Access to Behavioral Health Appointments and Care

Access to Behavioral Health Appointments and Care

Access to mental health services is uneven

Missed mental health appointments are a risk factor for all-cause mortality, according to a 2019 BMC Medicine study, with mental health patients experiencing an eightfold increase in risk. The poor access to mental health treatment is exacerbated in rural areas by 1) the shortage of mental health professionals in rural America, 2) the subsequently longer distances individuals have to travel to access such services, and 3) the low frequency of rural public transportation services to transport individuals to services. 

Simplifying Transportation Access for Behavioral Health Patients
This NCMM Video shows lessons learned from one of our Design Challenge teams in El Paso County, Colorado in making it easier for behavioral health patents to routinely access care. 

The Importance of Consistency and Predictability in Transportation Services for Behavioral Health Patients
This NCMM Video shows lessons learned from one of our Design Challenge grantees in Flint, Michigan on how to ensure community members are not missing behavioral health appointments. 

Transportation and substance use disorder treatment

Treatment for substance use disorders (SUDs) has different phases and activities, each of which informs the associated transportation need.

The acute phase is where an individual chooses to enter intensive treatment to address their addiction to a substance.  A person’s first point of contact with substance abuse treatment may be a medical doctor or mental health professional who then refers the person to an addiction treatment program. While treatment at this initial stage may be provided in outpatient settings, people with more severe or long-term instances of addiction might need inpatient or residential care. It is important for an individual, once referred to a treatment center, to enroll in treatment immediately while they are still open to treatment.

Transportation to SUD treatment can be an issue, even with outpatient treatment centers, as they may not be on a public transit route, and even if they are, a public bus may not be the most appropriate choice for the individual at that point in time as they may encounter other individuals with whom they used or from whom they bough substances in the past. 

Transportation to residential treatment centers may be even more difficult; because there is such a demand for their services, there is often a waitlist for these services, and case managers may only be able to locate a center far from the individual’s home. The individual may not have friends, family, or other contacts to help the individual get to that center.

In the recovery phase, the individual’s need for transportation may be significant. Recovery may include several different types of activities, listed below with their associated transportation need:

  • Group and individual therapy — usually occurs on a regular schedule, or at least scheduled in advance, apart from crisis situations
  • Random urinalysis — intentionally not on a regular schedule, needs access to on-demand transportation
  • Medically assisted treatment (“MAT,” such as methadone) — may be a daily occurrence for dosing, which implies the need for intensive level transportation
  • Physical health appointments — usually scheduled in advance, apart from crisis situations


Embracing a Community Network to Support Recovery from Addiction
This NCMM Video shows lessons learned from one of our Design Challenge grantees in Shiawassee, Michigan on creating a system to help community members recover from addiction. 

For further investigation . . .

Barriers to Mental Health Treatment in Rural Areas

This tool provides data on a set of transportation and public health indicators for each U.S. state and metropolitan area that describe how the transportation environment affects safety, active transportation, air quality, and connectivity to destinations.

Additional resources

Needham Community Council Rides to Health Care

Needham Community Council – Needham, MA
In 2017, the Needham Community Council began supplementing its volunteer driver medical transportation program with trips provided through the ridehailing company, Lyft. Lyft rides were funded through the Needham Community Council operating budget and a donation from Beth Israel Deaconess Hospital – Needham.

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Engaging Older Adults in Mobility Management

Brookline Council on Aging – Brookline, MA
Transportation Resources Information Planning and Partnership for Seniors (TRIPPS) is an initiative of the Brookline Council on Aging. TRIPPS launched in 2015 with initial funding through a grant from the Massachusetts Department of Transportation using federal 5310 funding. We provide information, resources, and support to older adults in Brookline who are looking for transportation options. Our focus has been on older adults who are either not driving or are transitioning from driving to other modes. About 70 percent of our older adults who we work with do not own a vehicle.

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Seniors on the GO

Gloucester Health Department – Gloucester, MA
Cape Ann Seniors on the GO launched in October 2019 across the communities of Gloucester, Rockport, Essex and Manchester by-the-Sea to meet an identified need of improving access to healthy food and opportunities for physical activity among low income older adults through increased transportation access. This pilot grew out of the work of the Cape Ann Mass in Motion coalition, a part of the Massachusetts Department of Public Health’s Municipal Wellness & Leadership Program. The need for food and physical activity access was identified through root cause analysis and examining high rates of chronic disease among older adults in our Cape Ann communities. Over half of older adults who reside in Gloucester have four or more comorbidities.

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RideLink-Transportation for Older Adults​

Dakota County Community Services, “The Rapid” – Dakota County, MN
RideLink is a network of five area transportation providers that together provide older adults (age 60+) with door-to-door transportation as a complement to the fixed route bus. RideLink can be utilized for medical appointments, shopping trips, and recreational trips, which sets it apart from other options in the area that limit rides for older adults for specific purposes. RideLink’s providers have multiple types of vehicles that provide service to those who use a wheelchair accessible, and also accommodate service animals and caregivers.

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In-House Microtransit in Rural Massaschusetts

Franklin Regional Transit Authority – Greenfield, MA
In 2019, FRTA launched the FRTA Access microtransit program. In contrast to many microtransit programs that are contracted out to a third-party company, FRTA operates its microtransit in house: FRTA upgraded its scheduling software to allow riders to book on-demand rides, and uses its existing demand-response vehicles to make the trips. Eligible demand-response riders have priority when they reserve in advance, and then any remaining capacity is open to the general public through the FRTA Access app. Initially, riders could only summon rides through the app, but over time FRTA also added an online reservation as some parts of the region lack good cell coverage.

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Taxi-Based Employment Program in Partnership with WIB

Franklin Regional Transit Authority – Greenfield, MA
In April 2021, the Franklin Regional Transit Authority (FRTA), which provides transportation in 41 communities in rural Western Massachusetts and fixed-route services in the small city of Greenfield, added a new pilot to expand mobility for workers needing to commute to late night and early morning shifts. In partnership with the local Workforce Board, FRTA received a grant to fund taxi rides for workers needing to get to second and third shift jobs during hours when public transit was not operating. In addition to getting a ride to work, participants could also stop at a childcare facility if they needed to drop off or pick up their children on the way.

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