Challenges for rural youth
I have written before about the greater prevalence of suicide in rural youth (Runkle et al. 2023) and the value of telemedicine in working with rural clients (Kaur et al., 2022). Here, I speak to substance abuse and telepsychiatry. First, Kopak & Raggio (2023) published “Substance Use Disorder and Rural Detention Center Readmission: Results from a 3-year prospective cohort study” in Journal of Rural Mental Health. Here are the impact statement and abstract, edited with some information in bold:
The majority of people admitted to rural jails present indications of substance use disorder, but comprehensive assessments are not available in many facilities. Rural jails must facilitate connections to care in order to reduce lengths of detention and the risk of repeated admissions. Despite the steady increase in drug-related overdoses and deaths in custody recorded in jails, limited research has focused on substance use disorder (SUD) in rural county detention facilities. The first goal of this study was to provide an accurate assessment of the prevalence of SUDs in a rural jail and the second was to determine how these specific conditions were associated with readmission over a 3-year period. Comprehensive interviews consistent with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition SUD diagnoses were conducted with a cohort of 283 participants admitted to a rural detention center in a southern Appalachian County. Official records were obtained from the facility’s database to determine the number of admissions and the length of detention. After identifying bivariate associations between specific SUDs and readmission, multivariate models were estimated to further assess these relationships while accounting for demographic background factors. Alcohol use disorder (71.0%) was the most prevalent condition, followed by methamphetamine (48.8%), and cannabis (36.4%). Those who endorsed criteria consistent with more severe designations of methamphetamine use disorder (MUD) had higher rates of readmission (incidence rate ratio [IRR] = 1.11, p = .031) compared with those who did not endorse similar criteria. A MUD was also associated with a significantly higher rate of days detained (IRR = 1.17, p = .004), demonstrating a longer period of detention for those who endorsed these criteria. Identifying specific SUDs in rural jail populations is an important first step toward a long-term strategy to reduce lengths of confinement and the likelihood of repeat admissions.
I think this study is important in highlighting the relationships between substance use and incarceration. It’s especially interesting that, while a smaller percentage of detainees use methamphetamines relative to alcohol, they are much more likely to be readmitted to detention centers. The second article emphasizes telepsychiatry. I use it here because, in addition to identifying substance abuse in incarcerated individuals, professionals must also often diagnose and treat them. A history of substance abuse can make medication prescription more challenging.
Zemel & Norris (2023) published “Telepsychiatry’s Collaborative Care Model: Extending mental health care access to rural communities” in Journal of Rural Mental Health. Here’s the edited impact statement and abstract with some information in bold:
Rural areas are particularly psychiatrically underserved due, in large part, to the scarcity of mental health care providers, underdiagnosis of mood disorders, and high suicide rates. The aim of this article is to propose a solution to the disparity in mental health care access between rural and urban regions in the United States. An extensive literature review was conducted to evaluate potential solutions to the disparity between psychiatric needs and available care in underserved rural locations in the United States. Telepsychiatry, in combination with the collaborative care model, is a promising tool to incorporate psychiatric care within primary care, which, in the context of the growing mental health care provider shortage, would be particularly useful for increasing access to mental health care in underserved rural locations.
In an era in which rural medical and mental health services are being cut despite expanded need for services, a collaborative care model that incorporates telehealth makes sense to me -- especially if it can predict readmission to jails and prisons.