In 2021 the National Rural Health Alliance suggested that, while the prevalence of people living with a diagnosed mental illness was similar, at 20%, for all Australians, this may well conceal a much higher rate of psychological distress and undiagnosed mental illness for those living in rural and remote communities. Self-harm and suicide rates increase with remoteness and rates of long term and risky drinking and substance misuse, which are often comorbid with mental illness, show strong regional dependence. This is complicated by both access and utilization issues with those living remotely experiencing difficulties finding services which are often delayed and expensive compared to those in the city.
Understanding ‘barriers and facilitators to accessing and utilising mental health services within the rural Australian context’ was the motivation for a scoping review conducted by Kavanagh et al (2023).
Collecting the Data
53 studies were identified, 25 of which described barriers and/or facilitators from the vantage of the health providers, 13 from the client’s perspective and 8 combined the two. Most of the studies were conducted in NSW. While the client populations vary, 4 focussed on Aboriginal and Torres Strait Island people, 4 on mental health services for young clients, 4 included a proportion of users under 18 and 2 discussed services for older people.
What Were the Barriers?
The most prominent barrier for both providers and users was limited resources including ‘lack of available general and specialist services, limited-service capacity, workforce shortages, difficulty attracting and retaining staff, and staff turnover.’ The complexity navigating the health care system was of concern to providers and users resulting in long wait times and delays in assessment and diagnosis.
Users identified attitudinal and social issues as constraints and in particular privacy and confidentiality concerns in the delivery of services in local communities. This was particularly worrying for local medical practitioners who felt the need to be ‘stoic’.
While technology was acknowledged to be of advantage for some it was deemed less satisfactory for older users and aboriginal and Torres Strait Islander people who prefer face to face services.
Lack of awareness by both referrers and users was also a barrier. This included understanding of mental health issues, needs and services.
Service users were specifically affected by the spatial distances required to travel to obtain care especially for older people and those with physical disabilities. They also reported limited ability ‘to meet the needs of culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander communities’.
What Facilitated Care
Both users and providers identified collaborative and non-judgemental person-centred care delivered regularly and non-intrusively as a key facilitator.
For some, technological facilitation in the form of telehealth, live chat, SMS appointment reminders and mental health pages were valued. These services provided deliverers with connection and information sharing, supervision, access to specialists, upskilling and security. Service users valued ‘immediacy of consultations, cost savings, anonymity, and reduced mental health hospitalisations and admissions, additional client appointments, the need to travel, stigma, and family stress’.
A non-clinical and comfortable environment was important for young people and co-located services facilitated information sharing and service integration. Integration into the community which ensured providers were aware of community and local issues and could share and collaborate was also a facilitator.
For service users, mental health literacy and culturally sensitive practice aided access.
In Conclusion
We live in a vast country, and it is unjust that those who live in the most remote locations who contribute to us all should be so disadvantaged. While limited resources are clearly the major constraint and must be addressed it is heartening to identify factors that can be addressed at a community level that make access to services easier.
Kavanagh et al. BMC Health Services Research (2023) 23:1060 https://doi.org/10.1186/s12913-023-10034-4
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