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2002
AI
This findings paper examines the opinions of mental health service users in the Highlands regarding the formal mental health care services available to them. It highlights significant issues related to access, particularly due to geographical disparities in service distribution, and discusses user experiences with various services including psychiatrist consultations, Community Psychiatric Nursing, and General Practitioner support. The paper concludes with reflections on medication use, service provision, and crisis care, emphasizing the need for improved accessibility and user support in rural and remote areas.
Mental Health and Illness in the Rural World
A large proportion of people live in rural areas of the world especially in the lowto middle-income countries. The services for mental disorders of rural population remain poor even in high-income countries. The treatment gap for mental illness is about 80% in low-income countries and perhaps even worse for rural people. The reasons of treatment gap are complex. Mental health is often given low priority despite constituting nearly one fifth of the overall health morbidity. Low investment in mental health leads to limited mental health resources available to the country's health service. In low-to middle-income countries, these are concentrated in the cities, depriving rural communities of any specialist mental health services. Stigma, discrimination, poor literacy, and specific cultural belief toward mental illness restrict rural people to accept and access appropriate help. Integration of mental health at primary care level is the only way forward to address this unmet need. Primary care health workers, however, lack in knowledge and skills to detect and manage mental disorders. The World Health Organization has come up with an ambitious mhGAP initiative to train primary care workers using its intervention guidelines. Recent mental health programs (PRIME) involving primary care workers and local organizations have shown some benefits as well as highlighted challenges in organizing services especially in low-income countries to serve predominant rural communities. Organizing services for people in the rural areas needs to involve local people by understanding their views and perception of mental disorders, an extensive public health education program addressing the issues of stigma and discrimination existing toward mental illness, investing in adequate mental health resources, but more importantly integrating mental health with general health. This can be achieved by training frontline health workers in diagnosing and managing mental disorders supported by specialists. Modern technology and tools using mobile-and computer-assisted methods could greatly assist frontline workers if well supported by telemedicine approaches by mental health specialists.
Australian Journal of Rural Health, 2007
To identify service providers' and community organisations' perceptions of the resources available to support people with mental illness and the unmet needs of this client group in rural Queensland. Design: An exploratory study was undertaken involving focus group interviews across the study sites. Setting: Five regional towns in rural Queensland. Participants: Ten to 14 members were recruited for each of the five focus groups. The groups represented a diverse mix of participants including health and community service providers and representatives from community organisations. Results: Participants identified gaps in services in relation to health, employment and education, housing and accommodation, transport and social inclusion and health promotion. Inter-service communication and inappropriate funding models were themes affecting service delivery. Conclusions: Specific service issues of housing and transport were identified to be particularly problematic for people with mental illness across all towns. Intersectoral communication and funding models require further research.
Australasian Psychiatry, 2007
To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use.
BMC Health Services Research, 2013
Background: The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia. Methods: A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables. Results: The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services. Conclusions: An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.
The Lancet, 2006
Visiting-specialist clinics (specialist outreach) have the potential to overcome some of the substantial access barriers faced by disadvantaged rural, remote, and Indigenous communities, but the effectiveness of outreach clinics has not been assessed outside urban and non-disadvantaged settings. We aimed to assess the effects of outreach clinics on access, referral patterns, and care outcomes in remote communities in Australia.
The Journal of Primary Prevention, 1982
Disability and Rehabilitation, 2013
Purpose: Throughout the world, people with a disability who live in rural and remote areas experience difficulty accessing a range of community-based services including speech-, physioand occupational therapy. This paper draws on information gathered from carers and adults with a disability living in a rural area in New South Wales (NSW), Australia to determine the extent to which people living in rural areas may receive a person-centred therapy service. Methods: As part of a larger study in rural NSW into the delivery of therapy services, focus groups and individual interviews were conducted with 78 carers and 10 adults with a disability. Data were analysed using constant comparison and thematic analysis. Results: Three related themes emerged: (i) travelling to access therapy; (ii) waiting a long time to get therapy; and (iii) limited access to therapy past early childhood. The themes overlaid the problems of recruiting and retaining sufficient therapists to work in rural areas. Conclusions: Community-based rehabilitation principles offer possibilities for increasing person-centred therapy services. We propose a person-centred and place-based approach that builds on existing service delivery models in the region and involves four inter-related strategies aimed at reducing travel and waiting times and with applicability across the life course.
BMC Psychiatry, 2014
Background: Rural and remote Australians face a range of barriers to mental health care, potentially limiting the extent to which current services and support networks may provide assistance. This paper examines self-reported mental health problems and contacts during the last 12 months, and explores cross-sectional associations between potential facilitators/barriers and professional and non-professional help-seeking, while taking into account expected associations with socio-demographic and health-related factors. Methods: During the 3-year follow-up of the Australian Rural Mental Health Study (ARMHS) a self-report survey was completed by adult rural residents (N = 1,231; 61% female; 77% married; 22% remote location; mean age = 59 years), which examined socio-demographic characteristics, current health status factors, predicted service needs, self-reported professional and non-professional contacts for mental health problems in the last 12 months, other aspects of help-seeking, and perceived barriers.
2012
The information contained in this publication is intended for general use to assist public knowledge and discussion and to help improve the development of sustainable regions. You must not rely on any information contained in this publication without taking specialist advice relevant to your particular circumstances. While reasonable care has been taken in preparing this publication to ensure that information is true and correct, The Commonwealth of Australia gives no assurance as to the accuracy of any information in this publication.
Australian Psychologist, 2007
The aim of this review was to determine which sociodemographic, illness-related and psychological/attitudinal factors impact on a person's decision to seek help and the factors associated with attitudes to help-seeking in rural contexts. A computer search of the literature for 1990-2006 using the terms ''help-seeking'' and ''mental'' found 350 studies. Examination of the abstracts by one of the authors (AK) identified 20 relevant studies, which we review under two major headings: those papers dealing with help-seeking studies not specific to (but which may have included) rural settings; and a second group of studies conducted specifically in rural locations or that directly compared rural with urban locations. A number of factors were found consistently to be predictive of both mental health utilisation and attitudes toward formal help-seeking. They included sociodemographic factors such as gender, age, and marital status; illness-related factors such as having a mental disorder, comorbidity, and psychological distress; and, to a much lesser extent, psychological/attitudinal factors, including stigma, stoicism, and self-efficacy. Psychological/attitudinal factors have been poorly investigated compared to sociodemographic and illness-related variables and are worthy of further investigation. Their impact and value may vary according to location. Proposed herein is the development of a comprehensive framework that has emerged from the health and place literature as one way of understanding barriers to accessing mental health care.
Australian & New Zealand Journal of Psychiatry, 2019
Objective: Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. Method: This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults.
Administration and Policy in Mental Health, 1995
Frontiers in Psychiatry
IntroductionMental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas.MethodsThe study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed ...
2020
Mental health care and illness prevention present distinct challenges in rural areas with limited resources. This paper examines rural-specific mental health care concerns and uses a public health prevention model to discuss the most current and prolific strategies to address these issues. The unique role of the social work profession in implementing these strategies is highlighted.
Health and Social Care in the Community, 2004
This paper draws on a consultation with 200 stakeholders about a mental health plan in the most remote region of South Australia to discuss primary mental healthcare improvement strategies. In rural and remote environments, a lack of services means that it is more difficult to deal with a mental illness or provide assistance for circumstantial life problems. The authors' consultations revealed difficulties with service access, acceptability and teamwork. They also found that the availability of local human service workers leads to their use as first-level mental health contacts, but these workers are neither skilled nor supported for this. These difficulties will require attention to the boundaries between different service providers which can otherwise create inflexibility and service gaps. The regional mental health plan that is being rolled out will develop collaboration through regional interagency task groups, networking groups for local human service workers and the position of a regional mental health coordinator in order to overcome these difficulties and to operationalise service partnerships.
Maine Rural Health …, 2010
Due to chronic shortages of mental health services, much of the burden of care for mental health issues in rural areas has shifted to the primary care sector (Gale & Lambert, 2006). The National Advisory Committee on Rural Health and Human Services recognized the important role played by the primary care sector in meeting the mental health needs of rural residents in its 2004 report to the Secretary of the Department of Health and Human Services (National Advisory Committee, 2004). With almost 3,800 clinics in operation, Rural Health Clinics (RHCs) are an important rural primary care resource (CMS, 2009). An earlier study of RHCs found that few offered mental health services (0.12% employed a doctoral-level psychologist and 0.07% employed a clinical social worker) (Gale & Coburn, 2003). This study examined changes in the delivery of mental health services by RHCs, operational characteristics of these services, barriers and challenges experienced by RHCs, and policy options to encourage more RHCs to deliver mental health services. Methodology Using 2005-2006 Medicare Hospital and Independent RHC Cost Reports, we identified 62 (out of 1,117) independent RHCs and 28 (out of 1,349) provider-based RHC that employed a doctoral-level psychologist or clinical social worker. From this group, we completed in-depth semi-structured interviews with 14 randomly selected RHCs (six independent and 8 providerbased) to explore the reasons for developing mental health services, barriers and challenges to doing so, the operational and clinical characteristics of their mental health services, and challenges to their ongoing operation and sustainability. Thirteen clinics were currently providing mental health services and had done so for an average of eight years. One providerbased RHC had terminated services when its sole mental health provider left the practice. Findings Approximately 6% of independent and 2% of provider-based RHCs offer mental health services by employing doctoral-level psychologists and/or clinical social workers. The models used to provide mental health services included contracted and/or employed clinicians housed in the same facility as the primary care providers. The most commonly treated conditions were depression, attention deficit hyperactivity/attention deficit disorders, and anxiety. Participants
Advances in Mental Health, 2014
Background: Rural and remote residents have been identified as a group with limited access to mental health services. Older rural people may experience additional problems due to lack of access to transport, limited opportunities for social engagement and the stigma attached to mental illness. Aim: To explore the extent to which service providers, carers and consumers view the Older Persons' Mental Health Service (OPMHS) as meeting the needs of older people with mental health problems in rural South Australia. Methods: Semi-structured interviews were conducted at 3 case study sites with 22 key informants from mental health teams and organisations providing care to older people and with 4 consumers and 5 carers. Results: The establishment of OPMHS clinicians at the sites studied led to increased access to specialist services for older people leading to earlier assessment and treatment of consumers. It has also led to greater service integration and knowledge sharing about older persons' mental health. Participants identify ongoing service needs particularly for remote, CALD and Aboriginal populations and for after-hours crisis care. Conclusion: The localisation of services and attachment of specialist older persons' clinicians to rural mental health teams has enhanced service delivery for older people through enabling case management within rural communities. There are however, ongoing service needs which need to be resolved. ED3 ED4
Social Science & …, 2010
Abstract: Equitable access to primary care for people with common mental health problems in the UK remains problematic. The experiences of people from hard-to-reach groups offer important insights into barriers to accessing care. In this study, we report on secondary analysis of qualitative data generated within seven previously-reported studies. Thirty-three of ninety-two available transcripts were re-analysed using a new heuristic of access, generated to frame narrative-based comparative case analysis. The remaining transcripts were used to triangulate the findings via a process of collaborative analysis between a secondary researcher, naïve to research findings of the original studies, and primary researchers involved in data generation and analysis within the original studies. This method provided a rich body of ‘fine grain’ insights into the ways in which problem formulation, help-seeking, use of services and perceptions of service quality are interlinked in a recursive and socially embedded matrix of inequitable access to primary mental health care. The findings indicate both extensive commonalities between experiences of people from different ‘hard-to-reach groups’, and considerable diversity within each group. An idiographic generalisation and aggregation of this variety of experiences points to one main common facilitator (communicated availability of acceptable mental health services) and two main common barriers (lack of effective information and multiple forms of stigma) to equitable access to primary mental health care. We conclude that there is a need to provide local care that is pluralistic, adaptive, holistic, resonant and socially conscious in order to ensure that equitable access to mental health services can become a reality. © 2010 Elsevier Ltd. All rights reserved
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