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Poor access to health care services for rural populations has been a difficult and long-standing problem. The twin conditions of shortages of trained providers and the stigma of mental illness have made the provision of mental health services in rural areas a particularly difficult challenge.
The paper beginning on page 956 and the four papers that follow are based on presentations given at a symposium on rural psychiatry held on March 14, 1997, to mark the opening of a center for rural mental health at Mercer University School of Medicine in Macon, Georgia. The major mission of the medical school is to train primary care physicians to care for patients in underserved rural communities. The recent growth of interest in rural psychiatry coincided with the medical school's decision to establish the center for rural mental health as a joint program of the medical school's departments of community science and psychiatry. The center's purpose is to conduct research and evaluation and provide education to improve the level of access and care of those in need of mental health services in rural and underserved areas of the southeastern United States.
The first paper, on planning the future size of the psychiatrist workforce, discusses methods for determining whether a geographic area has a surplus or a shortage of psychiatrists and how such workforce issues may affect mental health services for rural areas. If managed care continues to shift from specialties to generalists for the provision of services, the number of psychiatrists in training will be markedly reduced, and the delivery of care in rural areas may be adversely affected. On the other hand, a surplus of psychiatrists might benefit currently underserved rural areas if it encourages movement of psychiatrists into those areas. Whether the future brings an under- or oversupply of psychiatrists, the bulk of psychiatric care in rural areas will be provided by nonpsychiatrists. Thus it is important to ensure that family practice physicians and other primary care practitioners are well trained in psychiatry.
The second paper, on psychiatric patients and their families, is an account of the problems faced by patients and family members living in rural areas. This paper also highlights the impact of managed care on mental health services, focusing on its effects in the public sector.
The third paper, on rural telepsychiatry, describes how gaps in delivery of mental health care can be filled by modern technology. It is now possible for the individual psychiatrist to operate a telemedicine system from a personal computer. These advances mean a saving in time that used to be spent commuting between office and television studio. In addition, the psychiatric consultant and caregivers and patients in remote areas can communicate much more rapidly and conveniently.
The fourth paper reviews what is known about collaboration between primary care and psychiatry in rural areas. The fifth paper offers an international perspective on the role of the psychiatrist in rural psychiatry.
Dr. Moore is professor and director of psychiatric research and Dr. Nelson is professor and chair in the department of psychiatry and behavioral sciences at Mercer University School of Medicine, 1550 College Street, Macon, Georgia 31207.
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