People living in rural areas are more likely to experience attitudinal mental health help-seeking barriers than their urban equivalents, but the role rurality plays in this inequality is poorly understood. This systematic qualitative review aimed to explore the attitudinal barriers experienced by rural residents and better define rurality's role in them. Four attitudinal barrier themes are identified from this review as being experienced by rural residents-stoicism, stigma, distrust, and meaning, and the coexistence of multiple barriers were observed. Rurality is found to have an influence on the stoicism, stigma, and distrust barriers and is explicitly vocalized within barrier statements. With a relationship between rurality and mental health help-seeking barriers strongly implied, we endorse the need for targeted research to inform future policymaking and practice to address urban and rural mental health help-seeking inequalities.

Background Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. Methods Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. Results Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services

Suicide is a leading cause of death, particularly in rural and remote areas. Although depression is strongly related to both suicidal ideation and attempt, it lacks specificity as a predictor, and little is known about characteristics that increase suicide risk among people with depression. A telephone version of the World Mental Health Composite International Diagnostic Interview explored lifetime depression, suicidal ideation, suicide attempt, and related factors among a community-dwelling sample of rural and remote Australians, selected for an interview based on a screener for psychological distress (100% of those with high distress, 75% of those with moderate distress, and 16% of those with low distress). Of 1051 participants interviewed, 364 reported lifetime symptoms of depression; of these, 48% reported lifetime suicidal ideation and 16% reported a lifetime suicide attempt. While depression severity was a significant correlate of suicidality for both males and females, suicide attempt was significantly more common among females with a younger age of depression onset, and a higher number of psychiatric comorbidities. No additional factors were significant for males. Among rural and remote residents with lifetime symptoms of depression, the identification of suicide risk may be enhanced by considering individual and contextual factors beyond depression severity. Further research focusing on risk factors for males would be beneficial.

Objectives Globally, Indigenous people have lower-health status compared to non-Indigenous people due to unequal access to health care. Barriers or enablers to accessing maternal health services by Indigenous women are not well researched. This review aims to determine accessibility and utilisation of maternal primary healthcare services among Indigenous women in lower-and middle-income countries. Methods We conducted a systematic integrative review of published and grey literature published between 2000 and 2017. Studies on maternal healthcare service utilisation by Indigenous women in lower-and middle-income countries were included. From 3092 articles identified, 10 met the eligibility criteria. ResultsThe most prominent barrier to accessing maternal primary healthcare services was the top-down nature of intervention programmes, which made programmes culturally unfriendly for Indigenous women. Distance, cost, transport, accommodation, language barriers and lack of knowledge about existing services also impacted access. Conclusions Findings provided insights into understanding the gaps in existing policies for Indigenous women and their access to maternal health services. Results suggested that efforts be made to ensure appropriate programmes for Indigenous women's maternal health right.

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.