Evidence and Support for Rural Mental Health Care

Submitted by Karen MacDonell, CPSBC Library

Mental health care is a significant part of family practice services1.  The challenges of providing and accessing face-to-face mental health services in rural areas, including patients’ out-of-pocket costs and safety concerns due to travel, practitioner turnover, limited options for referral to specialty services, and mental health stigma2, can be eased with psychotherapy delivered through the Internet, using personal computers or mobile devices, or by telephone.  A recent systematic review reports that computer-delivered cognitive behavior therapy (CBT) is effective for depression and anxiety in rural locations and is especially acceptable to rural patients3, offering autonomy and confidentiality.  Similarly, telephone-based CBT effectively reduced worry, generalized anxiety disorder symptoms and depression in rural older adults as reported in a recent randomized controlled trial4. This is particularly valuable considering that specialists in late life mental health care are in short supply in rural locations. Other studies on telemedicine-delivered CBT for rural health can be viewed using this Medline search in PubMed. College of Physicians and Surgeons of BC registrants are welcome to request copies of any of these articles from the College library.

The College of Physicians and Surgeons of BC library offers an online and print collection to support practitioners offering CBT, other psychotherapies and pharmacotherapies in rural areas. PsychiatryOnline is a core resource and includes DSM-5, American Journal of Psychiatry, American Psychiatric Publishing Textbook of Psychiatry, APA Textbook of Psychopharmacology,  APA Textbook of Substance Abuse Treatment, Clinical Manual Of Geriatric Psychiatry, Dulcan’s Textbook of Child and Adolescent Psychiatry, and handouts in What Your Patients Need to Know About Psychiatric Medications and Helping Parents, Youth and Teachers Understand Medications for Behavioral and Emotional Problems.  Comprehensive, evidence-based summaries on psychotropic drug prescribing for adults, adolescents and children can be found in Clinical Handbook of Psychotropic Drugs (CHPD) Online and CHPD for Children and Adolescents OnlineClinicalKey features a psychiatry collection of ejournals and ebooks integrated with an easy to use search function. ClinicalKey is also available as an app to all BC physicians through the College – see instructions at https://www.cpsbc.ca/library/search-materials/point-of-care-drug-tools.  A large selection of online and print books in mental health (and all aspects of medicine) can be found in the College library catalogue. Delivery and return of books by mail is free.  Physicians are welcome to contact the College library at 604-733-6671 or medlib@cpsbc.ca.

REFERENCES

  1. Clatney L, Macdonald H, Shah SM. Mental health care in the primary care setting: family physicians’ perspectives. Can Fam Physician. 2008 Jun;54(6):884-9. Available from: http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=18556498
  2. Collaborative mental health in rural and isolated Canada: stakeholder feedback. Ryan-Nicholls KD, Haggarty JM. J Psychosoc Nurs Ment Health Serv. 2007 Dec;45(12):37-45. [request copy from College library]
  3. Vallury KD, Jones M, Oosterbroek C. Computerized cognitive behavior therapy for anxiety and depression in rural areas: a systematic review. J Med Internet Res. 2015 Jun 5;17(6):e139. Available from: http://www.jmir.org/2015/6/e139/
  4. Brenes GA, Danhauer SC, Lyles MF, Hogan PE, Miller ME. Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: a randomized clinical trial. JAMA Psychiatry. 2015 Oct;72(10):1012-20. [request copy from College library]