Issue 4: Lack of Support Network and Isolation of Rural Providers

Goal: Develop, enhance and fund models and support systems that maximize the use of indigenous rural resources and the coordination of internal and external resources.

Discussion

Due to complex situational demands and social pressure, rural mental health providers feel alone, isolated and estranged from peer support. They often feel an extreme sense of responsibility for addressing mental health-related needs in their communities. These factors combine to create a sense of powerlessness and burnout, and result in increased turnover among rural providers.

Most rural mental health providers work in isolated communities which range in population from a few hundred to a few thousand residents, and are typically accessible only by air. Rural mental health programs have limited professional, paraprofessional and program support personnel. Rural program expenditures are also higher than their urban counterparts due to high transportation, facility, shipping and utility expenses.

Rural mental health workers, at both the village and rural hub level, must be available on a 24-hour per day, seven days per week basis to respond to various types of crises. In addition, rural paraprofessional and professional providers are expected to participate in numerous community events ranging from celebrations to gatherings regarding community tragedies.

In larger rural communities, the mental health programs are generally the only mental health resource in the area and have little or no back-up professional support during times of crisis. Rural hub providers are often perceived as a clearinghouse for many social services, in addition to mental health services, and experience extraordinary demands on their time and energy.

At the village level, paraprofessional workers may have access to a professional program director in a rural hub community for guidance and support. At the same time, these village workers are often perceived by their communities as the only mental health resource and feel an increased burden of responsibility for community well being. Since the village paraprofessionals are community members themselves, they have multiple roles and the line between community member and community helper often becomes blurred.

Of particular concern are the tragedies which occur in small communities. When a sudden, unexpected death occurs, the whole community is overwhelmed and shocked with the event, and must address feelings of disbelief, loss and grief. The rural mental health provider, who shares these emotional responses, is also expected to provide comfort and support to both the community and individual community members. Village paraprofessionals often feel an additional sense of responsibility for the loss and lack a support system to process their own feelings.

Actions

144. Work in concert with Native corporations to identify and strengthen cultural and familial support networks in rural communities; these support systems should include village elders whenever possible.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Alcoholism and Drug Abuse, Division of Family and Youth Services, Alaska Mental Health Board, Governor's Advisory Board on Alcoholism and Drug Abuse

145. Establish and publicize a 24-hour per day, seven day per week, support system for rural providers to access in times of emergency or when clinical consultation is needed.

146. Provide updated telecommunication technologies to rural mental health workers including telemedicine services, E-mail and Internet access, and provide training in use of new technologies. The use of telemedicine as a tool in screening, assessment, evaluation and treatment should be explored.

147. Enhance and strengthen the linkage between Alaska Psychiatric Institute and rural providers (including rural hospitals) by offering orientation programs for new rural providers and ongoing staff development for existing rural paraprofessional and professional providers.

148. Strengthen the relationship between urban community mental health centers and rural providers by offering orientations and network building at the urban centers.
Responsible party (actions 2-5): Division of Mental Health and Developmental Disabilities, Alaska Mental Health Board, Alaska Community Mental Health Services Association, Rural Alaska Mental Health Directors Association, Alaska Mental Health Trust Authority

149. Ensure adequate funding for rural paraprofessionals and supervisors to attend the Rural Human Services Training Program through the University of Alaska to enhance skill development and increase peer support networks.

150. Provide funding for periodic rural mental health conferences to address the staff development and networking needs of mental health professionals and paraprofessionals in rural communities.
Responsible party (actions 6-7): Division of Mental Health and Developmental Disabilities, Alaska Mental Health Board, Division of Alcoholism and Drug Abuse, Governor's Advisory Board on Alcoholism and Drug Abuse, University of Alaska, Alaska Mental Health Trust Authority