Rural East Tennesseans suffer shortages of mental health services
In many parts of East Tennessee, especially in rural areas, it can be difficult or even impossible to find conveniently located mental health services. This is especially true for low-income people or people without a car because, as a recent report found, the overwhelming majority of mental healthcare providers in the United States work exclusively in metropolitan areas – cities. Numbers show the provider shortage in rural areas acts as an added barrier to care for many people who need it most.
We spoke with Tim Marema, vice president of the Knoxville nonprofit Center for Rural Strategies, who says one promising solution to the rural healthcare provider shortage – telemedicine – is being held up by a complicated combination of nationwide infrastructure issues, including a lack of reliable public transportation and fast Internet service.
An estimated 55 million people live in rural parts of the country. And Marema says the shortage of mental health services means anyone who wants to talk to a mental health counselor, or get a prescription for antidepressants, for example, has to drive long distances, and possibly miss work or school.
The shortage may also mean longer waits in the Knoxville region for critical treatments such as detox.
The Tennessean reports the Tennessee Association of Mental Health Organizations finds just "4 percent of Tennessee adults who needed addiction treatment in 2014 received services, with the wait longest in East Tennessee."
“The number just keeps going down the more rural you get in terms of the ratio of providers to people. There are about half as many mental health providers proportionately in rural Tennessee than in urban areas.”
And what happens when someone can’t drive? Maybe they’re a senior citizen, or maybe they can’t afford a car. Lack-of-transportation is a big issue in rural East Tennessee, even when there are plenty of doctors, Marema says.
One way to potentially get around the lack of transportation in rural areas, many health experts say, is by expanding “telemedicine,” a low-cost healthcare model where doctors and nurses examine patients remotely using technology like teleconferencing or web video. Many analysts say telemedicine could help the U.S. could deliver more care to isolated or underserved populations.
But there's a problem ... And it’s something you might not associate with going to the doctor: Broadband Internet access. Health care organizations typically need a lot of bandwidth, Marema says. But many small towns across America already lack dependable high-speed Internet access.
“The holy grail in a lot of cases rural is broadband. And mental health services tend to lend themselves to that type of care. You need to be able to look someone in the eye, know what they look like, pick up on nonverbal cues in a video conference. It’s not a replacement for person-to-person therapy, but it could be a good augmentation.”
The adverse impact of Internet access disparities on telemedicine was highlighted during an April 2015 hearing of the Senate Commerce, Science and Transportation Committee. Todd Rytting, chief technology officer of Panasonic of North America, testified that while providing Internet-based heartmonitoring services for elderly residents of the New York City area, his company found several places where there was no wired broadband, Wi-Fi, or strong mobile signals available. The SmartCare monitoring service significantly reduced the numbers of heart patients who had to return to the hospital, but “the biggest problem we faced was the lack of broadband to some of our citizens,” Rytting said.
Read more about the issue of rural broadband access and health at the Daily Yonder.