The Northwestern Mental Health Center (NMHC), in Crookston, MN, has been with the National Health Service Corps (NHSC) for over 17 years, and in that time we’ve benefitted from 20 NHSC providers. We serve six rural counties in northwest Minnesota, and the widely distributed locations of our services reflect the sparsely populated geography of the area. We are very much an integrated, rural mental health program, integrating mental health with primary health care services and public education through co-location. The facility operates in 12 locations in the area and in client homes.
The average income in our community is below the state-wide average, and several of the counties are the poorest counties in Minnesota. Also, one of our counties is located in the Indian reservation, which presents the challenge of providing a culturally-sensitive care program. We also address language barriers when providing care, so we have staff members who are bicultural and capable of bridging the cultural barriers to address those populations.
One of the pioneering services we are developing is real-time care. Rather than the arduous process of making referrals and setting up an appointment a month later, with a small probability that the patient would actually show up, we try to have real-time care so that access can improve dramatically. But, you can’t do that unless you have enough staff. The NHSC allows us to retain enough people to do some cutting-edge access management for a rural mental health area.
The NHSC has also helped us to make incredible connections. We had an NHSC Scholar from Portland for a four-year NHSC commitment; after which, he moved back to Oregon. The Northwestern Mental Health Center was able to ensure that he continued working with our community through the use of Instruction Television Technology (ITV) technology—“seeing” patients from where he is in Portland. He now has hundreds of our patients who are cared for with ITV technology. It is a great resource for us, because we can easily move him around and place him in alternate settings, including the local corrections facility and nursing homes.
This represents a new way we are achieving access to services in remote areas. At the end of the day, we want to make it possible that any patient, anywhere in this region, can be seen on a same-day basis and get an immediate response, without having to leave their community. One of the things I am proud of, even though we are rural, is that when you examine the data about the amount of people who get access to mental health care in Minnesota, we are ahead of the state-wide average.
Most of the NHSC providers this site has had over the years have stayed in their positions long after the NHSC service commitment was met. Our retention rate is excellent—I believe the loan repayment program is a tool that helps to retain providers. In the past, we would have a six-month delay to see a patient, and now it’s a few weeks at most. The NHSC has allowed us to stabilize our programs and to continue to grow our services in each of these small communities.