In the Carolinas, most mental health specialists work in cities. But mental health issues, substance abuse, and developmental disabilities occur all across the region, leaving rural residents to struggle with conditions that can impact every area of their lives.
Support from The Duke Endowment is helping to make it easier for residents to find mental health care at their doctors' offices.
In Henderson, N.C., one licensed therapist is at the forefront of the effort. Sandi Gray-Terry, who holds a master's degree in social work and is a licensed clinical social worker, coordinates three doctors' offices for the ICARE Partnership, a group working to expand mental health services across the state. The partnership's name represents the type of health care system it seeks to develop: Integrated, Collaborative, Accessible, Respectful and Evidence-based (ICARE).
Integrating Mental Health Services
"I was brought on to help integrate mental health, substance abuse, and developmental disabilities into primary care settings," says Gray-Terry. "The intention was to hire therapists to work there, but it's challenging to find professionals willing to relocate to rural areas. Since I've worked here so many years and know the needs are extraordinary, I said, ‘Let me.'"
Gray-Terry works at three practices in the Henderson area: Vance Family Medicine (a rural health clinic), a pain clinic affiliated with Maria Parham Hospital, and Premier Women's Health (an obstetrics/gynecologist practice).
Her initial task was to educate other health providers about her role.
As doctors direct patients to her, she is able to assess their needs, provide therapy or recommendations and refer people to other resources for long-term treatment. The results from having a mental health expert with the doctors have been positive.
"Just having someone in-house at the primary care provider was tremendously important," Gray-Terry says. "One of things I was able to do was teach doctors how to communicate with therapists—without asking for the specific details that would compromise patient privacy.
Mental and Physical Health Needs Met
"We also saw a lot of people who would never have gone to a mental health practice. Having me there decreased the stigma of mental health, since the doctors could simply introduce me as ‘someone who knows more about these issues.' It also shifted awareness, helping the staff understand how psycho-social issues can overlap with medical needs."
According to Gray-Terry, integrating mental and physical care has a financial payoff, too. "Sometimes all people need is someone to sit and hear them so they don't blow up their medical issues and have a panic attack," she said. "By addressing their needs, we were able to reduce their costly emergency room visits from every six weeks to only once every seven or eight months."
Endowment support for projects like the ICARE partnership makes a difference in expanding mental health services for patients. "Our resources are still lacking in rural areas," says Gray-Terry, "but this project was helpful in increasing awareness of mental health issues and serving people who had never been helped before."
Lin B. Hollowell III
Director of Health Care