Adaptation of Intensive Mental Health Intensive Case Management to Rural Communities in the Veterans Health Administration

There has been increasing concern in recent years about the availability of mental health services for people with serious
mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks
for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses
VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans
who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed
with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater
likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their
treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE
and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment.
The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer
outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate
the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small
specialized case management teams in rural areas.