If there's a will, is there a way? Integrating HIV and mental health services in rural areas
In North Carolina, more than 50,000 of the 84,000 people with serious mental illness who need services from the community-based health system or the public mental health system are not served. In the 1990s, federal authorities investigated the state's Medicaid mental health funding after reports of multi-million dollar mismanagement. By 2001, North Carolina faced its worst fiscal crisis in more than a decade with a deficit of nearly $900 million. Concurrently, HIV/AIDS in the southeastern United States became a serious public health problem. Many people living with HIV/AIDS have multidimensional problems, yet few professionals are trained to deal with all of them, and services funding is limited. Psychiatric disorders increase the chance of acquiring HIV because they may provoke high-risk behaviors; thus, mental health treatment in HIV-care settings can help to reduce the spread of HIV. Public health initiatives to prevent transmission of new infections must make multiply diagnosed patients a priority population for care through the recognition and treatment of psychiatric disorders. In this article, we describe the efforts of the Health Inequalities Program (HIP), which focused on integrating services for adults who were multiply diagnosed with HIV disease, a mental disorder, and/or a substance related disorder who lived in the eastern half of North Carolina, a primarily rural area. Integration targeted the continuum of ambulatory care by educating various providers, creating local and regional provider networks with links to fiscal resources and existing care networks, and creating awareness of the systemic unavailability of care for multiply diagnosed patients.
Scott, K; Ngayen, TQ; Whetten, K
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