Development and evaluation of a pilot program to reduce stigma of mental illness among rural adolescents

Two forms of stigma – social and self – represent barriers to receiving professional help for rural Australian adolescents with mental health issues. Characteristics of rural communities such as self-reliance, social proximity and social exclusion are thought to compound experiences of stigma, creating a fear of seeking professional help. The aim of this project was to design and evaluate a stigma reduction program for rural secondary school students. A two-stage quasi-experimental research design was developed. Study 1 involved working collaboratively with seven students from a rural secondary school to develop a population specific program. The curriculum development process was evaluated and the final form of the intervention documented. Study 2 involved delivering and evaluating the intervention within the same secondary school. The aim of Study 2 was to decrease adolescents‟ stigma of mental illness, as measured by social and self stigmatic attitudes, desired social distance, and help-seeking intentions. The treatment group comprised students from year 7, 8, 9, and 12, and the control comprised a delayed treatment group of comparable students from these year levels. After accounting for attrition, the treatment group comprised 31 (16 females) participants, and the delayed treatment group 36 participants (16 females). Measures of stigmatic attitudes, desired social distance and help-seeking intentions were taken at pre-, post-, and 12-week follow-up. The intervention comprised two sessions each of 90 minutes spaced one week apart. Focus-group discussions held post-intervention expanded evaluations of the program; and suggested areas for improvement. The first hypothesis, that prior to intervention, adolescent boys would have significantly higher social stigma, self stigma, desired social distance from those with mental illness, and perceived barriers to seeking help than females, was supported. The second hypothesis, that participants in the treatment group would report lower social- and self-stigma, desired social distance, and fewer perceived barriers to seeking help post-intervention than pre-intervention and compared to the control group was supported in part. The third hypothesis, that reductions in social stigma, self stigma, desired social distance, and barriers to seeking help would be maintained at follow-up also received mixed support. Qualitative data confirmed that student attitudes towards those with mental health issues improved slightly; however, it also indicated that more change was possible and provided direction for future programs. Results have implications for anti-stigma campaign development and implementation. Suggestions for developing more effective anti-stigma programs that will help to lift the burden of stigma and to increase help-seeking behaviours for rural youth are discussed.Doctor of Psycholog

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

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

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

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

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

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