Practising Psychology in Rural Settings: Issues and Guidelines.

Abstract

Abstract Rural practice presents important yet challenging issues for psychology, especially given the North American and international distribution of the population, levels of need for psychological services in rural settings, limited availability of rural services, and migration of rural residents to urban centres. Direct service issues include the need to accommodate a wide variety of mental health difficulties, issues related to client privacy and boundaries, and practical challenges. Indirect service issues include the greater need for diverse professional activities, including collaborative work with professionals having different orientations and beliefs, program development and evaluation, and conducting research with few mentors or peer collaborators. Professional training and development issues include lack of specialized relevant courses and placements, and such personal issues as limited opportunities for recreation and culture, and lack of privacy. Psychology will need to address more fully these complex issues if rural residents are to receive equitable treatment and services. Psychologists who practice in rural settings face many challenges, including geographic issues, unique qualities of rural residents, and considerable need for but lesser availability of services. We document these and other challenges, suggest how psychologists can adapt to rural settings, and identify areas for further research. The paper reviews literature in rural psychology and related areas (e.g., community psychology, rural sociology), and is illustrated by experiences working in rural and northern Manitoba. The issues are also relevant to urban practitioners wishing to adapt services to clients who have migrated from rural settings. Although the world is increasingly urban, many people remain in rural areas (Murray & Keller, 1991). The last Canadian census (Statistics Canada, 1996) classified 22.1% of Canadians as rural, a total of over 6.3 million people. The percentage rural varied from 55.8% for Prince Edward Island to 16.7% for Ontario, but even the latter figure represented 2 million people. In 1990, 24.8% of the U.S. population was rural, representing over 60 million people (Ricketts, Johnson-Webb, & Randolph, 1999). The number and percentage of people in rural areas is even more dramatic globally, which is relevant to international development and training practitioners for non-Western countries. In 1990 (United Nations, 1991), the percent of people in nonurban regions was over 66% for Oceania (excluding Australia and New Zealand), Asia (excluding Japan), and Africa, and was 25-35% for Eastern and Southern Europe, the USSR, Latin America, North America, and Japan. The figures were under 20% only for Western and Northern Europe, and Australia and New Zealand. Even the relatively low percentages still represented large numbers of rural citizens. International statistics also showed a strong association between ruralness and economic development, with the percent nonurban decreasing markedly from least (80%) to most (27%) developed nations. Although distinct definitions of rural are used for such statistics, ruralness varies in degree. Some rural regions are close to urban centres, such as the regions of Manitoba that surround Winnipeg, the provincial capital with 600,000 people. At the other extreme are isolated or frontier regions remote from large centres or psychological services, and perhaps accessible only by plane or seasonal ice roads. Many communities fall between these extremes, such as Thompson, Manitoba, a town 800 kilometres north of Winnipeg with approximately 15,000 people. Whether people live in rural areas close to major centres or in more remote locations, the challenges of rural practice (e.g., isolation, transportation, lack of privacy) remain problematic to some degree. The preceding statistics change constantly as people move between rural and urban settings. …