Mental health service delivery in rural areas: organizational and clinical issues.
The Appalachian Regional Comprehensive Alcoholism Program in Beckley, West Virginia, was established in 1972 to meet the needs of a four-county catchment area. In designing the program, planners took into account the special cultural and economic characteristics of the population to be served--individualism, isolation, religiosity, conservatism, distrust of newcomers, and economic deprivation--and set up a program they believe respects local norms. For instance, the program has been staffed mainly by local professionals. Individual therapy, family therapy, and crisis intervention are used much more frequently than group psychotherapy, and clients have a strong voice in treatment decisions. Local ministerial associations are involved whenever possible, and outreach efforts include home visits as well as the use of the media to disseminate information.