General practitioners\u2019 experiences and perceptions of mild moderate depression management and factors influencing effective service delivery in rural Australian communities: a qualitative study

Tamishka De Silva,Marjia Daniella Johns,Sandhya Yarlagadda,Vibeke Hansen,Kate Sandy,Sabrina Pit,Sue Phelan,Anjali Prakash

doi:10.1186/s13033-017-0159-x

Abstract

BackgroundRural communities in Australia face significant disadvantages relating to geographical isolation and limited access to mental health services. Documenting general practitioners’ (GP) experiences and perception of mental health services in rural Australia may be useful to gain insight into rural GP management of mild to moderate depression.AimsTo explore GPs’ experience and views on which factors influence access to mental health services for mild to moderate depression.MethodThis qualitative study was conducted in 2014 in the Northern Rivers, NSW, Australia. Data were obtained from semi-structured in-depth face-to-face interviews with ten GPs, and analyses were performed using a general inductive method of thematic analysis.ResultsMost GPs believed that the current services for managing mild-moderate depression were adequate, however they also identified the need for better access and more services that were free for patients. GPs had a positive perception of management of depression in a rural setting, identifying advantages including better doctor-patient relationships, continuity of care and the proximity of services. However, GPs also identified several barriers to access to mental health services in a rural setting, including long waiting-times, inadequate patient rapport with referred professionals, cost of treatment, transportation, geographical location, stigma, and lack of education about available mental health services. As a result, GPs frequently self-managed patients in addition to referring them to other community mental health service providers where possible.ConclusionOverall, GPs appeared relatively satisfied with the resources available in their communities but also identified numerous barriers to access and room for improvement. Rural GPs often self-managed patients in addition to referring patients to other mental health services providers. This should be taken into account when designing mental health policies, developing new services or re-designing current services in rural communities.

Highlights

Rural communities in Australia face significant disadvantages relating to geographical isolation and limited access to mental health services
Most general practitioners’ (GP) believed that the current services for managing mild-moderate depression were adequate, they identified the need for better access and more services that were free for patients
GPs identified several barriers to access to mental health services in a rural setting, including long waiting-times, inadequate patient rapport with referred professionals, cost of treatment, transportation, geographical location, stigma, and lack of education about available mental health services

Summary

Introduction

Rural communities in Australia face significant disadvantages relating to geographical isolation and limited access to mental health services. There is evidence that mental health services are best delivered in the community and at or close to peoples’ homes [4, 6] Notwithstanding this evidence, and the ongoing call for mental health service reform globally, there remain numerous barriers that delay further mental health service reform such as reduced access to services, unequal mental health resource allocation, stigma and discrimination [6]. To combat these barriers, Abdulmalik and colleagues [6] call for a ‘balanced model of care’ that takes into account: the available resources and context; promoting a task sharing approach between hospital and community care; and increased use of community mental health services.

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Conclusion