Montana Mental Health Professional  Shortage 2016-2019

Montana Mental Health Professional  Shortage 2016-2019

The RMHP3 Model was created to respond to the lack of mental health support services across the state of Montana. Montana has been known for having grossly high percentages of suicides, practically doubling the national average. In 2017, a survey conducted by the Office of Public Instruction showed that almost 15% of middle school students had made a suicide attempt by the 8th grade. This frightening information sparked conversation among our counselor educators and posed the question, "What can we do about this?" After further investigation, our counselor educators determined in order to reach our most vulnerable populations, we will need to train, support, and deploy mental health professionals where they are needed the most; rural Montana. 

Educators from Montana State University and the University of Montana engaged in a joint effort to explore the best way to meet these goals within their own education programs. Thus, the Rural Mental Health Practice/Preparation Pathway was designed. 

Figure 1:  Suicide Death Rates in Montana and the Nation (from https://afsp.org/about-suicide/suicide-statistics/)

Suicide Death Rates in Montana and the Nation (from American Foundation for Suicide Prevention Statistics)

Need/Problem 

The rural context of Montana – with its vast distances and sparse population – is not simply a backdrop for its citizens.  Rather, the fabric of each rural community in Montana has a complex and dynamic culture shaped by unique social, economic, political, cultural, and historical relations. Montana has three profound mental health needs that will be addressed by this project. Currently, Montana faces the alarming distinction of having:

  1. The highest suicide death rate in the nation;
  2. A growing set of challenges connected to drug abuse and addiction,and; 
  3. A serious shortage of rurally-prepared mental health providers, contributing to a growing disparity in rural schools’ and communities’ access to mental health professionals.

Overall, we found that rural Montana schools are struggling to recruit and amplify/retain qualified mental health professionals. Additionally, mental health needs across the state continue to amplify, especially in relationship to youth suicidality and substance abuse.

We determined we could do more to help train and place mental health professionals in rural communities, starting in our own programs by expanding recruitment in rural Montana.

Our Model

To address the needs of Montana, we proposed the Rural Mental Health Preparation/Practice Pathway (RMHP3) :
a cohort model of counselor preparation where graduate counseling candidates serve in rural communities and participate in a professional learning community throughout their program and their post-graduate prelicensure employment. Together with their peers, graduate counseling candidates will engage in a graduated set of supervised, professional experiences in rural communities. This approach is grounded in prior research examining the preparation PK-12 teachers for rural settings (Downey, 2017). Our two flagship Institutions of Higher Education (IHEs) recognize that typical competition between universities will not adequately address the rural mental health needs in Montana. Therefore, we are combining our resources and expertise to work together to develop and implement this innovative counselor preparation program.

Rural Mental Health Preparation/Practice Pathway (RMHP3)Rural Mental Health Preparation/Practice Pathway (RMHP3)

Accessibility presents a serious challenge for meeting the state’s mental health needs due to our massive geographic distances – both for those seeking services and those seeking preparation. To address issues of accessibility, RMHP3 will strategically prepare and place graduate counseling internship candidates in those schools and communities where distance makes access to mental health services the most challenging. RMHP3 will address issues of accessibility by providing time, space, and transportation support for counseling candidates to participate in a graduated set of supervised, professional experiences occurring in rural frontier schools and communities (Breen & Drew, 2012).

Availability highlights the dearth of mental health providers working in rural areas. Rural mental health professionals tend to face large caseloads, significant isolation, and limited professional support due to the geographic isolation of their communities. RMHP3 will address the issue of isolation and limited professional support by employing a cohort model in which graduate counseling candidates will participate in a professional learning community throughout their program.  Together with their peers they will be supported by technology-assisted supervision in addition to cohort learning.

Acceptability in this context refers to the stigma that can be associated with receiving mental health counseling. Experts suggest that in rural communities, stigma may involve “holding negative stereotypes of behavioral health issues experienced by others as well as self … and this may prevent families from acknowledging a problem or seeking treatment” (Siceloff, et al., 2017, p. 25). We are addressing these unique rural challenges to address stigma sensitively early in counselor development. Through their participation in the RMHP3, counseling candidates will be familiar with, and prepared to effectively respond to, rural families’ reluctance to seek treatment.

Sustainability is a fourth factor that will be addressed by RMHP3. Through the generation of a pathway from field experience to rural professional life, counselors who engage in this process will be prepared and motivated to remain in the communities in which they are placed.  Furthermore, these rural mental health professionals will then become the next generation of clinical partners available to serve as hosts for future RMHP3 counselors-in-training who seek to become fully prepared rural mental health service providers. 

Intervention

We plan to meet our goals by establishing four Counseling Cohorts of ten (totaling 40 mental health professionals) from Montana’s Flagship Universities serving rural mental health needs in Montana’s high needs schools. In order to train our cohorts, we are using a 4 step process:

  1. Rural Life Orientation
  2. Rural Professional Practicum and Rural Counseling Course.
  3. Rural Internship and online learning modules.
  4. Rural Professional Practice.

Short-Term Outcomes

Our short-term objectives are what we aim to achieve during our five year grant period. Our objectives include: 

  1. Increase Partnership capacity with Montana State University, University of Montana, the Office of Public Instruction, public schools, communities, and School Based Mental Health providers.
  2. Prepare counselors with the necessary awareness, knowledge, and skills to address mental health needs sensitively and effectively in rural contexts.
  3. Expand University recruitment, preparation, and retention practices for rural students returning to their communities to practice.
  4. 40 counselors-in-training prepared to serve rural MT schools and communities.

Long-Term Goals

The long-term goals for this model are made possible through our model's focus on sustainability; by bolstering our counseling student's support and knowledge we are setting them up for success and the ability to maintain their position in a rural community. With sustainability in mind, our long-term goals are: 

  1. Develop a model of best practice that prepares counselors-in-training to work in rural communities.
  2. Increased student and community access to fully prepared, high quality counselors.
  3. Counseling graduates are well prepared to address challenges of rural mental health.
  4. Increased networking and consultation available for rural mental health providers.
  5. 40 Mental Health Professionals employed and retained in rural MT schools and communities.