Official records offer a relatively inexpensive, nonintrusive strategy for checking on the accuracy of self-reported drug use. Responses of a small sample (N = 67) of former drug treatment clients interviewed using procedures exactly modeled on the National Household Survey on Drug Abuse were compared to their clinic records. The accuracy of reports compared to clinic records varied by drug, with the percentage of known users reporting their use highest for marijuana, followed by cocaine and hallucinogens, and lowest for heroin. Almost half of this sample of former treatment clients denied ever receiving drug treatment.
The mental health funding cuts and the block grant shift of the last decade have placed an increased emphasis on fee-generating services. In already underserved rural areas, this has generated immense challenges for mental health professionals on how to provide services to persons other than those with chronic mental illness. This chapter has discussed alternatives and innovations that have proven successful. Linkages with primary care physicians and indigenous residents who have been trained to provide basic mental health services under the supervision of mental health professionals are just two of the ways in which mental health professionals have risen to meet the challenges placed before them. A review of the literature produced few articles about rural programs addressing the issues of substance abuse, services to women, children, the elderly, those with severe mental illness or developmental disability, and the homeless, or crisis intervention programs. Much work needs to be done to provide adequate services to these special rural populations. It is hoped that the renewed interest in rural areas generated by the farm crisis will produce additional programs addressing the needs of these often underserved populations.
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