Rural Mental Health Services Research Articles

Mental Health Care Delivery for Older Adults in Rural Greece: Unmet Needs.

Mental disorders may go unrecognized and undertreated in older adults. This is the rationale for the launch of specialized mental health services for the elderly in high resourced settings. Rural areas, however, do not receive adequate mental health care owing to socioeconomic and geographical reasons, and this is the case of rural Greece, where research on mental health of the elderly is scarce. This article discusses the challenges of providing mental health care for older adults in rural Greece and the available options. Care can be delivered through the existing rural mental health services that are the mobile mental health units and through the primary care physicians. Training in psychogeriatrics for the personnel of the former and in mental health for the latter is warranted.

Is rural mental health workforce a policy imperative?

An available and effective rural mental health workforce is critical to the provision of contemporary mental health care. Duringthe last 5years new mental health plans and strategies have been released every state and territory of Australia. This policy analysis examines the extent to which workforce, and particularly rural workforce issues are considered in these policies. The analysis revealed that rural workforce issues receive scant attention in state and territory mental health plans. Rural Australians comprise 28% of the total population, yet rural workforce issues are canvased, on average only6% of the time generalworkforce issues are addressed. National mental health workforce plans do focus on the rural workforce, but these arenot referenced in the state or territory strategies or workforce plans. Given the rural mental health workforce shortages, and consumer challenges inaccessing rural mental health services, more planning and consideration to supporting and developing a rural workforce appears warranted.

Older people's mental health in rural areas: Converting policy into service development, service access and a sustainable workforce.

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15-year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence-based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialistmental health-residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step-up step-down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.

The Youth Stream: evaluating the transition to a new model of care at a regional health service.

To determine what benefits and challenges are associated with a cost-neutral organisational change within a rural Community Mental Health Service from a Traditional Care model to a Youth Stream model. Retrospective descriptive analysis of the last 18 months of the Traditional Care model and first 18 months of the Youth Stream model. There was a 17% increase in the number of referrals once the service moved to a Youth Stream model. The increased referral numbers did not lead to a proportionate increase in the number of service contacts, but rather more single assessments were performed. The increased engagement was not reflected across all demographics, with vulnerable youth groups continuing to have below average engagement. Key aspects of data that would allow for further analysis by diagnosis and illness severity were missing from the dataset. Cost-neutral changes to services can create change, if that change is based on need identified within the service. As much care needs to be taken with data entry and evaluation if the service is aiming to perform a retrospective analysis.

Enhancing Team-Work and Supportive Working Environment of the Admission and Transfer Processes in Rural Mental Healthcare Services Using Lean Philosophy

Aim: To improve team work through joint development of clinical processes between regional, rural community mental health teams and rural hospitals using Lean philosophy. Background: There was lack of clarity of the roles and responsibilities of staff in the admission of mental health consumers in rural hospitals and in their transfer to regional acute mental health inpatient unit. This resulted in cross departmental animosity in Central Queensland health services which further led to compromised provision of consumer care. The impetus of this paper; therefore, is to present the application of Lean to the admission process in rural mental healthcare services as well as transfer to the regional acute inpatient unit in order to enhance teamwork and supportive working environment to improve consumer outcomes. Methods: The study utilized a qualitative approach where an online survey monkey was used to capture an in-depth understanding of the perceptions and experiences of the hospital and mental health staff pre- and post-implementation of the new processes. Key results: The participants reported improved collaborative working among the staff which resulted in more effective care provision for mental health consumers. Conclusion: Lean philosophy was successfully applied in creating effective administrative and clinical processes in rural and remote mental health services. Joint development of procedures and processes enhanced adherence to standards, improved teamwork and, consequently, ameliorated consumer outcomes.

Perceptions of rural school mental health services: a focus group study

The presence of emotional or behavioural disorders has an impact on academic achievement. Access to behavioural health services is a challenge, particularly in rural communities. School-based mental health services have been recognised as an effective means of addressing the needs of students with emotional or behavioural disorders. This qualitative focus group study explored the service needs, gaps, and barriers to mental health services. Themes related to time, space, family engagement, and education for teachers and caregivers emerged from the focus groups.

Improving specialist accessibility and involvement in treatment management planning for rural and remote mental health services using Lean practices

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Understanding the Implementation of Telemental Health in Rural Mississippi: An Exploratory Study of using Technology to Improve Health Outcomes in Impoverished Communities

Residents in rural communities often lack access to affordable mental healthcare, which is a significant policy problem. Access to health care is also a major concern for the sustainability of rural communities. Telemental Health (TMH) is the provision of mental health services from a distance by using communication and Internet-based technologies. Our research examines the efficacy of TMH as an administrative tool to provide rural mental health service, to improve the mental health of rural patients, and to advance the sustainability of rural communities. The project was made possible by a grant from the Intelligent Community Institute at Mississippi State University, with the purpose of examining approaches to build prosperous, inclusive, sustainable intelligent rural communities. Given that the administrative features of TMH is an understudied topic, we implemented an exploratory research design to gather foundational knowledge for future work. We conducted semi-structured interviews with subjects working at Community Mental Health Centers (CMHC) in Mississippi. We found that rural providers hold negative and positive opinions of TMH. The interviewees argued that TMH increases access to mental health professionals, and they noted how patients were mostly pleased with the care provided by TMH. However, providers noted a lack of clinical procedures for TMH, less of a rapport between counselor and patient, and an increase in costs of care.

Rural School-Based Mental Health Services: Parent Perceptions of Needs and Barriers

Abstract The benefits of school-based mental health services have been supported in prior research and literature. Studies have shown that approximately one in five youths in schools today have diagnosable mental health disorders. However, research has identified that close to 70 percent of those youths do not receive the services they need. This gap in care has a significant impact on the academic, social, and emotional well-being of youths. Parent involvement is essential in bridging services. However, parents often face barriers in accessing mental health care for their child. The aim of this study was to explore parent perceptions of needs and barriers to school-based mental health services. This exploratory study included 607 parent and guardian respondents. Findings showed that parents were overwhelmingly in support of schools being involved in addressing the mental health needs of students. Anxiety, depression, and bullying were the top emotional and behavioral issues that parents recognized as the main challenge for their child. Lack of parent support, understanding that mental health issues even exist in youths, and lack of supportive school programs were identified as key factors that place youths at risk of not receiving the services they need.

Prioritizing rural and community mental health in India

With a huge population of 1.3 billion and deficient mental health personnel and infrastructure, India needs newer strategies for rural and community mental health care. There is a huge and unmet gap in mental health services, which needs our immediate attention. The National Mental Health Program and District Mental Health Program have made very welcome beginnings, but they are a long way off from even remotely reaching an optimal coverage. Nongovernmental organizations have been playing their important part as well. However, an important impetus can potentially come from the new mental health policies and legislation, which are in keeping with the United Nations Convention on Rights of Persons with Disabilities. Still, there is a lot to be done. The rural mental health services are often neglected and need immediate attention considering the burden of disease and treatment gap. Identifying the economic, social, and political barriers to the utilization of existing services would strengthen the delivery and utilization of these services. The mental health professional should be at the helm of leading and heralding the changes needed. This provides us with the challenge, as well as an opportunity.

Characteristics of alleged homicide offenders with and without schizophrenia in Sichuan, China.

Little is known about the characteristics of people with and without schizophrenia who have been charged with homicide in China. Our research question was what differences are there between alleged homicide offenders with and without psychosis? All archival records of alleged homicide cases referred for assessment to the West China Forensic Central Medical Service during 1998-2006 were retrieved. The centre serves a large catchment area in the mainly rural province of Sichuan. A random 20% of cases with schizophrenia and all cases without psychosis were selected for comparison. Demographic, criminological and mental health data were extracted from the records, and violence was rated by using the Violence Risk Scale (Chinese version). The two groups differed significantly in age, education, occupation, marital status and relationships to victim. The estimated risk of reoffending was higher in the schizophrenia group than the non-psychotic group, even after controlling for demographic differences. Despite many individuals reporting long histories of mental illness, about 40% of those with schizophrenia had never had any psychiatric treatment and less than 4% were in treatment at the time of the alleged homicide. The tendency for homicidal people with schizophrenia to be older, less educated and more socially isolated than their non-psychotic peers is similar to experience in Western countries, but the apparently higher risk scale scores of the Chinese schizophrenia group and their greater tendency to attack strangers are different. The lack of reported previous engagement with mental health services by a clearly ill and risky group of people is a likely explanation. Similar rural problems compared with better served urban areas have been reported in the Chuvash Republic. The case for better rural mental health services seems strong. Copyright © 2017 John Wiley & Sons, Ltd.

Characteristics of patients seen by visiting psychiatrists through Medicare in a rural community mental health service with an established telemedicine service.

We aimed to determine characteristics of patients receiving Medicare-funded face-to-face consultations by psychiatrists in a rural service with an established telemedicine service. For this study, 55 case-managed patients from four rural community mental health teams in South Australia provided information through questionnaires regarding psychological symptoms, quality of life, body mass index (BMI) and gave access to their Medicare data. In a logistic regression, it was found that being younger was more likely associated with a Medicare psychiatric consultation ( p<0.05). Participants with at least one recorded visit to a Medicare psychiatrist consultation also tended to have lower levels of psychological distress at the end of the 4-year period, have a higher BMI, and more general practitioner consultations. The study provides clinicians and policy makers with preliminary information on the subtle differences in clinical profile of patients seen by Medicare-funded psychiatrists within an established state-managed telepsychiatry service.

Factors affecting job satisfaction of Aboriginal mental health workers working in community mental health in rural and remote New South Wales.

Objective The aim of the present study was to identify factors affecting the job satisfaction and subsequent retention of Aboriginal mental health workers (AMHWs). Methods Five AMHWs working in New South Wales (NSW) for NSW Health in rural and remote community mental health (CMH) services participated in in-depth, semi-structured interviews to understand how employment and rural living factors affected workers' decisions to stay or leave their CMH positions. Results Using a constructivist grounded theory analysis, three aspects negatively impacting the job satisfaction of AMHWs were identified: (1) difficulties being accepted into the team and organisation; (2) culturally specific work challenges; and (3) professional differences and inequality. Conclusions Policy and procedural changes to the AMHW training program may address the lower remuneration and limited career opportunities identified with regard to the Bachelor Health Sciences (Mental Health) qualification. Delivering training to increase levels of understanding about the AMHW training program, and cultural awareness generally, to CMH staff and NSW Health management may assist in addressing the negative team, organisational and cultural issues identified. What is known about the topic? The Bachelor Health Sciences (Mental Health) qualification and traineeship pathway undertaken by AMHWs differs significantly from that of other health professionals working in NSW Health's CMH services. The health workforce literature identifies that each health professional group has its own culture and specific values and that forming and maintaining a profession-specific identity is an extremely important aspect of job satisfaction for health workers. What does the paper add? AMHWs working in rural and remote NSW CMH services commonly experience low levels of job satisfaction, especially while undertaking the embedded training program. Of particular concern is the health sciences qualification not translating into NSW Health's 'professionalised' workplace, as well as having negative effects with regard to remuneration and career opportunities within NSW Health. In addition, role challenges involving cultural differences and managing additional professional and personal boundaries negatively affects the job satisfaction of AMHWs. What are the implications for practice? The current structure of the AMHW training program creates workplace conditions that contribute to job dissatisfaction among rural and remote-based AMHWs. Many issues could be rectified by NSW Health making changes to the degree qualification obtained under the training program, as well as raising the level of understanding about the program and Indigenous cultural awareness generally among CMH staff and NSW Health management.

People, processes, and systems: An observational study of the role of technology in rural youth mental health services

The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.

Psychogeriatric SOS: A unique clinician-to-clinician web-based service for rural and remote clinicians

Introduction: The Norwegian Anti-Discriminatory and Accessibility Act adopted in 2008 states that web based electronic services geared towards the public should be accessible to all. Today, the web content accessibility guidelines (wcag-2) is an agreed standard in Norway. However, it should be fair to state that the developers of Norwegian e-health services have not focused on universal design to any particular extent. To obtain a brief estimate of the status in the field, we have investigated the accessibility to some randomly selected e-health services, applying a ad hoc user panel of 4 persons. Methods and materials: We have during 2015 set up a Windows 7 machine with NVDA synthetic speech output and a Brazie Powerbraille display installed. Using Mozilla Firefox, we have investigated the accessibility to 11 Norwegian web based health services. Our investigation included state, municipal and private service providers. The wcag-2 standard and “Referansekatalogen for e-helse” constituted the point of offset for our evaluation. Four users were given specific tasks in connection with each website, and we observed and interviewed the informants as they interacted with each service. We focused especially on the users' ability to operate the services with the keyboard, and if all the functionality on the web pages could be utilized without applying a mouse. Results: The Helseportalen (https://helsenorge.no) provides access to the electronic health record for Norwegian citizens and constitutes a major national initiative in the field of e-health. To which extent can this service be regarded as universally accessible? The html code was found to be robust and consistent, and the functionality, which we investigated, could be operated by the keyboard. This was not true for all of the services, which we evaluated. The login to Helseportalen can be done with mobile bank id, or by a code generator equipped with synthetic speech. However, the initial registration of login method could not be performed by our users. The login to Helseportalen relies on services from private enterprises, and are not necessarily free of charge. The quality of the code on the various sites varied considerably, which potentially causes problems for users of peripheral equipment. Inconsistent use of html headline-tags slows down navigation on several of the evaluated pages. Multimedia content is not followed by a descriptive text (not required by wcag-2 level aa). Discussion: If the construction of e-health services is regarded a work process involving planning, prototyping, implementation, testing, refinement and documentation, the users should be involved in each of this phases to ensure accessibility to the services made. User oriented design methods have a stronghold in Scandinavia, but if for economic or practical reasons such approaches are not regarded feasible, expert evaluations with emphasis on accessibility should be performed on each stage in the development cycle. Background : Rural mental health services are under-resourced and over-burdened. Given the aging population and escalating health costs, we need to innovate to solve this resourcing crisis. Psychogeriatric SOS is a unique service that offers information, advice, supervision, training, education and case conferencing to rural and remote clinicians working with older adults across all disciplines, allowing them to establish a supportive professional relationship with our psychogeriatric multidisciplinary team via a web-conferencing platform. This nascent service has the potential to be a pathway for more efficient use of time for primary clinicians and specialty psychogeriatric services. Aims: To describe rural clinician/user demographics, delineate how this model satisfies unmet clinician professional needs, and determine whether it improves clinician confidence. It will also provide a forum in which members of the Australian GP community can make comments and suggestions. Methods: Rural and remote clinicians in three under-resourced local health districts in NSW and one NGO were provided this service in 2015. During the first 12 months, demographic data, uptake rates, user satisfaction, and pre- and post- intervention clinician confidence measures were collected. Results: 100 registrants participated in a combination of 15 education forums, 25 case conferences and 14 supervision sessions. Confidence questionnaires indicated confidence depended on clinician, context of practice, and number of years practicing (with those having worked 1-5 years being the most confident followed by those having worked more than 21 years). The most prominent areas of need identified by clinicians were educating patients’ carers, and education and case conferencing around clinical psychogeriatric issues. All users returned to use the service more than once. Conclusion: There is a need for the Psychogeriatric SOS model of e-health rural outreach, which may constitute a step towards the more efficient and effective use of mental health resources in rural and remote Australia.

Service providers’ experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service

BackgroundDespite evidence of benefits of telehealth networks in increasing access to, or providing, previously unavailable mental health services, care providers still prefer traditional approaches. For psychiatric assessment, digital technology can offer improvements over analog systems for the technical and, subsequently, the social quality of provider-client interaction. This is in turn expected to support greater provider uptake and enhanced patient benefits. ObjectiveWithin the framework of Innovation Diffusion Theory, to study service providers’ experiences of an existing regional telehealth network for mental health care practice twelve months after digitisation in order to identify the benefits of digital telehealth over an analog system for mental health care purposes in rural Australia. MethodsQualitative interviews and focus groups were conducted with over 40 service providers from June to September 2013 in South Australia, ranging from the metropolitan central operations to health providers located up to 600km away in rural and remote areas of the same state. Participants included rural mental health teams, directors of nursing at rural hospitals, metropolitan-based psychiatrists and registrars, the metropolitan-based mental health team dedicated to rural provider support, rural GPs, administrative staff, and the executive group of the state rural health department. Fieldwork was conducted 12 months after the analog system was digitised. The interview and focus group data were analysed using thematic analysis, focusing on three key areas of innovation diffusion theory: relative advantage, technical complexity and technical compatibility. ResultsFive themes with 11 sub-themes were identified: (1) “Existing Uses”, with three sub-themes: current mental health use, use by GPs, and use for staff support; (2) “Relative Advantage”, with four sub-themes: improved technical quality, improved clinical practice, time and cost benefits for providers, and improved patient care; (3) “Technical Complexity”; (4) “Technical Compatibility” with two sub-themes: technical-clinical and technical-administrative; and (5) “Broader Organisational Culture”, with two sub-themes: organizational policy support and ‘digital telehealth' culture. ConclusionsThe digitised telehealth network was generally well received by providers and adopted into clinical practice. Compared with the previous analog system, staff found advantages in better visual and audio quality, more technical stability with less “drop-out”, less time delay to conversations and less confusion for clients. Despite these advantages, providers identified a range of challenges to starting or continuing use and they recommended improvements to increase uptake among mental health service providers and other providers (including GPs), and to clinical uses other than mental health. To further increase uptake and impact of telehealth-mediated mental health care in rural and remote areas, even with a high quality digital system, future research must design innovative care models, consider time and cost incentives for providers to use telehealth, and must focus not only on technical training but also how to best integrate technology with clinical practice and must develop an organization-wide digital telehealth culture.

Integration in a nurse practitioner-led mental health service in rural Australia.

Integration of mental health services is a prominent Australian mental health policy goal; however, there is little detail in the literature of how integrated mental health services are established or function. This study aimed to describe a nurse practitioner-led primary healthcare rural mental health service and evidence of how the service was integrated with other services and the community. This pragmatic exploratory study used case study methodology and analysed documents, quantitative data and qualitative data from individual and group semi-structured interviews and a 'stakeholder meeting'. The study was part of a formal evaluation of this nurse practitioner service. Rural New South Wales. Twenty-one service providers and stakeholders. Introduction of a nurse practitioner led mental health service. Not applicable. Purposely sampled participants were interviewed. Documentary evidence included briefing notes, minutes and progress reports and provided important background information. Non-identifiable aggregated client data were analysed. Thematic analysis of the qualitative data produced a description of how and why the service was established, a description of the service and its impact and three analytic themes providing evidence of integration. Challenges to integrating this service are also discussed. The service was highly regarded. It addressed the drug and alcohol and mental health needs of a vulnerable rural community. The inception and implementation of the service were community driven, led by a number of agencies supported by a steering committee and underpinned by a Partnership Agreement. The service demonstrated key features of integration alongside experiencing challenges in optimising integration with acute mental health services.

Improving quality of a rural CAMHS service using the Choice and Partnership Approach.

This study outlines the service issues and adjustments associated with the implementation of Choice and Partnership Approach (CAPA) into a rural Child and Adolescent Mental Health Service (CAMHS). A mixed-methods approach examined the impacts of the CAPA implementation. A qualitative review of the minutes from team and implementation group meetings illustrated themes according to 11 key CAPA components. Quantitative internal audit data illustrated waiting list times. Findings showed that inclusive language has replaced the traditional, pathology-driven psychiatric discourse, though this has been met with mixed response from CAMHS clinicians, service users and referrers. Data also showed that a waiting list for clinician allocation has been eliminated, and the waiting time between the referral date and the first face-to-face contact has decreased from 63.9 days to 10.7 days. A modified CAPA Choice appointment system has allowed quick access without a waiting list, in line with government guidelines. A full-booking system and focussed, goal-oriented interventions has led to lower caseloads and optimum use of CAMHS clinician skillsets.

Retention challenge facing Australia's rural community mental health services: Service managers' perspectives.

This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia. Semi-structured interviews. Public health sector, rural New South Wales. Five community mental health managers, running services in rural Australia. Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study. Three key retention focussed themes were identified: (i) Staffing is a persistent challenge; (ii) Small remote towns pose the biggest challenge; and (iii) The decision to stay or leave is complex and multifactorial. The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions.

Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description.

BackgroundRecovery-oriented care is a guiding principle for mental health services in Australia, and internationally. Recovery-oriented psychiatric rehabilitation supports people experiencing mental illness to pursue a meaningful life. In Australia, people with unremitting mental illness and psychosocial disability are often detained for months or years in secure extended care facilities. Psychiatric services have struggled to provide rehabilitation options for residents of these facilities. Researchers have argued that art participation can support recovery in inpatient populations. This study addressed the research question: Is there a role for the creative arts in the delivery of recovery-oriented psychiatric rehabilitation for people with enduring mental illness and significant psychosocial disability detained in a secure extended care unit?MethodsThe study had two major aims: to explore the experiences of consumers detained in a rural Australian secure extended care unit of an art therapy project, and to examine the views of nurse managers and an art therapist on recovery-oriented rehabilitation programs with regard to the art therapy project. A qualitative descriptive design guided the study, and a thematic network approach guided data analysis. Ethics approval was granted from the local ethics committee (AU/1/9E5D07). Data were collected from three stakeholders groups. Five consumers participated in a focus group; six managers and the art therapist from the project participated in individual interviews.ResultsThe findings indicate that consumer participants benefitted from art participation and wanted more access to rehabilitation-focussed programs. Consumer participants identified that art making provided a forum for sharing, self-expression, and relationships that built confidence, absent in the regular rehabilitation program. Nurse manager and the art therapist participants agreed that art participation was a recovery-oriented rehabilitation tool, however, systemic barriers thwarted its provision.ConclusionsThe transformation of mental health services towards a recovery orientation requires commitment from service leaders to provide evidence-based programs. Psychiatric rehabilitation programs based on local need should be included in public mental health services. This study supports the use of art-based rehabilitation programs for people detained in rural secure extended care facilities. Introducing these programs into clinical practice settings can improve the consumer experience and support organisational culture change towards a recovery orientation.