DEVELOPING RURAL MENTAL HEALTH SERVICE DELIVERY SYSTEMS USING SYSTEMS DESIGN PRINCIPLES

摘要

This paper presents a case study of a rural behavioral health system. More specifically it examines the relationships and consequences of the application of an urban model of behavioral health care within a state in which 87% of its counties are rural. When the definitions, assumptions, and criteria for service are established using a single urban model, the consequences for those in rural or frontier areas are significant. The current "urban model" is not an equitable model across all social and economic environments (Beeson, 1992). Changing this paradigm requires a systemic view of organizational change in which the social process of change incorporates and negotiates social relationships that are mutually beneficial.. Consistent with systems thinking, rural community mental health centers survive "through their ability to nurture mutually beneficial relationships in their environments" (Baskin, 1998, p.68). Rural community mental health centers have unique strengths to address the mental health needs of their consumers. Cooperation between public and private (for profit) providers is more likely, a wide of array of social service institutions are relatively accessible to the mentally ill, and knowledgeable practitioners are frequently active members of the community. Traditional delivery systems have not built upon these strengths. At the same time, rural mental health centers have unique challenges as the prevalence of mental illness may be higher, funding formulae do not adjust for the realities of practice in rural areas, and recruitment and retention of qualified staff is difficult.