier? Integrate Primary Care and Mental Health Care. In the rural areas, the most common healthcare provider is the family practice. Integrating primary care with mental health care could be a promising method of expand- ing treatment. Increase Access to Telehealth Services. Telehealth has the potential to treat a wide range of mental health conditions in a variety of settings, such as outpatient clinics, hospi- tals, and military treatment facilities. And it can improve access to care for patients liv- ing in isolated areas as well as reduce travel time, expenses, and delays in receiving care. Expand public transportation systems. Implementing a statewide public transpor- tation systemcould improve access tomental health providers. In addition, a far-reaching systemwould also improve access to educa- tion opportunities, such as community col- leges, universities, and adult learning, and economic opportunities, especially jobs, job training, and consumer goods and services. In the coming months, I will explore each of these risks as well as potential solutions to the issues of prevalence and access. However, instead of presenting a one-sided column, I also hope to hear from you about potential solutions. n