Rural Mental Health Services Research Articles

Growing the peer workforce in rural mental health and social and emotional well-being services: A scoping review of the literature.

Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings. Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature. A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search. A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'. While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services. The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

Reflections on being an insider researcher: a study exploring the experiences of men accessing rural mental health services.

An embedded single case-study design was used to explore the experiences of men in rural New Zealand accessing mental health services. It is essential for researchers to acknowledge positionality in case study research and the lead author used reflexive practice to acknowledge his values and beliefs. To explore and demonstrate the reflexive process of the lead author's position as an inside researcher. Three groups were involved in the research: men with mental health challenges, their partners, and mental health clinicians. The article presents the initial research through memos and diarying in the context of current literature. Reflexivity is essential for ensuring the research process is complete and biases are identified. Positionality exists on a continuum and it is critical for researchers to be honest with themselves, the topic and the group being investigated, to show respect for the participants and the people they represent, as well as to be committed to revealing the truth. Insider research has the potential to bridge the gap between academia and practice. It facilitates the transfer of research knowledge directly to practitioners, leading to more evidence-informed decision-making and practice.

Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol

IntroductionNegative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive–behavioural therapy...

From not knowing to doing: An interprofessional approach to clinician training in use of Goal Attainment Scaling (GAS) as a recovery-oriented outcome measure in a rural mental health service.

Outcome measurement and feedback are key to quality improvement in healthcare. Goal attainment scaling (GAS) is a tool that could be used to measure outcomes of mental health services delivering recovery-oriented care. The objective of this prospective study was to evaluate the effectiveness of tailored, interprofessional, multilevel and adaptable GAS training on clinician views, learning, competence, performance and confidence in the use of GAS. Thematic analysis of eight clinician participant views was done using the method proposed by Braun and Clarke (Thematic analysis: a practical guide to understanding and doing, 2022). Four main themes were generated: clinicians found that this type of training is useful, GAS influenced the way they thought about their roles in goal setting and recovery-oriented care and COVID-19 pandemic impacts. Furthermore, clinicians' skills to set scalable GAS goals with consumers and clinician confidence in using GAS improved. The results of this study show a positive impact of tailored, interprofessional, multilevel and adaptable training supporting development of clinician skills in the GAS process. The training design had a favourable effect on clinician views, learning, competence, performance and confidence of GAS as a recovery-oriented outcome measure. The approach to GAS training and use of GAS as a recovery-oriented outcome measure should be considered in response to mental health service reform.

Younger people with dementia registered to public mental health services in Victoria, Australia.

Objectives Individuals living with young-onset dementia fall through the gaps of adult and geriatric services. Given that non-cognitive symptoms of dementia in younger people are often psychiatric and behavioural in nature, these people may contact mental health services. There is sparse information investigating the frequency of people with young-onset dementia who contact mental health triage in Victoria. Methods Triage data were obtained from the Victorian Agency for Health Information. The data contained demographics for people registered with Victorian mental health services. Consumers who had an International Classification for Diseases code for dementia and were aged less than 65 years were identified as people with young-onset dementia. Using information of the frequency of people with young-onset dementia who were registered with each area-based mental health service, population census statistics were used to make estimates of the frequency of young-onset dementia. Results Of the 6172 people who had a dementia diagnosis, 1020 of them were aged less than 65 years and had young-onset dementia. There were proportionally more men who had young-onset dementia compared to women. There were more people with young-onset dementia registered to rural mental health services compared to metropolitan services. Conclusion Findings provide important information for service planning in Victoria. Recommendations include upskilling and education for the assessment of dementia for those clinicians who work in mental health services, particularly in rural regions.

Service Users’ Descriptions of Recovery-Oriented Elements of a Rural Mental Health Service

ABSTRACT Recovery-oriented practice is the dominant framework for mental health services in Australia. However, evidence demonstrating recovery processes outside public services is scant. This study explores how key processes from the Connectedness, Hope, Identity, Meaning, and Empowerment (CHIME) personal recovery conceptual framework related to service-user experiences of a rural mental health service during the COVID-19 pandemic. Qualitative telephone or video-conference interviews were conducted with 19 service users. Deductive and inductive data analysis was employed, applying the CHIME framework as a predetermined organisational structure. Themes were constructed according to the CHIME framework categories. The data reflected all five categories; connectedness and empowerment were salient. Participants’ service-delivery experiences could either enhance or hinder connectedness, the cultivation of hope, a positive identity, meaning in life, and empowerment. Nonclinical aspects of their experience were viewed as an extension of treatment. Opportunities exist for mental health practitioners to intentionally prioritise and strengthen recovery-oriented practice. Trauma-informed approaches are consistent with and complement personal recovery principles. Accountability structures are needed to monitor recovery-oriented practice in mental health settings. Family-focused interventions also need strengthening to build connectedness, meaning, and hope. IMPLICATIONS Recovery can be promoted and enhanced within primary care mental health services through intentional focus on the key processes. Trauma-informed principles and care are congruent with a recovery-oriented approach and support connectedness and empowerment. Social workers are well placed to lead and drive recovery-oriented practices in private settings that move beyond an individualistic focus to include holistic care and family-focused practice.

It takes a village: what lessons can the UK learn from rural community mental health services in Ghana?

PurposeThis paper aims to provide new insights into and offer potential solutions to the challenges encountered by mental health services working with remote, rural or underserved communities in the UK.Design/methodology/approachIn this paper, the authors reflect on the utility of integrating conventional clinical approaches, with preventive care and empowering work within the community, to provide culturally sensitive and accessible mental health services. The authors describe an example of community intervention from a mental health service in Ghana designed to enhance reach within remote and rural communities and identify potential lessons for practice in the UK.FindingsThe partnership between community mental health services and the rural communities, including families and existing social frameworks, applies collaborative care to overcome the lack of resources and facilitate the acceptability of mental health services to the local population. There are a series of important lessons from this experience including the importance of understanding the culture of a community to optimise reach and the importance of working IN the community and WITH the community.Originality/valueThis paper is novel because it provides learning from a model of care applied in the global south that has potential for implementation with underserved populations in the UK. The authors suggest a reframing of the notion of community care to encompass existing frameworks of community, not merely a biomedical conceptualisation.

Cognitive remediation therapy - implementation and translation into clinical practice in rural and metropolitan New South Wales mental health services.

Cognitive Remediation Therapy (CRT) is an effective intervention in managing the significant cognitive deficits experienced by those living with psychosis. Given its strong evidence base CRT is recommended in Australian and international guidelines for rehabilitation of people with psychosis, however, access to CRT remains limited. In this commentary, we describe recent efforts to implement CRT programs within NSW mental health services. Development of CRT delivery has been successfully achieved in both rural and metropolitan settings, utilising both face-to-face and telehealth methods. The delivery of CRT in public mental health services is feasible and adaptable to diverse settings. We strongly advocate for sustainable implementation of CRT into routine clinical practice. This will require policy and practice change to enable resources for CRT training and delivery to become embedded in the roles of the clinical workforce.

Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe.

Mental 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. The 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 by two independent raters. The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.

An evaluation of junior doctors' experience in smoking cessation training in a rural mental health setting.

IntroductionSmoking prevalence remains high amongst people with mental illness, however, they are less likely to be screened for tobacco dependence and offered treatment to quit. Smoking cessation and education training are insufficient in medical schools, despite a positive relationship between training and practice once qualified. However, the question as to whether there is adequate skill and expertise to address smoking in people with mental illness within Australian mental health settings is unclear. Furthermore, people living in rural and remote areas smoke at higher rates, quit at lower rates than those in urban areas, and experience limitations in their ability to access smoking cessation supports. The Smokers’ Clinic is an initiative established in a rural Australian mental health service offering a smoking cessation service to patients and staff employed by the service.AimThis study aims to assess the change in the knowledge and confidence of resident medical officers in their understanding of nicotine dependence, smoking cessation strategies and prescribing nicotine replacement therapy in a community mental health setting. It was hypothesized that providing education and supervised clinical experience would improve knowledge, increasing confidence and motivation in managing smoking cessation in mental health patients. The research was undertaken using data collected through a questionnaire obtained from surveying resident medical officers administering the Smokers’ Clinic following a 10-week rural community mental health rotation.Materials and methodsTwenty resident medical officers completed the 10-week rotation, with 14 completing the questionnaire. Knowledge of tobacco smoking, nicotine dependence and smoking cessation interventions improved with the experience of the Smokers’ Clinic during the clinical rotation. Resident medical officers were motivated to spend additional time engaged in self-directed learning and all reported continued use of acquired experience and information in their clinical work after the rotation.ConclusionThis study indicates the utility of a novel approach in delivering education, training, building clinical expertise, and facilitating sustained clinical capacity amongst junior medical staff for smoking cessation in a rural community mental health setting. It offers an efficient approach for mental health services to deliver smoking cessation services to reduce the morbidity and mortality burden associated with tobacco smoking.

Integrating Telepsychiatry Based Care in Rural Acute Community Mental Health Services? A systematic literature review

BACKGROUND: There is limited local literature specific to emergency department assessment and subsequent telepsychiatry follow up in the community and most literature on telepsychiatry does not cover the case of urgent assessment and crisis follow up in the community. AIM: This literature review explores the use of videoconferencing technology to overcome the burden of distance and access to tertiary mental health services in regional and remote areas of Australia. METHODS: A systematic search in Medline, CINAHL, Psychiatry Online, Google Scholar, and the NSW Health Clinical Info Access Program (CIAP) was conducted. A combination of key terms: “Telepsychiatry” OR “Mental Health Telemedicine” OR “Telemedicine” OR “Telehealth” OR “Videoconferencing” OR “Mental Health Videoconferencing” OR “Telepsychiatry Ethics” AND “Acute Community” AND “Emergency Assessment” were used. Based on the screening and eligibility criteria, 21 peer-reviewed articles published in English between 2005 and 2020 were included in the review. RESULTS: Key themes were found which support the use of remote telepsychiatry. Common in the literature were themes of equivalence to in-person review, as well as themes of convenience, overcoming remoteness and timely access to specialist assessment. Ethical and technical considerations was also commonly cited. The literature search found no direct examples of an acute psychiatric assessment in the emergency department with a subsequent follow-up in the community using videoconferencing technology. CONCLUSION: Telepsychiatry in both the home and emergency department areas had merit and equivalence to face to face review, with the added benefit of wider access and timeliness to specialist assessment and treatment.

Developing a Trauma-Informed and Recovery-Oriented Alternative to ‘Aggression Management’ Training for a Metropolitan and Rural Mental Health Service

For clinicians working in mental health services, ‘aggression management’ training is generally prioritised, and often mandated. Traditional ‘aggression management’ training has the potential to reinforce the perception that violence and aggression are inevitable, and thus defensive and coercive practices are needed. This paper outlines the principles and processes that underpinned the development of two training programs designed as recovery-oriented and trauma-informed alternatives to traditional ‘aggression management’ training. The focus of the paper is on exploring how ‘aggression management’ training can be aligned with best practice principles. The programs were developed in a metropolitan and rural mental health service and aimed to reduce the need for defensive and coercive practices by promoting therapeutic engagement. A key feature of both programs is an orientation towards safety rather than risk. By embedding the principles of recovery and trauma-informed care in their development and orienting training towards enhancing safety, clinicians are provided with a new way of conceptualising and responding to ‘aggression’. Experiential methods in the delivery of the training, and the co-design and co-delivery with peer (consumer) educators were important in supporting attitudinal change. To promote safety, the language and content of training programs must reflect contemporary principles and approaches such as trauma-informed care and recovery. This paper illustrates that to be effective, these principles and approaches must not just be described, but modelled in the development, design, and delivery of the training.

Mental Health Service Use, Suicide Behavior, and Emergency Department Visits Among Rural US Veterans Who Received Video-Enabled Tablets During the COVID-19 Pandemic

Suicide rates are rising disproportionately in rural counties, a concerning pattern as the COVID-19 pandemic has intensified suicide risk factors in these regions and exacerbated barriers to mental health care access. Although telehealth has the potential to improve access to mental health care, telehealth's effectiveness for suicide-related outcomes remains relatively unknown. To evaluate the association between the escalated distribution of the US Department of Veterans Affairs' (VA's) video-enabled tablets during the COVID-19 pandemic and rural veterans' mental health service use and suicide-related outcomes. This retrospective cohort study included rural veterans who had at least 1 VA mental health care visit in calendar year 2019 and a subcohort of patients identified by the VA as high-risk for suicide. Event studies and difference-in-differences estimation were used to compare monthly mental health service utilization for patients who received VA tablets during COVID-19 with patients who were not issued tablets over 10 months before and after tablet shipment. Statistical analysis was performed from November 2021 to February 2022. Receipt of a video-enabled tablet. Mental health service utilization outcomes included psychotherapy visits, medication management visits, and comprehensive suicide risk evaluations (CSREs) via video and total visits across all modalities (phone, video, and in-person). We also analyzed likelihood of emergency department (ED) visit, likelihood of suicide-related ED visit, and number of VA's suicide behavior and overdose reports (SBORs). The study cohort included 13 180 rural tablet recipients (11 617 [88%] men; 2161 [16%] Black; 301 [2%] Hispanic; 10 644 [80%] White; mean [SD] age, 61.2 [13.4] years) and 458 611 nonrecipients (406 545 [89%] men; 59 875 [13%] Black or African American; 16 778 [4%] Hispanic; 384 630 [83%] White; mean [SD] age, 58.0 [15.8] years). Tablets were associated with increases of 1.8 psychotherapy visits per year (monthly coefficient, 0.15; 95% CI, 0.13-0.17), 3.5 video psychotherapy visits per year (monthly coefficient, 0.29; 95% CI, 0.27-0.31), 0.7 video medication management visits per year (monthly coefficient, 0.06; 95% CI, 0.055-0.062), and 0.02 video CSREs per year (monthly coefficient, 0.002; 95% CI, 0.002-0.002). Tablets were associated with an overall 20% reduction in the likelihood of an ED visit (proportion change, -0.012; 95% CI, -0.014 to -0.010), a 36% reduction in the likelihood of suicide-related ED visit (proportion change, -0.0017; 95% CI, -0.0023 to -0.0013), and a 22% reduction in the likelihood of suicide behavior as indicated by SBORs (monthly coefficient, -0.0011; 95% CI, -0.0016 to -0.0005). These associations persisted for the subcohort of rural veterans the VA identifies as high-risk for suicide. This cohort study of rural US veterans with a history of mental health care use found that receipt of a video-enabled tablet was associated with increased use of mental health care via video, increased psychotherapy visits (across all modalities), and reduced suicide behavior and ED visits. These findings suggest that the VA and other health systems should consider leveraging video-enabled tablets for improving access to mental health care via telehealth and for preventing suicides among rural residents.

Impact of Electronic Health Record Interoperability on Telehealth Service Outcomes.

This paper aims to develop a telehealth success model and discusses three critical components: (1) health information quality, (2) electronic health record system quality, and (3) telehealth service quality to ensure effective telehealth service delivery, reduce professional burnout, and enhance access to care. The paper applied a policy analysis method and discussed telehealth applications in rural health, mental health, and veterans health services. The results pointed out the fact that, although telehealth paired with semantic/organizational interoperability facilitates value-based and team-based care, challenges remain to enhance user (both patients and clinicians) experience and satisfaction. The conclusion indicates that approaches at systemic and physician levels are needed to reduce disparities in health technology adoption and improve access to telehealth care.

Value-based Healthcare: The Politics of Value-based Care and its Impact on Orthopaedic Surgery.

Value-based Healthcare: The Politics of Value-based Care and its Impact on Orthopaedic Surgery.

COVID-19 from the perspective of urban and rural general adult mental health services.

COVID-19 has presented society with one of the greatest challenges in living memory. Community Mental Health Teams (CMHTs)have needed to adapt quickly to a rapidly developing situation which has had a dramatic impact on society. In this piece, we describe some of the early challenges for CMHTs within two mental health services based in Dublin and Wicklow. We also discuss ongoing developments and anticipate the need for further vigilance as the COVID-19 pandemic continues to evolve.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

Rural mental health service utilization in a Texas telepsychology clinic.

To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas. Archival data from 290 low-income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors. Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity. A "hub and spoke" model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health-related barriers to care experienced by clients when implementing services and policies.

Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

ObjectivesIndividuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who...

RURAL MENTAL HEALTH FOR CHILDREN AND ADOLESCENTS: CHALLENGES AND OPPORTUNITIES

Known barriers to child and adolescent mental health service delivery in rural settings include shortages and maldistribution of mental health providers, geographic isolation, transportation difficulties, and stigma, yet methods developed to address disparities in rural mental health service delivery have not been applied systematically or consistently. This presentation will examine effective strategies for improving access to mental health services for youth in rural communities and highlight successful programs designed to serve this vulnerable population.