A series of psychiatric hospital closures has led to a movement of care for individuals with mental illness from state-run facilities to managed care centers. Many of the individuals who no longer reside in psychiatric hospitals have become ensnared in the criminal justice system. Correctional facilities have an increased burden to care for the needs of the mentally ill, but lack the training and facilities to do so adequately. In this study, the lived experiences of correctional staff who have experienced the process of a hospital closure were examined. Psychiatric rehabilitation and gatekeeper theories served as the theoretical framework for the study. Data were collected using focus group interviews with 17 correctional officers and individual interviews with 3 administrative staffers at a jail in a southern U.S. state. Data were recorded and transcribed and then analyzed for themes. Six themes emerged: (a) open the psychiatric hospital back up, (b) training, (c) they don't need to be here, (d) mental health housing/they can't function in general population, (e) public awareness, and (f) they didn't think it through. Analysis of study data resulted in the identification of several gaps in community supports that can improve the lives of mentally ill individuals. These include avoiding future hospital closures, improving correctional mental health bed space, and providing correctional-specific training for staff at the jail. The study has positive social change implications for both correctional staff and mentally ill inmates in that the study can inform the improvement of officer training and the development of new community supports, which can reduce negative outcomes for mentally ill individuals.

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Indiana University-Purdue University Indianapolis (IUPUI) / Access to healthcare services is important for improving health outcomes, preventing and managing illness, and achieving health equity. The geographic maldistribution of physicians has a negative impact on rural areas compared to urban, particularly as it relates to access to healthcare. Rural hospitals have been closing or converting to another form of healthcare service at an increasing rate, adding another element to the existing complexities in rural access to care. Although a hospital closure in any location may have a considerable impact on the community, the closure of a rural hospital may have disproportionately more substantial implications for the economy and employment, health outcomes, and access to care. The contributing factors preceding rural hospital closures have been studied, but less is known about the full impact of rural hospital closures on the community. There is some evidence of shortages in healthcare providers and services, and therefore communities may employ multiple strategies to mitigate the shortages and provide services, including utilizing telehealth/virtual services. This dissertation proposes to examine the effects of rural hospital closures on the community, healthcare services, access to care, and provide a qualitative assessment of telehealth as a strategy to bridge gaps in provider access. This dissertation includes three studies: 1) a systematic review of the literature to examine the impact of rural hospital closures on the community; 2) an empirical study that utilizes a generalized difference in difference design with county and year fixed effects to estimate the relationship between rural hospital closures and nursing homes; and 3) a qualitative study exploring the perceptions and experiences of the nurses that piloted a virtual care support project, providing insights into crucial elements important to the implementation of similar models and the role of telehealth in bridging healthcare workforce gaps.

No description available.