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Confronting the Mental Health Needs of Rural Elders: Epilogue and Exhortation

Our current nonsystem of health care, including mental health care, is upside down. We have abandoned our commitment to values and principles and have substituted a dollar-driven profit motivation. In rural health care, we see managed care as potentially another rural extractive industry following in the traditions of mining and logging. Managed care organizations and tertiary care centers often see in the rural environment an opportunity to extract dollars for their own benefit without consideration for the rural economy and rural individuals’ access to quality care. This contributes to the well-documented problem of out-migration as a destructive element in rural health care. Out-migration is based on reality to the extent that the quality, confidentiality, and availability of services are deficient in the rural community. It is partly perceptual as rural institutions are devalued. In many instances, outmigration is stimulated by managed care organizations and tertiary care providers. Despite these serious and seemingly intractable problems, it is essential that we remain challenged to apply our learning to organizational and operational improvement. In that vein, I conclude this special issue of the Journal of Gerontology with 10 points that I have perceived as common threads throughout the articles it contains.