Academic journal article Health and Social Work

The Linkage Model for Delivering Mental Health Services in Rural Communities: Benefits and Challenges

Academic journal article Health and Social Work

The Linkage Model for Delivering Mental Health Services in Rural Communities: Benefits and Challenges

Article excerpt

The movement of health care delivery into a period of increased emphasis on primary care, community-based health services, and management of chronic health problems makes it increasingly important to develop service delivery models incorporating the assessment of physical, social, and psychological well-being into the treatment process (Berkman, 1996; Mechanic, 1994). Physical health and mental health are intertwined. Mental health issues affect recovery from physical illness (Berkman, 1996). Depression, one of the major mental health problems presented in primary health care settings, contributes to disabilities in functioning that are as severe as those resulting from most chronic physical illnesses (Wells et al., 1989; Zung, Broadhead, & Roth, 1993). Although the mental health system has typically been viewed as having major responsibility for delivering mental health services, primary care providers also play a central role in caring for people with mental health needs (Schulberg, 1995), especially in rural areas (Rost, Humphrey, & Kelleher, 1994).

Recognition that mental and general health are intertwined suggests the need to find ways to link these sectors of care (Gonzales, Magruder, & Keith, 1994). The linkage model involving placement of mental health center staff within general health care settings represents one promising prototype of linking services. Examples of this linkage arrangement are present throughout the United States (Bird, Hartley, & Lambert, 1996).

Several difficulties in providing accessible and adequate mental health services in rural areas make it particularly important to discover ways to integrate general health with mental health services (National Advisory Committee on Rural Health, 1991). These difficulties include shortages of trained health care professionals, community stigma attached to mental health problems and services, and large geographic distances between clients and providers (Berger & Dixon, 1990; U.S. Congress, Office of Technology Assessment, 1990; Wagonfeld, Murray, Mohatt, & deBruyn, 1994).

This article presents the results of research on the linkage model of service delivery, findings from a study examining this model from the perspective of mental health staff placed within rural general health care settings, and some implications for social work practice. The study discussed in this article targeted ongoing linkage arrangements rather than programs established in response to specific research projects.

The findings of this study are of particular importance for social workers who traditionally have been concerned about incorporating psychosocial aspects into health care (Badger, Ackerson, Buttell, & Rand, 1997), because social workers are major providers of mental health services.


Given the shortages of mental health services in rural areas and the difficulties people have in using existing services, rural primary care providers are especially likely to care for people with mental health problems and to encounter problems in referring them for specialized care (Rost et al., 1994). Unfortunately, mental health problems frequently remain undiagnosed in primary care settings and are not appropriately treated despite promising pharmacological and psychosocial treatment approaches (Brody et al., 1994; Mynors-Wallis & Gath, 1993; Robinson et al., 1995; Schulberg, 1995). For example, informing primary care providers about the diagnosis of depression in specific patients and recommending appropriate treatment strategies do not necessarily result in adequate treatment for depression (Brown, 1997). Major gaps also occur in referrals for specialized services (Attkisson & Zich, 1990; Saltz & Magruder-Habib, 1985; Schulberg, 1991; Spitzer et al., 1994).

Federal Policies

Federal policies between 1978 and 1981 encouraged collaborative efforts between mental health services and other community services. …

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