Cutler Institute for Health and Social Policy

Population Health and Health Policy

Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey


While it is established that rural residents often seek care for mental health problems in primary care settings, or in some cases in a Community Mental Health Center, lack of providers and lack of insurance may lead those with mental illness to the hospital emergency room (ER). Critical Access Hospitals (CAHs) are, by definition, located in small, remote and underserved rural communities and must offer 24-hour emergency services. In such communities, access to local mental health services is more likely to be a problem, and the ER may be a key piece of the mental health ?safety net.? This study investigates the extent and types of cases that present with mental health problems in CAH ERs, as well as the resources available to ER staff for addressing such problems and what actually happens to such patients.
Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. In addition, 184 of these hospitals completed ER logs documenting all ER visits in two 24-hour periods, with details about presenting symptoms, treatment, and final disposition.

Publication Type: 
Publish Date: 
September 1, 2005

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Dr. Ziller to speak on Rural Implementation and Impact of Medicaid Expansions

The impact of the ACA Medicaid expansion on health care coverage and access in rural areas is largely unknown and will depend on the different state policy contexts in which the expansions are implemented and on existing system capacity. Understanding how many rural residents are likely to become newly eligible for Medicaid under the ACA, as well as their characteristics and health status, will provide important information to aid policymakers in structuring outreach and enrollment strategies and ensuring that the healthcare infrastructure and delivery systems in rural areas can address the needs of these individuals.

On March 18th, Dr. Ziller, Deputy Director of the Maine Rural Health Research Center at the University of Southern Maine, will present via a SHARE webinar, nationally representative information identifying rural-urban differences among low-income non-elderly adults (18 to 65) in the following areas:

  • Medicaid eligibility, pre-ACA
  • Medicaid participation, pre-ACA
  • New Medicaid eligibility in 2014

Dr. Ziller will also analyze the characteristics associated with any rural-urban differences in the above areas. Characteristics to be considered include age, gender, employment, education, income, Census region, health status, current relationship to primary care provider, primary care supply, and FQHC availability.

This webinar is based on Dr. Ziller's research under a State Health Access Reform Evaluation (SHARE) grant to inform federal and state implementation of the ACA Medicaid expansion by estimating the size and characteristics of the rural population likely to be newly eligible.
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