Service utilisation by rural residents with mental health problems

Centre for Rural Mental Health, Monash University, School of Psychiatry, Psychology and Psychological Medicine, Bendigo Health Care Group, Bendigo, Vic., Australia.
Australasian Psychiatry (Impact Factor: 0.47). 06/2007; 15(3):185-90. DOI: 10.1080/10398560601123724
Source: PubMed


To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use.
This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample.
Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000).
While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking.

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Available from: Henry Jackson, Mar 01, 2014
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    • "However, as mentioned above, the effect of gender role on resistance to help-seeking is mediated, at least to some extent, by self-stigma, in that persons with mental illness, believe themselves to be inferior or “weaklings” for needing to seek treatment. Self-stigmatization of seeking help is more pronounced in men than in women.15,16 Self-stigmatization is probably more amenable to intervention than public stigma or traditional gender roles. "
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    ABSTRACT: There are two principal types of stigma in mental illness, ie, "public stigma" and "self-stigma". Public stigma is the perception held by others that the mentally ill individual is socially undesirable. Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves. The result of this process is "self-stigma". Stigma has emerged as an important barrier to the treatment of depression and other mental illnesses. Gender and race are related to stigma. Among depressed patients, males and African-Americans have higher levels of self-stigma than females and Caucasians. Perceived stigma and self-stigma affect willingness to seek help in both genders and races. African-Americans demonstrate a less positive attitude towards mental health treatments than Caucasians. Religious beliefs play a role in their coping with mental illness. Certain prejudicial beliefs about mental illness are shared globally. Structural modeling indicates that conformity to dominant masculine gender norms ("boys don't cry") leads to self-stigmatization in depressed men who feel that they should be able to cope with their illness without professional help. These findings suggest that targeting men's feelings about their depression and other mental health problems could be a more successful approach to change help-seeking attitudes than trying to change those attitudes directly. Further, the inhibitory effect of traditional masculine gender norms on help-seeking can be overcome if depressed men feel that a genuine connection leading to mutual understanding has been established with a health care professional.
    Neuropsychiatric Disease and Treatment 07/2014; 10:1399-1405. DOI:10.2147/NDT.S54081 · 1.74 Impact Factor
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    • "The 20 rural communities that participated in the AARC project were selected because they had a population size between 5,000 and 20,000 (identified as the approximate optimal size for effective activation of community-based studies [27,28], were at least 100 km away from a major urban centre (population ≥ 100,000) and were not currently involved in another public health project to reduce alcohol harm. "
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    ABSTRACT: Given limited research evidence for community-based alcohol interventions, this study examines the intervention preferences of rural communities and alcohol professionals, and factors that influence their choices. Community preferences were identified by a survey of randomly selected individuals across 20 regional Australian communities. The preferences of alcohol professionals were identified by a survey of randomly selected members of the Australasian Professional Society on Alcohol and Other Drugs. To identify preferred interventions and the extent of support for them, a budget allocation exercise was embedded in both surveys, asking respondents to allocate a given budget to different interventions. Tobit regression models were estimated to identify the characteristics that explain differences in intervention preferences. Community respondents selected school programs most often (88.0%) and allocated it the largest proportion of funds, followed by promotion of safer drinking (71.3%), community programs (61.4%) and police enforcement of alcohol laws (60.4%). Professionals selected GP training most often (61.0%) and allocated it the largest proportion of funds, followed by school programs (36.6%), community programs (33.8%) and promotion of safer drinking (31.7%). Community views were susceptible to response bias. There were no significant predictors of professionals' preferences. In the absence of sufficient research evidence for effective community-based alcohol interventions, rural communities and professionals both strongly support school programs, promotion of safer drinking and community programs. Rural communities also supported police enforcement of alcohol laws and professionals supported GP training. The impact of a combination of these strategies needs to be rigorously evaluated.
    BMC Public Health 01/2012; 12(1):25. DOI:10.1186/1471-2458-12-25 · 2.26 Impact Factor
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    • "As part of their involvement in a RCT of the effectiveness of a community-based intervention, the Alcohol Action in Rural Communities (AARC) project, 20 rural communities in New South Wales (NSW), Australia, participated in this study. Communities were invited to participate if they had a population between 5,000 and 20,000 (n=27), a population size identified as likely to be optimal for effective activation of community-based studies (Judd et al. 2007). Of the 27 communities that met this first criterion, three were excluded because they were within 100 km of an urban centre (population≥100,000) and were, therefore, likely to utilise health services and resources of those centres rather than in their own communities. "
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    ABSTRACT: Aim: A whole-of-community approach can be defined as a range of intervention strategies simultaneously implemented across a whole community. One possibility for the lack of evidence for the effectiveness of this type of approach to reducing alcohol-related harm is that whole-of-community strategies to date have not examined whether this type of approach, relative to alternative strategies, is acceptable to communities. Methods: The acceptability of a whole-of-community approach and a range of uni-dimensional strategies are examined using 3,017 survey responses from a random sample of 7,985 individuals (aged 18-62) across 20 rural communities in NSW, Australia, as part of a large-scale randomised controlled trial: the Alcohol Action in Rural Communities (AARC) project. Using the Australian Electoral Roll, the sample was selected to reflect specific characteristics (i.e., gender and age) of each participating town as defined in the Australian Bureau of Statistics 2001 census. Results: Relative to other commonly implemented intervention strategies, the whole-of-community approach acceptability rating (85.5%) was statistically significantly greater than increased random breath testing (80.7%), pharmacist information (76.2%) and workplace training (77.0%), and less than increased pub/club compliance (95.8%), high-school programs (96.2%), increased police enforcement (89.5%) and hospital-based advice (88.6%). Intervention acceptability ratings were not associated with exposure to the suggested intervention with two exceptions: those exposed to pub/club compliance provided a lower acceptability rating, while those exposed to workplace training/policies provided a higher acceptability rating. Conclusions: The high level of public support for alcohol interventions and the relatively low exposure to such interventions suggest scope for increasing awareness of intervention activity in communities and implementing a coherent whole-of-community approach.
    Journal of Public Health 12/2010; 18(6):543-551. DOI:10.1007/s10389-010-0339-5 · 2.06 Impact Factor
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