Issues in rural adolescent mental health in Australia

The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised – including the nature of mental health issues for rural adolescents and barriers to seeking professional help – are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.C

Detection and management of eating disorders by general practitioners in regional Australia

The aim of this study was to explore the prevalence of eating disorders in primary care in the Ballarat region and to highlight the role of GPs in the detection and management of eating disorders in regional Australia. We used anonymous data previously collated by the Ballarat and District Division of General Practice on the prevalence of eating disorders and patterns of referral of eating disorder patients among GPs in their Division. Over half of GPs surveyed indicated that they treat patients with eating disorders within their practice rather than referring patients to other services. In referring on, GPs were more likely to refer to mental health professionals and dietitians. A notable finding was that these regional GPs were more likely to refer to metropolitan specialist services than local hospitals if their patients required an admission. GPs in regional Australia do significant work to detect and manage patients with clinical eating disorders in the absence of locally-based, specialist services. In this context, we recommend the establishment of linkage partnerships between GPs and mental health practitioners to facilitate early intervention for rural and regional eating disorder patients. Further research into the current treatment practices of regional GPs is also needed to ascertain their specific training needs with respect to this patient population.C

Australian rural adolescents’ experiences of accessing psychological help for a mental health problem

Objective: This study aims to explore Australian rural adolescents’ experiences of accessing help for a mental health problem in the context of their rural communities. Design and setting: A qualitative research design was used whereby university students who had sought help for a mental health problem during their adolescence were interviewed about their experiences. Interviews were conducted face-to-face at the university. Main outcome measures: A semi-structured interview schedule was designed around the study’s main research questions. Audio-taped interviews were transcribed and thematically coded using a constant comparative method. Participants: Participants were first-year undergraduate psychology students between the ages of 17 and 21 years who sought help for a mental health issue during their adolescence and who at that time resided in a rural area. Results: Participants highlighted various barriers to seeking help for mental health problems in the context of a rural community, including: social visibility, lack of anonymity, a culture of self-reliance, and social stigma of mental illness. Participants’ access to help was primarily school-based, and participants expressed a preference for supportive counselling over structured interventions. Characteristics of school-based helpers that made them approachable included: ‘caring’, ‘nonjudgemental’, ‘genuine’, ‘young’, and able to maintain confidentiality. Conclusions: The findings support previous research that reveals barriers to help seeking for mental health problems that are unique to the culture of rural communities. The study raises questions about the merit of delivery of primary mental health care to young people via GPs alone and suggests that school-based counsellors be considered as the first step in a young person’s access to mental health care.C

Mental health problems in rural contexts : A broader perspective

The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help-seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in-depth understanding of the help-seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities.C

Interpretive phenomenological approaches to rural mental health research

While researchers in the fields of social work and nursing have recognised the usefulness of qualitative research methods for many years, researchers in psychology have tended to lag behind in their understanding of the value and applicability of qualitative approaches. The aims of this article are to consider the role of qualitative research in psychology, to outline the various steps involved in conducting qualitative data collection and Interpretive Phenomenological Analysis (IPA) for those not versed in these techniques, and to provide a case example of the applicability of these methods to rural adolescent mental health research. The final section of this article includes a detailed discussion of the advantages and limitations of IPA.C

Socioeconomic status as a mediator of the relationship between depression and rurality in Australian adolescents

The purpose of this study was to establish whether socioeconomic status would mediate the relationship between rurality and depression in a sample of Australian adolescents. Participants were 65 rural and 64 urban secondary school students from Years 11 and 12 who completed a survey that included a brief demographic questionnaire and the Centre for Epidemiological Studies - Depression Scale. Schools were selected for their degree of rurality as measured by the Accessibility and Remoteness Index for Australia, and the socioeconomic status of each individual was estimated via postal code using the Socio-Economic Index of Australia. Although a significant relationship between degree of rurality and depression was found, socioeconomic status did not mediate this relationship. These results suggest that the relationship between rurality and depression for young people is not due to simple differences in socioeconomic status between urban and rural areas. Other features of 'place' must be considered in accounting for rural-urban differences in adolescent depression.C

Understanding barriers to mental health service utilization for adolescents in rural Australia

INTRODUCTION: There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities. METHOD: A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia. RESULTS: Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery. CONCLUSIONS: There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.C

Rural adolescents' attitudes to seeking help for mental health problems

Little research has been undertaken into the barriers facing rural adolescents seeking help and support for mental health problems. This study presented students from rural secondary schools in Victoria with hypothetical scenarios of an adolescent living in a rural area with a mental disorder and posed questions inorder to create group discussion. The results revealed a range of perceived barriers to help-seeking that could be considered unique to rural settings. However, adolescents also expressed positive attitudes and identified a range of professional help sources available to them. The findings support recent moves towards providing school-based mental health services to young people in rural areas.C

Preferences and intention of rural adolescents toward seeking help for mental health problems

Introduction: In Australia, rural adolescents still face barriers to obtaining professional psychological help due to poor availability and accessibility of services in rural areas when delay in seeking help for mental health problems can lead to poorer treatment outcomes. The aims of this study were to: investigate the preferences and intentions of rural Australian youth towards seeking help for mental health problems; determine predictors of help-seeking intention among rural adolescents; and verify results from previous qualitative research on the barriers to help-seeking in a rural context. Method: Participants were 201 adolescents recruited from 8 rural schools in the state of Victoria, Australia. Participants ranged in age from 11 to 18 years. Using the Accessibility and Remoteness Index of Australia (ARIA+), approximately 149 participants were classified as currently living in an inner regional area of Victoria, whereas 52 participants lived in an outer regional area. Participants completed an open-ended survey of help-seeking intention. Results: Overall, 55.7% of the sample indicated that they would seek help for a mental health problem. The majority of participants, regardless of subgroup, indicated that they would seek help for a mental health problem from a school counsellor as their first choice. Gender differences were observed such that males had a higher preference for seeking help from a psychologist than females. Furthermore, older adolescents were more likely to prefer seeking help from a GP than younger participants. A multivariate analysis of help-seeking intentions revealed that ARIA was the only predictor of help-seeking intention; however, when extreme scores of depression and anxiety were also taken into account, these also predicted help-seeking intention. A content analysis of the barriers to help-seeking nominated by participants revealed that perceived limited availability of professional services in towns, perceived social proximity and fear of rural gossip, and difficulties associated with travelling to obtain help were the most significant concerns for these youth. Conclusions: These findings verify previous research on help-seeking among rural youth and reinforce that these young people face additional barriers to help-seeking by virtue of living in a rural environment. The availability of services for rural youth needs to be improved, as do young people's knowledge of service availability and access (especially travel options). It must be taken into account that rural adolescents of different ages and sex may differ in their help-seeking preferences. Finally, mental health promotion work with rural youth should consider the influence of rural culture on help-seeking intentions