Providers' perceptions of barriers to the treatment of emotional disorders in non-urban primary care clinics

Context: Primary care providers (PCPs) are often the main source of mental health treatment in rural areas. Greater concerns about income and insurance, negative attitudes to mental illness and help-seeking, limited availability of mental health referrals, and increased travel distances have been suggested as barriers to the treatment of emotional disorders in rural areas. Purpose: The purpose of this study was to investigate PCPs' views on the significance of barriers faced by patients in obtaining treatment for emotional disorders to determine which barriers were most problematic and which barriers were associated with rurality. Methods: PCPs (n=180) completed the Barriers to Treatment Questionnaire rating the severity of difficulties in various domains of assessment and treatment for mental health problems. Rurality was determined by the population of the city from the PCPs' mailing addresses. Findings: PCPs rated barriers associated with income and insurance as the most severe barriers, followed by attitudes to mental illness and help-seeking. Barriers associated with rurality included concerns about confidentiality and distance to referral facilities. Limitations: PCPs, not patients, reported on perceived barriers. The sample was based on PCPs in small cities and rural areas, but did not include urban areas, and the response rate was relatively low. Conclusions: Problems associated with financial concerns and patient attitudes are the most severe barriers to the treatment of mental illness in rural areas. Concerns about confidentiality, poor quality of referrals, and travel distance were more severe in more rural areas.