Family Perspectives on Pathways to Mental Health Care for Children and Youth in Rural Communities

Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, Ontario, Canada.
The Journal of Rural Health (Impact Factor: 1.45). 02/2006; 22(2):182-8. DOI: 10.1111/j.1748-0361.2006.00029.x
Source: PubMed


There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem.
This study examines issues of access to mental health care for children and youth in rural communities from the family perspective.
In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders.
Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-à-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews.
The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.

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Available from: Katherine Boydell, Oct 10, 2015
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    • "Forbes, Morgan and Janzen (2006) found that, while both rural and urban residents with dementia reported barriers to accessing healthcare such as long wait times and cost, rural residents often additionally reported that they did not know where to access care. Boydell et al. (2006) found that barriers to accessing mental healthcare for children in rural areas may include not only a lack of services and a lack of awareness of services, but also a fear of stigma related to the smaller social networks in rural communities. Overall, at least three related points emerge from a review of existing rural health services research. "
    06/2014; 7(1):67. DOI:10.5130/ijcre.v7i1.3390
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    • "Corcoran et al. (2007) stated that the fear of labeling results in the adoption of certain coping mechanisms by family members (excusing secrecy, denial). The same attributes were also observed in the study of Judge et al. (2008) and Boydell et al. (2006). Link et al. (1991) stated that psychiatric labels are associated with negative societal reactions which exacerbate the course of the person's disorder. "
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    • "Thus, we find that the role of close-knit social networks to be something of a double-edged sword. This paradox has been found in other studies of barriers to mental health services in rural areas (Boydell et al., 2006). In the field of rural health care, researchers and ethicists have described this dilemma as " the problem of overlapping roles " (Roberts, Battaglia, & Epstein, 1999). "
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    ABSTRACT: Researchers have not adequately addressed the unique characteristics of rural areas that influence the accessibility of services for families with children who have serious emotional problems. Understanding rurality is particularly important to "systems of care" grant sites because these grants are intended to restructure mental health service delivery by building upon the strengths of a community and addressing the community's needs. This qualitative study examines the barriers to and supports for participation in services within a rural system of care site through the reported experiences of eight caregivers and nine staff. Findings indicate families face many challenges related to rurality, including stigma, transportation, isolation, poverty, and service availability. In addition to these challenges, however, participants reported many meaningful supports such as the religious community and the close-knit community of families and service providers. We present implications for planning, implementing, and evaluating systems of care in rural areas.
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