Interagency Collaboration in Rural Mental Health: Experiences and Perspectives of Service and Public Insurance Providers

Background and Purpose: Research suggests that rural residents experience mental health concerns at a similar rate to their urban equivalents; however, rural residents do not access mental health services in the same way. Impediments to rural access identified in research include accessibility, acceptability, and availability. In an effort to identify specific issues that can be addressed within state government, this project examined experiences and perspectives of service and public insurance providers around service accessibility, acceptability, and availability in the state of Pennsylvania. By identifying these specific topics, policy recommendations are developed in order for the state government to make changes to meet the needs of rural populations. One such topic that emerged was interagency collaboration. Previous research notes that interagency collaboration is perceived as helpful by both service users and providers and it can address needs that individual agencies in rural contexts cannot meet alone.

Methods: Data was gathered virtually from June through October of 2020. The sample included both mental health service providers and insurers (identified by the National Committee for Quality Assurance report cards for health plans). Thirty-one focus groups were conducted in total: twenty-five with providers (n=119) and six with public insurers (n=28). During the focus groups, participants were asked to reflect on barriers to service use and service delivery, as well as what they saw as the most pressing issues to change. Interviews were transcribed by Zoom software, cleaned, and coded thematically using NVivo software and a codebook generated by the researchers. The intercoder process produced 96.7% agreement between 2 coders.

Results: Interagency collaboration emerged as one of the central factors facilitating, or impeding, mental health service access in rural areas. While all participants, insurers and providers alike, noted the importance of interagency collaboration to the health of service users, many noted that there is neither the time nor the funding to support it long term. While the reliance on interagency collaboration was noted as particularly important in rural areas, the differing cultures in agencies, high staff turnover and the siloed nature of mental health serve as deterrents to effective collaboration. The importance of relationships between those involved in treatment to the process of treating mental health was stressed by both insurance and service providers alike.

Conclusions and Implications: These findings highlight the importance of collaboration in the treatment of mental health in rural areas. They also demonstrate the challenges that insurers and service providers alike face that impede this collaboration. As such, it is important that policymakers address this by providing a funding stream to allow for collaboration to be compensated as well as creating legislative task forces that include greater representation of individual providers.