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.

ObjectiveMental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help‐seeking.DesignData were gathered through a cross‐sectional survey distributed by a social media boosted post.SettingA total of 349 “small” rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5.ParticipantsA total of 765 adult, rural residents completed the survey.Main outcome measure(s)Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help‐seeking easier or harder.ResultsStudy participants felt that a help provider with lived experience of mental illness or distress would make mental health help‐seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help‐seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress.ConclusionsEngaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help‐seeking for mental distress. Increased mental health help‐seeking is likely to have a positive impact on instances of serious mental illness.