Critical issues in reforming rural mental health service delivery

Abstract

Critical issues in reforming rural mental health service delivery systems under health care reform are outlined. It is argued that the exclusive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural area, which should focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural areas are delineated and three assumptions about the structure of rural communities which are shaping the dialogue on rural health and mental health service delivery are examined. These assumptions include the notion that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and that rural dwellers represent a low risk population which can be effectively served through existing facilities and by extending existing services.

Rural behavioral health services for children and adolescents: An ecological and community psychology analysis

“…The exploration of how rural areas compare to urban ones in terms of the incidence, prevalence, and severity of mental health and substance abuse disorders-all issues at the ontogenetic level-constitutes the bulk of the research that has been focused specifically on rural populations. Rural behavioral health researchers assert that these disorders tend to be more problematic and pervasive in rural areas than popular belief would indicate, approaching or surpassing urban areas by some accounts (Blank et al, 1995).…”

Coal seam gas development and community conflict: a comparative study of community responses to coal seam gas development in Chinchilla and Tara, Queensland

“…Also important to note is the agreement among scholars about the implication of stigma in relation to health. This further broadens the understanding of how and why stigmatised groups in a society are more exposed to health impacts and how they are related to stigma that defines social exclusion (Major & O'Brien, 2005;Reidpath et al, 2005;Blank et al, 1995). I link the literature on stigma and health to understand how perceived health impacts or risk perception relates to stigmatised identity relating to the CSG project development.…”

“…In particular, the social exclusion of ‗Blockies', either by the Tara Agrarians to protect their socio-cultural norms, or self-imposed to minimise the chances of stigmatisation, limited their access to social networks or a wider community support system which were important to cope with health-related issues. The importance of such social networks is undoubtedly connected to health-related issues (e.g., O'Brien et al, 1994;Blank et al, 1995).…”

“…I also argue that perhaps this attitude becomes necessary to guard the self-esteem of those whose self has been rejected by the normals. Such a rejected, devalued, discredited self is left only to reside in a judgmental atmosphere controlled by oneself in a ‗back place' without community support (e.g., Goffman, 1963;O'Brien et al, 1994;Blank et al, 1995). In the case of the Tara subdivisions, accusing the CSG industry of causing the health impacts could be considered an easier way to comprehend the situation and reject or conceal the negative attributes possessed by the identity.…”

Human trafficking: an examination of available services and support in Prince George, B.C.

“…Health care in rural and remote communities is unequal to that in urban areas due to a variety of limiting factors, including Canada' s expansive geography (Commission on the Future of Healthcare in Canada, 2002), harsh climate (Leipert, 2002), physician retention difficulties (Humphreys & Gregory, 2012 ;Roberts, Battaglia, & Epstein, 1999;Toguri, Jong, & Roger, 2012), reorgan ization of the health care del ivery system in British Columbia's non-metropolitan areas (Hanlon & Halseth, 2012), and an assumption that rural residents retain ties to urban areas, thus failing to address issues of availability, access and financing (Blank, Fox, Hargrove & Turner, 1995). Furthermore, due to the restructuring of government policy, there is increasingly greater reliance on family and the voluntary sector for health care provision in rural areas (Hanlon et al, 2007;Skinner, 2008).…”