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Abstract: The mental health of people in rural communities is influenced by the robustness of the mental health ecosystem within each community. Theoretical approaches such as social ecology and social capital are useful when applied to the practical context of promoting environmental conditions which maximise mental health helping capital to enhance resilience and reduce vulnerably as a buffer for mental illness. This paper explores the ecological conditions that affect the mental health and illness of people in rural communities. It proposes a new mental health social ecology framework that makes full use of the locally available unique social capital that is sufficiently flexible to facilitate mental health helping capital best suited to mental health service delivery for rural people in an Australian context.
Rural Mental Health Ecology: A Framework for Engaging with
Mental Health Social Capital in Rural Communities
Rhonda L. Wilson,
1
G. Glenn Wilson,
2
and Kim Usher
1
1
School of Health, University of New England, Armidale, NSW 2351, Australia
2
Environmental and Rural Science, University of New England, Armidale, Australia
Abstract: The mental health of people in rural communities is influenced by the robustness of the mental
health ecosystem within each community. Theoretical approaches such as social ecology and social capital are
useful when applied to the practical context of promoting environmental conditions which maximise mental
health helping capital to enhance resilience and reduce vulnerably as a buffer for mental illness. This paper
explores the ecological conditions that affect the mental health and illness of people in rural communities. It
proposes a new mental health social ecology framework that makes full use of the locally available unique social
capital that is sufficiently flexible to facilitate mental health helping capital best suited to mental health service
delivery for rural people in an Australian context.
Keywords: mental health, ecology, social capital, young people, rural, health
INTRODUCTION
Social ecology describes how people within communities
interact and transact with each other in the context of that
community’s specific characteristics (Bronfenbrenner
2005). As with the natural world, and the ecology of
organisms generally, relationships within the context of the
environment in which they occur are influenced by con-
ditions (Krebs 1985). If conditions are optimal for the
proliferation of health and well-being, then the community
is more likely to be healthy (Krebs 1985). However, where
conditions are suboptimal, then poor health and greater
vulnerability for ill health can be anticipated (Kellert 2012).
Social ecology is a perspective that seeks to understand the
optimal conditions for human health and well-being
(Bronfenbrenner 2005).
Rural social ecology has specific dynamics that inter-
face with the mental health and illness experiences of rural
people. Help-seeking for mental health problems requires
that individuals are first able to self-recognise that a mental
health problem may exist for themselves, and to believe that
seeking some help to resolve the problem may be beneficial.
Self-recognition is influenced by health beliefs, attitudes,
values and the knowledge that people have about health
and health services, along with their attitudes about the
perceived helpfulness of any available services (Judd et al.
2006). In Australia, approximately one third of the popu-
lation live outside of major cities and rural people are 16%
more likely to experience a mental health problem than
their urban counterparts. Furthermore, the rural life ex-
pectancy in Australia is up to four years less than urban life
expectancy and suicide is 66% more likely in rural settings
Correspondence to: Rhonda L. Wilson, e-mail: rhonda.wilson@une.edu.au
EcoHealth
DOI: 10.1007/s10393-015-1037-0
Original Contribution
Ó2015 International Association for Ecology and Health
than in major cities (Australian Bureau of Statistic 2011).
The rural context is a significant determinant of health and
understanding the rural social ecology applied to mental
health in particular is the focus of this paper.
Rural relationships are complex and need to be
understood across multiple systems and layers of local
relationships, dual relationships and across a variety of
directions (Kilpatrick and Wilson 2012). The selection of a
theoretical framework that can be applied to the mental
health context of rural people requires careful attention. A
large body of evidence supports the fact that social capital
plays an important role in determining the physical and
mental health of individuals beyond their genetic and be-
havioural characteristics (Bronfenbrenner 2005; Boyd and
Parr 2008; Byun et al. 2012; Kellert 2012; Stokols et al.
2013). Social capital, a growing area of health discourse,
refers to the collection of community or personal assets,
trust and cohesiveness that is available in a human social
system (Boyd et al. 2008). It is recognised within a com-
munity in to the extent to which the flexibility of trans-
actions occur that enhance, protect and accommodate
social needs for sustainability and development within that
community (Kilpatrick and Wilson 2012), as such, it is seen
as a moderator between illness and health. A rural health
system that is limited to a traditional biomedical and
generic model of service delivery will inevitably fail to
comprehensively meet demands of all rural situations. In
other words, a ‘one size fits all’ service delivery may not
effectively address the cultural aspects which underpin the
social capital resources, values, and beliefs evident within
many rural settings, yet these are crucial aspects to be
considered when deploying a sufficiently diverse health
service to rural communities (Fraser et al. 2002; Farmer
et al. 2012). However, while it is apparent that a generic or
traditional system of health service delivery will be suffi-
cient for a proportion of the population, it does not nec-
essarily hold that it will be sufficient for all members of the
community. Establishing a service delivery model that is
inclusive of unique local rural social capital that is adaptive,
flexible and less restrictive is more likely to reach a broader
cross-section of demand. While we recognise that
improvement of rural mental health care delivery and
outcomes continues to be a challenge for health policy
makers, we argue that disentangling rural mental health
services from restrictive delivery models is needed to
facilitate timely and targeted mental health care for rural
communities.
The purpose of this paper is to offer an overview of the
ecological conditions that underpin mental health care
delivery in rural communities. A new mental health helping
framework (see Figure 1) is proposed that makes full use of
the locally available and unique social capital that is suffi-
ciently flexible to facilitate mental health helping capital
best suited to appropriate service delivery for rural people
in a rural context. Ways in which social capital can be
recognised as mental health helping capital and generated
within rural communities to improve mental health and
well-being will be explored and findings of recent explo-
rative research being undertaken in this area will be used to
help explain how a social ecological perspective can be
utilised to promote rural mental health resilience.
SOCIAL ECOLOGY
Social ecology has risen to prominence in health research
over the past ten years, with a particular focus on social
capital (Yang et al. 2011). It describes how populations
develop and utilise their connections and strengths within
communities to enhance and develop cohesion and pro-
ductivity (Putman 2000; Yang et al. 2011; Byun et al. 2012).
Many commentators have influenced the conceptuali-
sation of social capital, while various strains of the concept
have developed over time and have been applied to various
situations. Social ecology as developed by these theorists
focused on how the environment is organised into systems
(Bronfenbrenner 2005; Boyd et al. 2008; Kellert 2012). The
basic tenets of the social ecology framework suggest the
importance of the individual and his or her physiological
and psychological organisation and how these fit within a
microsystem made up of family and friends, a mesosystem
that includes work, neighbourhoods and organisations,
within a macrosystem of social order that includes policies,
public services and legal frameworks (Bronfenbrenner
2005).
Social Capital and the Natural Environment
Social capital is a constructive ecological condition which
when successfully harnessed, is able to enhance the devel-
opment of protective and resilient characteristics within a
community (Boyd et al. 2008). Social capital deployed
strategically, for example, to optimise the mental health
ecosystem of rural young people, offers an important buffer
R. L. Wilson et al.
to adverse social conditions within a community context
(Boyd et al. 2008).
Rural sociologists have largely focused on perspectives
that define social capital as connections among individu-
als—social networks and the norms of reciprocity and
trustworthiness that arise from them (Putman 2000; Byun
et al. 2012; Yang et al. 2011). In combination, social ecology
and social capital can be conceptualised as a feature of both
social organisations and as a community asset (Boyd et al.
2008; Putman 2000; Yang et al. 2011). In particular, social
trust, help (volunteerism), social connection and cohesion
have been identified as social capital attributes that are
protective of mental health in rural communities (Allen
et al. 2012; Berkman et al. 2000; Farmer et al. 2012; Yang
et al. 2011). Thus, a form of mental health protective social
capital within a framework of rural social ecology can be
seen to be a subset of such social capital. From ecological
and biophillic perspectives, an exploitation of the charac-
teristics that make up social capital, especially those that
form robust and protective mental health within rural
communities, will enhance the environment in such a way
that human thriving, wellness and productivity is achiev-
able for most people at optimal healthy levels (Kellert 2012;
Krebs 1985).
Biophillia can be described as the natural attraction
and appreciation people have towards the nature and their
capacity to intellectually comprehend the complex natural
environment with logic and reason (Albrecht et al. 2007;
Kellert 2012; Factor et al. 2013). This capacity to reason and
understand the environment has safety implications. For
example, people are adverse to environmental factors that
are threatening or that represent danger, such as floods or
fire. In a similar respect, people are adverse to climatic
conditions that are too hot or too cold. These types of
aversions are representative of mental health conditions
also, such as developing a fear of environments and social
conditions that may be harmful to mental health and well-
being (Kellert 2012). In contrast to the avoidance of
Figure 1. Framework for rural mental health care.
Rural Mental Health Ecology
harmful environments, people are likely to exploit envi-
ronments and social relationships that enhance health and
well-being. For example, harvesting natural resources for
practical utilisation and other gains, and social relation-
ships which are enjoyable and satisfying (Kellert 2012), and
this positively reinforces mental heath/ wellness and buffers
vulnerabilities towards mental illness. People also have an
affinity to form emotional bonds and attachment with the
natural environment and this particularly impacts on a
sense of mental health and well-being, so much so, that
people experience the desire to control the environment
(Factor et al. 2013). People experience a sense of connec-
tion, meaning and purpose related to their experiences of
the natural environment that provides a sense of spiritual
connection to the world beyond one’s self (Kellert 2012).
Finally, Kellert (2012) suggests that the human affinity
for the natural environment is so strong that it is sym-
bolically represented in images, language and designs and
that this too enhances a sense of well-being for people.
With these core biophillic values as the components of a
theoretical framework for understanding mental health and
well-being, it is possible to illuminate the experiences of
rural people with emergent mental health problems from a
unique perspective, and to better understand the complex
context in which mental health decline occurs for them.
Rural Social Ecology: A New Framework for Rural
Mental Health Care
A social ecological framework accommodates a broader
range of human and environmental interactions and
transactions with exchanges that are bidirectional and
mutually influential, and which are able to deal with
individuals, small and large groups, communities and
organisations (Kilpatrick and Wilson 2012, Stokols et al.
2013). Additionally, social ecological frameworks draw
from a broad range of social and ecological influences and
are well suited to accommodating perspectives from func-
tional ecology biophillia, social capital and health in an
effort to enhance social-environmental systems and im-
prove health outcomes for peoples and environments
(Stokols et al. 2013). A social ecological framework (see
Figure 1) which draws from a functional ecological basis
with applications to the social ecological context of mental
health social capital is a useful lens to apply to the rural
context so that all of the relevant factors affecting peoples’
mental health can be properly considered. Thus, by com-
mencing with a fundamental ecological lens and with filters
for social aspects in particular, a logical progression to
funnel towards a social ecological framework, it is possible
to illuminate the social capital and especially the mental
health helping capital availability and utilisation within
rural communities.
Human Development and Mental Health Ecology
The physiological development and maturation of the hu-
man brain is subject to the ecological conditions in which
development occurs (Blows 2011). Poor mental health, and
mental health risk or vulnerability, is related to the quality
of the whole environment in which an infant, child or
young person with a developing mind and brain progresses
towards adult human developmental maturity (Blows 2011;
Kellert 2012). If the environment is overcrowded (housing
as an example) it could be anticipated that the conse-
quences for successful and healthy maturation could be
compromised, just as it is in other species in natural world
settings (Krebs 1985). Or, if the food supply is of a sub-
optimal quality (for example, highly processed and lacking
in fruit and vegetables) to nurture physiological develop-
ment within the brain during key developmental matura-
tion phases, then it stands to reason that the brain will
struggle to attain an optimal developmental potential
(Krebs 1985). Similarly, if the brain is exposed to toxic
substances in the environment, or if toxic substances are
introduced to the body during sensitive brain develop-
mental phases, brain maturation may be effected. Such
contaminants, for example, drugs, cigarette smoke, or
alcohol, can cause developmental harm and compromise
optimal developmental maturation (Krebs 1985). In addi-
tion, if the social environment is depressed, for example,
the healthy development of emotional intelligence for
individuals is reliant upon learning adaptive social and
emotional responses from the affective cues provided by
the primary care giver during infant early brain develop-
mental phases (Wilson 2014). Where affective communi-
cation is limited between primary care giver and infant (for
example, a mother experiencing post-natal depression),
then a developmental vulnerability exists for the infant.
Thus, where the environment is poor, there is a natural
propensity for dysfunction, illness and poor physical,
mental and social developmental outcomes to occur or
proliferate (Factor et al. 2013). And, as a consequence there
is less plasticity for a healthy response to gain leverage in
such a depleted mental health ecosystem.
R. L. Wilson et al.
Social Capital and Mental Health Helping Capital:
Buffers for Vulnerability
Rural social mental health helping capital is defined as a
sub set of the social capital that is available in rural com-
munities and it is characterised by the way in which local
rural people are able to support and resource each other
towards meeting or improving the mental health and well-
being needs of people who are vulnerable towards mental
health decline within their community (Boyd et al. 2008;
Allen et al. 2012; Farmer et al. 2012; Wilson et al. 2012). For
example, rural churches, sporting clubs and service groups
are often involved with the practical provision of mental
health care and support to vulnerable people in their
communities, with the expression of care taking the form of
sharing time and experiences or stories of coping success,
providing transport to health appointments, facilitating
social inclusion in community activities, and assisting with
the practicalities of daily living when needed. This form of
specific social capital builds a robust layer of protection and
resilience and offers a buffer for mental health vulnerability
from a unique insider and locally embedded community
resident perspective and position (Boyd et al. 2008; Boyd
and Parr 2008; Allen et al. 2012). Social dynamics are
intrinsically woven into the experiences of emerging mental
health problems in rural communities, and this is also the
context in which mental health decline occurs. Thus, it is
insufficient to explore causes of mental illness without also
understanding the context in which it occurs (McDaniel
2013).
Practical Application of Mental Health Helping
Social Capital in Rural Australian Communities
Understanding practical application implications of fos-
tering and facilitating the benefits of enabling mental health
helping social capital in rural communities underpins the
transfer of theoretical knowledge to the delivery of mental
health care in those communities. The following subsec-
tions identify selected examples of practical implications
related to seeking and providing mental health help for
rural people.
Rurality
‘Rural’ is a concept that is inclusive of a rural person’s
culture, place, identity, and geography, and the extent to
which these align with standardised measures of rurality
and remoteness (Wilson 2014). People who live in rural
communities often identify closely with a deep sense of
‘place’. The concept of place has a number of facets that
include psychological, emotional, socio-economic and
geographical factors (Campbell et al. 2006). People within a
similar geographical region often share an interrelatedness
that includes an inherent sense of connection and mutual
support for each other that can also be thought of as
‘mateship’. In a mental health practice context, it is
important that mental health professionals strive to
recognise the richness of rural identity and culture, which is
the real life experience of rural people generally, and to
incorporate appropriate and uncontrived respect for this
culture into their professional practice and therapeutic
interactions (Wilson 2014).
Social context and social capital are fundamental as-
pects of social ecology, which can be thought of as the
multidimensional structures of human environments that
include biological, environmental and socio-political
components across time and place (Stokols et al. 2013).
Disruptions or threats to the stability of human social
ecology create a condition of vulnerability towards adverse
events and conditions (Stokols et al. 2013). In a mental
health and well-being context, this circumstance provides
an opportunity for mental health decline to accelerate. This
paper explores a theoretical framework applied to helping
when vulnerability for mental health problems emerge
amongst rural people, so it was important to consider how
resilience might be nurtured, and helpfulness recognised,
within the rural community and amongst the social capital
and mental health ecosystem available in rural settings. In a
practice context, building resilience can be considered as a
way in which adverse conditions can be absorbed and
reorganised such that individuals, groups or communities
can adapt, or be helped, sufficiently to maintain a nor-
mative function (Walker et al. 2004).
In both urban and rural clinical settings, care needs to
be taken by mental health clinicians, to ensure when
planning for recovery in collaboration with a person who
usually resides in a rural community, that therapy is con-
ducted with a positive regard for their usual environment,
rural cultures and circumstances (Wilson 2014).
Rural Respect, Trust, Values and Credibility
Rural communities value and trust community groups and
industry associations in their roles as facilitators of locally
accessible mental health programs and other health initia-
Rural Mental Health Ecology
tives (Kilpatrick et al. 2009,2012). Public health services
frequently fail to demonstrate a coordinated strategy or an
adequate understanding of locally conceived and initiated
public health promotion activities within rural communi-
ties. In practice, this results in a sending-in of misaligned
mental health programs into rural communities, without
recognising what had preceded it, what was most required
in a specific community, and without sufficient partnership
with industry and community stakeholders (Kilpatrick
2009; Kilpatrick et al. 2012; Kilpatrick and Wilson 2012).
When this practice occurs, a rural positioning of distrust of
outsiders is reinforced, and health change agency is com-
promised because the health promotion messages and
health service delivery does not adequately resonate with
the experiences of rural people, despite the well-meaning
efforts of health service personnel who visit rural com-
munities (Kilpatrick et al. 2012). Repetitive program
instruments are administered but without fitting in with
community preferences. In doing so, credibility and trust
are diminished and so too is the mental health helping
capital between health services and local rural people
(Kilpatrick et al. 2012).
Boundary Crossing Mental Health Champions
One practical way in which mental health helping capital
can be enhanced is by utilising the informal and formal
interactional infrastructures within each community, and
by ensuring that a healthy community with a common
purpose is established and maintained by a range of con-
tributions from various stakeholders (Kilpatrick et al.
2009). Boundary crossing champions in rural communities
are individuals or organisations who have accumulated
respect, trust, value and credibility across two or more
sectors and because of this characteristic contribute an
important source of social capital within their communities
(Kilpatrick and Wilson 2012). People who are boundary
crossers in their rural communities have local credibility
across two or more public, private, sporting, service, social,
community, agricultural industry, business, education and/
or health sectors and are able to broker appropriate mental
health support within their communities during difficult
times such as drought or other adversities (Kilpatrick et al.
2012). Targeted planning of formal mental health support
services in rural communities requires an understanding of
the informal interactional infrastructures that are unique
within each community, so that social capital is captured to
achieve desirable outcomes of community mental health
and well-being. The interactions that occur within rural
communities are best harnessed when champions of mental
health are identified within communities and supported in
their formal and informal dual roles within that commu-
nity (Kilpatrick et al. 2012; Kilpatrick and Wilson 2012).
For example, churches; community service organisations
such as Country Women’s Association; industry organisa-
tions, such as New South Wales Farmers Association;
school parent groups and volunteer rural fire services have
all been identified as groups that contain strong rural
cohesions and social capital, and the individuals who make
up these groups frequently have additional community or
employed roles (Kilpatrick et al. 2012). Rural champions
and leaders in organisations such as these, who are trusted
and have attained credibility across a number of domains,
are important collaborators for mental health service pro-
viders and planners because they provide access to the
principal sites of actual health service provision in rural
communities (Kilpatrick et al. 2012). These sites are not
always the traditional health service provision sites such as
hospitals, but instead can be clinics that operate at agri-
cultural field days, rural tennis or football clubs, and other
innovative places where people interact in rural commu-
nities (Kilpatrick et al. 2012). Boundary crossers in this
context are often busy people within their communities,
and while not a panacea for mental health care in rural
communities, acknowledging their collaborative contribu-
tion is an important consideration for service delivery
planners.
Rural Cultural and Social Geography
The way in which people traverse the cultural geography of
place has implications for mental health practice in rural
communities. People develop habits in daily life as they go
about their usual patterns of behaviour, work, and physical
movements around the places in which they live and
identify (Bissell 2013). The habits they form connect them
to places and they can move about and function with
practical competence in their familiar environments (Bissell
2013). However, as the environment, or components of
their place changes, or as people are moved, or people
move themselves to unfamiliar territories and places, peo-
ple tend to lose some of the easiness and smoothness in
regard to achieving their practical competencies that are
applied to their usual activities, or habits of living, and the
human connections that usually require little concentration
to fulfil, are also diminished. With unfamiliarity, an awk-
R. L. Wilson et al.
ward and pervasive restlessness develops and require more
focused attention. Later still, a clumsiness develops related
to navigating familiar life habits, when people are located
within unfamiliar circumstances or places (Bissell 2013).
From a practice perspective, the cultural geography of
rural people and places can be considered in a similar way,
because when the place is familiar and practical habits are
formed that allow people to conduct themselves compe-
tently in their cultural place, a sense of mental well-being
can be fostered. However, as changes occur, either inter-
nally or externally, a deterioration of practical competency
can develop, and further so if a person is required to travel
to unfamiliar places and access unfamiliar services to re-
ceive the supports they may need. It is therefore important
for mental health service providers to consider how mental
health support can be delivered in a way that supports and
enhances the usual practical competence of rural people,
and to minimise the ways in which services are provided
that involve unfamiliar locations, places, or practices, so
that vulnerability can be minimised, and mental health can
be protected and not further eroded (Farmer et al. 2012).
Locally accessible services may be more likely to enhance
the strengths and protective attributes needed for the timely
recovery for rural people.
Rural Adversity
The dynamics of rural communities are changeable and
respond to impacts such as environmental changes (for
example, drought, flood, salinity and/or climate change),
mining operations and workforce dynamics, downturns in
commodity prices, financial pressures with the lowering of
land values and loss of productivity, export demands, fly-
in-fly-out (FIFO) drive-in-drive-out workforce, population
declines and the related fragmentation of social networks,
farm amalgamations and corporatisation, as well as the
limited availability of educational and employment
opportunities for rural people (Speldewinde et al. 2009;
Farmer et al. 2012; Kilpatrick et al. 2012; Haslam Mckenzie
2013).
For example, in some settings the insidious impacts of
dryland salinity, that is, the rise of a salty ground water
table as deep-rooted trees are cleared from agricultural
areas to make way for productive agricultural landscapes
result in long-term degradation of land where it becomes
unusable for farming purposes or habitation. Farming
practices and environmental management are also threat-
ened by a long-term downturn in commodity prices and
other environmental impacts such as drought. Thus, the
economic impacts are also significant, and when combined
with the creeping effects of salinity, are recognised as a
vulnerability for mental health decline of residents because
psychological distress is frequently associated with people’s
sense of place, while their relationships and lived experi-
ences influence their psychological quality of life (Albrecht
et al. 2007; Speldewinde et al. 2009).
Implications for Help-Seeking
Help-seeking for mental health problems requires that
individuals are first able to recognise that a mental health
problem may exist for them, and secondly to believe that
seeking some help to resolve the problem may be beneficial.
Self-recognition is influenced by health beliefs, attitudes,
values and the knowledge that people have about health
and health services, along with their attitudes about the
perceived helpfulness of any available services (Judd et al.
2006).
Rural people often tend to rely more on family and
friends for support rather than health services, seeing it
their responsibility to find ways to cope with their own
mental health problems (Wilson et al. 2012). Rural people
have been previously reported as more likely to persist with
mental health problems and delay their help-seeking until
symptoms become more disabling because they associate
being able to work and remain productive as a key feature
of good health (Judd et al. 2006). Rural people have also be
described as stoic (for example, Judd et al. 2006), and until
they reach a point of disability or inability to work they are
less likely to believe that health care is warranted, because
not being capable of work is a definition for illness.
Therefore, from this perspective, for one to be healthy one
should try to work harder and be productive. These beliefs
about health may therefore be barriers to early help-seeking
by rural people with mental health problems.
Time Away From Rural Place, People, Work and
Home
Time away from important and time sensitive farming
duties, for example, planting, harvesting, shearing, milking,
has far-reaching consequences for many rural community
members. Rural people are aware of these impacts, so it is
reasonable to conclude that rural people develop attributes
of self-efficacy and stoicism to mitigate a wider range of
risks, of which mental health problems may be considered
Rural Mental Health Ecology
only one, and perhaps a minor factor, when a more holistic
view of rural mental health ecology is taken (Larson 2011).
In addition, the costs of travel, accommodation, and
employment of replacement staff, if available, are signifi-
cant barriers to seeking early health care for a mental health
problem (Larson 2011). Taken together, these barriers to
help-seeking are likely to reinforce the health behaviours,
values, beliefs and attitudes about mental health help-
seeking because the challenges related to lower levels of
stoicism and self-efficiency are unrelenting, especially so if a
view exists that early mental health intervention is not
likely to be immediately beneficial to the recipient (Wilson
et al. 2012).
Conversely, rural people are known to have a close
social cohesion, and therefore experience a sense of feeling
close to others, and this sense of social closeness is associ-
ated with a willingness to help others when needed (Lam-
mers et al. 2012). Thus, it may be that locally based rural
mental health clinicians have stronger social cohesion and a
legitimate insider type of social power that has a stronger
affinity for developing trust and a willingness to help oth-
ers, such as with people seeking help for a mental health
problem. Whereas visiting mental health clinicians from
outside of the local rural community might be perceived as
possessing an illegitimate social power that is more repel-
ling in regard to building trust with people and assisting
people and communities achieve outcomes of health
improvement (Larson 2011; Lammers et al. 2012). So,
where there are delays when rural people seek mental health
help, these can also be explained by rural people fostering
their own self-efficacy and stoicism which in turn promotes
their propensity for self-sufficiency, and reinforces their
perceptions of visiting mental health workers as holders of
illegitimate power, socially distant and uninterested in
developing an alliance that might be helpful in mitigating
mental health problems (Judd et al. 2006; Lammers et al.
2012). Thus, a perception can exist among rural would-be
recipients of mental health care that doubts the usefulness
of the professional ‘outsider’ help that is on offer (Judd
et al. 2006; Lammers et al. 2012). Paradoxically, health
services rely on mental health workforce distributions that
include FIFO non-resident visiting clinicians into rural
communities. FIFO workforces are necessary to provide
essential mental health services because the size of some
rural communities is unable to either recruit sufficient staff
or because the size of the population is not large enough to
support a sustainable business model to employ locally
based staff.
CONCLUSION
Rural communities are made up of richer human compo-
nents than just a series of geographical locations. The
people and places of rural communities are characterised
by a diversity of socio-economic, cultural, environmental,
industrial, agricultural and narrative attributes with loca-
tion used as a crude universal criterion to describe rural
communities in rural health policy (Fraser et al. 2002;
Larson 2011). By contrast, health policy is often designed to
equitably disperse health service provision using measures
that reflect population size, and distance travelled to ser-
vices as core selection criteria, regardless of the character-
istics of places and the people who inhabit them (Fraser
et al. 2002; Department of Health and Ageing 2011; Larson
2011; Wilson 2014). As a result, it is difficult to mitigate the
effects of rural mental health problems relating to rural
adversity or conditions because the population sizes that
require mental health services are not large enough to
sustain local health service financial resources (Larson
2011).
This paper has argued that the use of rural mental
health social ecology framework is an appropriate way to
respond to the mental health problems of rural people. It
has also explored ways in which social capital can assist in
our understanding of how mental health helping capital
can be generated and promoted within communities to
improve rural mental health ecosystems.
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Rural Mental Health Ecology
... It has been recognised that the early treatment of mental health problems promotes recovery, while conversely the lack of early treatment results in slower recovery with less promising outcomes (Endacott et al. 2006). The duration of untreated mental health problems of young people in rural communities is known to be longer than for young urban people (Stain et al. 2010, Wilson et al. 2015). This disparity between the treatment of rural and urban young people has significant detrimental impacts on the longer term functional capacity, well-being and recovery of rural individuals, resulting in delayed social, educational and vocational developmental milestones of up to 10 years (Early Psychosis Writing Group 2010). ...
... Transport between these communities is usually by private car with very limited public transport options available across the region. The agricultural sector is the dominant industry in the region which experiences a range of vulnerabilities including climate and market volatilities that have significant impacts on the population in the study region (Wilson et al. 2015). ...
... Rural health service systems are limited by structures and policies that are unable to exploit relatively abundant nursing human resource assets (Wilson et al. 2015). The social mental health helping capital in each rural community is made up of people within that community, some of whom have unique boundary crossing roles that do not lend themselves to state or national health strategic plans or medical systems. ...
Article
The aim of this research was to understand new ways that young rural people with mental health problems could be helped at an early point in their mental health decline. Rural nurses represent skilled mental health helping capital in their local communities, yet this important mental health helping resource, or helping capital, is both under-recognised and under-used in providing early mental health help in rural communities. In recent years international momentum has gathered in support of a paradigm change to reform the delivery of youth mental health services so that they align more closely to the developmental and social needs of young people with mental health problems. A mixed methods case study design was used to explore the early mental health care needs of young rural people. A cross-sectional survey was conducted and data were analysed with descriptive techniques. In-depth interviews were conducted and the transcribed data were analysed using thematic techniques. The results of this study demonstrate that in general rural people are willing to seek mental health care, and that rural nurses are well suited to provide initial care to young people. Non-traditional venues such as community, school and justice settings are ideal places where more convenient first conversations about mental health with young people and their families, and rural nurses should be deployed to these settings. Rural nurses are able to contribute important initial engagement interventions that enhance the early mental health care for young people when it is needed. © 2015 John Wiley & Sons Ltd.
... It has been recognised that the early treatment of mental health problems promotes recovery, while conversely the lack of early treatment results in slower recovery with less promising outcomes (Endacott et al. 2006). The duration of untreated mental health problems of young people in rural communities is known to be longer than for young urban people (Stain et al. 2010, Wilson et al. 2015). This disparity between the treatment of rural and urban young people has significant detrimental impacts on the longer term functional capacity, well-being and recovery of rural individuals, resulting in delayed social, educational and vocational developmental milestones of up to 10 years (Early Psychosis Writing Group 2010). ...
... Transport between these communities is usually by private car with very limited public transport options available across the region. The agricultural sector is the dominant industry in the region which experiences a range of vulnerabilities including climate and market volatilities that have significant impacts on the population in the study region (Wilson et al. 2015). ...
... Rural health service systems are limited by structures and policies that are unable to exploit relatively abundant nursing human resource assets (Wilson et al. 2015). The social mental health helping capital in each rural community is made up of people within that community, some of whom have unique boundary crossing roles that do not lend themselves to state or national health strategic plans or medical systems. ...
Article
The mental health of people in rural communities is influenced by the robustness of the mental health ecosystem within each community. Theoretical approaches such as social ecology and social capital are useful when applied to the practical context of promoting environmental conditions which maximise mental health helping capital to enhance resilience and reduce vulnerably as a buffer for mental illness. This paper explores the ecological conditions that affect the mental health and illness of people in rural communities. It proposes a new mental health social ecology framework that makes full use of the locally available unique social capital that is sufficiently flexible to facilitate mental health helping capital best suited to mental health service delivery for rural people in an Australian context.
... It has been recognised that the early treatment of mental health problems promotes recovery, while conversely the lack of early treatment results in slower recovery with less promising outcomes (Endacott et al. 2006). The duration of untreated mental health problems of young people in rural communities is known to be longer than for young urban people (Stain et al. 2010, Wilson et al. 2015). This disparity between the treatment of rural and urban young people has significant detrimental impacts on the longer term functional capacity, well-being and recovery of rural individuals, resulting in delayed social, educational and vocational developmental milestones of up to 10 years (Early Psychosis Writing Group 2010). ...
... Transport between these communities is usually by private car with very limited public transport options available across the region. The agricultural sector is the dominant industry in the region which experiences a range of vulnerabilities including climate and market volatilities that have significant impacts on the population in the study region (Wilson et al. 2015). ...
... Rural health service systems are limited by structures and policies that are unable to exploit relatively abundant nursing human resource assets (Wilson et al. 2015). The social mental health helping capital in each rural community is made up of people within that community, some of whom have unique boundary crossing roles that do not lend themselves to state or national health strategic plans or medical systems. ...
Conference Paper
http://www.iepaconference.org/blank/?page=poster_detail&show=authors&sort=board_a&go=&session=Wednesday_November%2019_11:30%20am%20-%2012:40%20pm_Hana&id=10 This paper presents the findings of research about the mental health help-seeking experiences of young rural people in northern New South Wales, Australia. A rural socio-ecological health theoretical framework and a mixed methods case study research design were selected to answer a research question: How can young rural people with emergent mental health problems be helped? Survey and in-depth interview data were collected and analysed using descriptive, content and thematic techniques. Results: • Theme 1: Characteristics of emergent mental health problems of young rural people. • Theme 2: Characteristics of helping young rural people with mental health problems. • Theme 3: Lack of meaningful connection with mental health services. • Theme 4: Characteristics of health, welfare and social service providers. Findings: • Providing positive first mental health encounters for young rural people in their rural communities enables successful initial and ongoing mental health helping. • Rural nurses are mental health capital in rural communities. • Barriers to mental health help-seeking for young rural people persist. The primary recommendation from this research is a co-location model for nursing assets in rural communities to promote the early engagement of young rural people into appropriate mental health care when it is required. Rural nurses are ideal in rural settings because nurses contribute expertise by paying adequate attention, careful listening, provide authentic care which is mindfully present and understand the local context for young rural people. The outcomes of this study provide new insights about the emergent mental health problems of young rural people.
... It has been recognised that the early treatment of mental health problems promotes recovery, while conversely the lack of early treatment results in slower recovery with less promising outcomes (Endacott et al. 2006). The duration of untreated mental health problems of young people in rural communities is known to be longer than for young urban people (Stain et al. 2010, Wilson et al. 2015). This disparity between the treatment of rural and urban young people has significant detrimental impacts on the longer term functional capacity, well-being and recovery of rural individuals, resulting in delayed social, educational and vocational developmental milestones of up to 10 years (Early Psychosis Writing Group 2010). ...
... Transport between these communities is usually by private car with very limited public transport options available across the region. The agricultural sector is the dominant industry in the region which experiences a range of vulnerabilities including climate and market volatilities that have significant impacts on the population in the study region (Wilson et al. 2015). ...
... Rural health service systems are limited by structures and policies that are unable to exploit relatively abundant nursing human resource assets (Wilson et al. 2015). The social mental health helping capital in each rural community is made up of people within that community, some of whom have unique boundary crossing roles that do not lend themselves to state or national health strategic plans or medical systems. ...
Conference Paper
A co-location model for nurses helping young rural people with emergent mental health problems Rhonda L Wilson RN BNSc MNurs (Hons) PhD candidate Lecturer Mental Health Nursing, University of New England, Armidale NSW Australia rhonda.wilson@une.edu.au Abstract This paper presents the findings of research about the mental health help-seeking experiences of young rural people in northern New South Wales, Australia. A rural socio-ecological health theoretical framework and a mixed methods case study research design were selected to answer a research question: How can young rural people with emergent mental health problems be helped? Survey and in-depth interview data were collected and analysed using descriptive, content and thematic techniques. Results: • Theme 1: Characteristics of emergent mental health problems of young rural people. • Theme 2: Characteristics of helping young rural people with mental health problems. • Theme 3: Lack of meaningful connection with mental health services. • Theme 4: Characteristics of health, welfare and social service providers. Findings: • Providing positive first mental health encounters for young rural people in their rural communities enables successful initial and ongoing mental health helping. • Rural nurses are mental health capital in rural communities. • Barriers to mental health help-seeking for young rural people persist. The primary recommendation from this research is a co-location model for nursing assets in rural communities to promote the early engagement of young rural people into appropriate mental health care when it is required. Rural nurses are ideal in rural settings because nurses contribute expertise by paying adequate attention, careful listening, provide authentic care which is mindfully present and understand the local context for young rural people. The outcomes of this study provide new insights about the emergent mental health problems of young rural people.
... Building community capacity capitalises on social cohesion that may be stronger in rural areas. 33 RAMHP focuses equally on delivering training to community members (to support their own wellbeing as well as to assist family, friends, colleagues and work clients) and to gatekeepers (professionals whose role brings them into regular contact with people at risk of mental illness). ...
Article
Full-text available
Issue addressed Rural Australians experience significant barriers in accessing mental health services, some of which may be overcome by increasing mental health literacy in rural communities. This paper evaluates Mental Health Support Skills (MHSS), short training courses developed by the Rural Adversity Mental Health Program (RAMHP). MHSS was designed to build the capacity of community members and gatekeepers to identify people with mental health concerns and link them to appropriate resources or services. Methods Program data from April 2017 to March 2020 were analysed to assess the reach and outcomes of MHSS training. Training feedback was collected through a post-training survey, completed directly after courses, and a follow-up survey two months after training. An app used by RAMHP coordinators (the trainers) recorded the geographic and demographic reach of courses. Results MHSS was provided to 10,208 residents across rural New South Wales. Survey participation was 49% (n=4,985) for the post-training survey and 6% (n=571), for the follow-up survey, two months post-training. The training was well-received and increased the mental health understanding and willingness to assist others of most respondents (91-95%). Follow-up survey respondents applied learnings to assist others; 53% (n=301) asked a total of 2,252 people about their mental health in the two months following training. Those in clinical roles asked a median of 6 people about their mental health, compared to 3 for those in non-clinical roles. Most follow-up survey respondents (59%, n= 339) reported doing more to look after their own mental health in the two months after training. Conclusion These results are encouraging as they suggest that short-form mental health training can be an effective tool to address poorer mental health outcomes for rural residents by improving the ability of participants to help themselves and the people around them. So what? Serious consideration should be given to short mental health courses, such as MHSS, to increase literacy and connection to services, especially in rural areas.
... A tiered approach to mental health support that recognises the individual, the community and the wider societal systems and structures has been identified by several commentators. This type of model is also reflected in 'socioecological' frameworks and interventions that look at the macro, meso and micro level determinants of mental health (Ahmed et al., 2018, Wilson et al., 2015. ...
Technical Report
EXECUTIVE SUMMARY Background The purpose of this study was to assess a proof of concept around a novel way of meeting mental health service needs in a small rural town using existing workforce resources. Our underlying assumptions were: • That rural towns have a disproportionally high burden of mental health needs, but are less able to access appropriate supports • That traditional models of care tend to emphasise individual approaches to meeting those needs, rather than looking at the community and their needs as a whole • That there are assets available within rural towns that can contribute to meeting the needs of those communities if they are appropriately identified and mobilised • If community mental health needs (demand) can be appropriately identified and concomitantly, the available workforce assets (supply) can be discovered, then it may be possible to better meet the needs of small rural towns by deploying existing competencies, rather than using traditional workforce models that rely on employing a “whole professional” who, if available, may only meet a component of the community needs. For the purpose of this study, “workforce” includes any person involved in the delivery of mental health support, including clinical, non-clinical, paid and unpaid workers, including carers and peer support workers. The aim of the study was to develop a new model for providing mental health supports in small rural towns that aligns the mental health needs identified by the town with the available competency assets that provide mental health supports in that town.
... Some studies have found greater helping in rural communities, while others found it was not town or city size, but rather values related to responsibility for others' well-being (Ferráns, Selman, & Feigenberg, 2012;Levine, Norenzayan, & Philbrick, 2001;Rushton, 1978). Social connections and helping have been described as a key feature of rural communities (Wilson, Wilson, & Usher, 2015), perhaps because most everyday helping occurs between friends, family, and other familiar individuals. Given that research suggests people in small rural communities know each other better, they might be more likely to help simply because there is more strength in the ties between people (Amato, 1990). ...
Article
Social support is key to well-being for victims of intimate partner violence (IPV), and bystanders have an important role to play in preventing IPV by taking action when there is risk for violence. The current study used qualitative interviews to explore young adults’ perspectives on helping in situations of IPV, and more general helping, in the rural communities in which they resided. Participants were 74 individuals between the ages of 18 and 24 years from 16 rural counties across the eastern United States. Participants generally described their communities as close-knit and helpful, especially around daily hassles (e.g., broken down car) and unusual circumstances (e.g., house fire). Although participants generated ways in which community members help IPV victims, these mostly focused on providing support or taking action in the aftermath of IPV as opposed to more preventive actions. Lack of financial resources were uniquely cited as a barrier to more general helping, whereas concerns about privacy and lack of deservingness of help were barriers to both general helping and helping in IPV situations, although these were more pronounced in IPV situations than general helping situations. Taken together, these results suggest that although people generally see their communities as helpful and close-knit, these perceptions and scripts did not necessarily translate to helping in situations of IPV. Bystander intervention programs are needed that provide more specific helping scripts for IPV.
Article
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Nursing care makes a significant contribution to the mental health of young people worldwide. Three quarters of all mental illness begins before people reach the age of 25. Advocacy for improving the care of young people with mental health problems is progressing on a global scale, but despite this, services continue to lag behind the most innovative aspirations. Dialogue in the context of international nursing conferences and site visits is beneficial for improving mental health care for young people generally. This article discusses some lessons learned during discussions that were triggered by scholarly exchange of ideas in the context of a nursing conference. Some themes were identified, as was the need to enhance international nursing collaborations and dialogues to improve mental health nursing practice for the care of young people. Read More: http://journals.rcni.com/doi/abs/10.7748/mhp.19.9.34.s22
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While links between rurality and health are clearly established, there continues to be interest in the resources that can make a difference to rural, often underserved, small communities. This research investigated how collective features of communities of place and industry communities of common purpose, influence farmer and fisher strategies to maintain good physical and mental health in the face of difficult climatic and economic factors. Centred on five farming and fishing sites in Australia, the research found it was not the health services in the sites, but the differences in the resources and capacity of non-health service community and industry groups and organisations that influenced the health and wellbeing behavioural choices of the farmers and fishers. Community groups and industry associations facilitated local access to programmes and their credibility persuaded people to participate. They cross the boundary between health services and farmer and fisher communities and are preferred, soft entry points to health information and support that can reduce the impact of occupational stress.
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Sociology of health and illness has been enlivened with increased understanding of the complex roles, social factors and structures play in individual and societal health and well-being. New insights are simultaneously empirical and conceptual, leading to innovative approaches to analysis, as well as new conceptual frameworks. Three examples are: the social gradient of health, the population health perspective and the saliency of social fabric to both individual and societal well-being. Nonetheless, puzzles remain such as how social inequalities get under the skin, why socioeconomic improvements do not always yield life expectancy gains, and how to reduce health disparities and inequalities.
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The concept of resilience has evolved considerably since Holling's (1973) seminal paper. Different interpretations of what is meant by resilience, however, cause confusion. Resilience of a system needs to be considered in terms of the attributes that govern the system's dynamics. Three related attributes of social-ecological systems (SESs) determine their future trajectories: resilience, adaptability, and transformability. Resilience (the capacity of a system to absorb disturbance and reorganize while undergoing change so as to still retain essentially the same function, structure, identity, and feedbacks) has four components-latitude, resistance, precariousness, and panarchy-most readily portrayed using the metaphor of a stability landscape. Adaptability is the capacity of actors in the system to influence resilience (in a SES, essentially to manage it). There are four general ways in which this can be done, corresponding to the four aspects of resilience. Transformability is the capacity to create a fundamentally new system when ecological, economic, or social structures make the existing system untenable. The implications of this interpretation of SES dynamics for sustainability science include changing the focus from seeking optimal states and the determinants of maximum sustainable yield (the MSY paradigm), to resilience analysis, adaptive resource management, and adaptive governance.
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Written by an experienced nurse lecturer who also trained as a mental health nurse, this book explores the underlying biology associated with the pathology of mental health disorders and the related nervous system. Fully revised for this second edition, the text includes three new chapters on brain development,pharmacology and learning, behavioural and developmental disorders. Integrating up-to-date pharmacological and genetic knowledge with an understanding of environmental factors that impact on human biology, The Biological Basis of Mental Health Nursing covers topics including: the physiology of neurotransmission and receptors hormones and mental health the biology of emotions, stress, anxiety and phobic states the biology of substance abuse the pharmacology of psychoactive drugs developmental disorders brain anatomy and development the biology of behaviour genetics and mental health affective disorders: depression, mania and suicide schizophrenia autism and other syndromes the ageing brain and dementia degenerative diseases of the brain epilepsy. Accessibly laid out, with many of diagrams, tables and key points at the end of each chapter, this is an essential text for mental health nursing students, practitioners and educators.
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Human health and well-being are inextricably linked to nature; our connection to the natural world is part of our biological inheritance. In this engaging book, a pioneer in the field of biophilia-the study of human beings' inherent affinity for nature-sets forth the first full account of nature's powerful influence on the quality of our lives. Stephen Kellert asserts that our capacities to think, feel, communicate, create, and find meaning in life all depend upon our relationship to nature. And yet our increasing disconnection and alienation from the natural world reflect how seriously we have undervalued its important role in our lives. Weaving scientific findings together with personal experiences and perspectives, Kellert explores how our humanity in the most fundamental sense-including our physical health, and capacities for affection, aversion, intellect, control, aesthetics, exploitation, spirituality, and communication are deeply contingent on the quality of our connections to the natural world. Because of this dependency, the human species has developed over the course of its evolution an inherent need to affiliate with nature. But, like much of what it means to be human, this inborn tendency must be learned to become fully functional. In other words, it is a birthright that must be earned. He discusses how we can restore this balance to nature by means of changes in how we raise children, educate ourselves, use land and resources, develop building and community design, practice our ethics, and conduct our everyday lives. Kellert's moving book provides exactly what is needed now: a fresh understanding of how much our essential humanity relies on being a part of the natural world.
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Innovation policy in many countries recognizes the significance of place-based innovation systems. Australia's innovation policy has incentives to bring universities and businesses together, but lacks place-based mechanisms to achieve this. Four case studies of regional intermediary organizations in Melbourne, Australia are examined to understand their role in enabling collaboration between university and industry. Each manages networks, facilitates collaboration, develops a shared direction and acts as a regional ‘door’ to broader systems. The ability of intermediary organizations to cross boundaries between knowledge generating and innovating entities is key to the cohesion and effective operation of the regional innovation systems. Resumen. Las políticas de innovación en muchos países reconocen la importancia de los sistemas de innovación basados en el lugar. La política de innovación de Australia incentiva el acercamiento entre las universidades y las empresas, pero carece de mecanismos basados en el lugar para poder lograrlo. Hemos examinado cuatro estudios de caso de organizaciones intermediarias regionales en Melbourne, Australia para entender su papel en cuanto a facilitar la colaboración entre universidad e industria. Cada una administra sus redes, facilita la colaboración, desarrolla una política común y actúa como un “portal” regional que permite la entrada a sistemas más amplios. La capacidad de las organizaciones intermediarias de actuar a caballo entre las entidades que generan conocimiento e innovación es clave para la cohesión y el funcionamiento eficaz de los sistemas regionales de innovación.