Seeking help for mental health issues in rural South Australia: a mixed methods approach.

Abstract

The aim of this thesis was to investigate access to and utilisation of mental health care services in rural areas. Given the drought in Australia and the unique stressors it brings to people living in country areas this research is timely. Specifically, the research aimed to explore how the individual, psycho-social and cultural aspects of rural people and rural locations interact with or influence help seeking behaviours, and more specifically, how aspects of the culture where people live may impact on or impede their seeking help for mental health issues. The aims were addressed using a mixed methodological approach with three separate but related studies: one quantitative and two qualitative. Bradley’s (2002) adaptation of the Andersen behavioural model provided the theoretical model that drove the research questions and its utility in this context was tested. Study one used sixteen semi structured interviews to address the aims of the study. Participants were recruited via general practice surgeries and via snowballing techniques. Data was analysed using prior-research driven (Boyatzis, 1998) thematic analysis techniques following Braun and Clarke (2006). The second study was a population survey using a representative sample derived from one rural South Australian electorate (N=259). Study three used qualitative data also collected via the population survey. Respondents were asked to comment further on mental health and mental health services in their area, this question was open-ended and respondents could answer in their own words. Ninety nine of the survey respondents (38%) made a written comment, these data were analysed using thematic analysis techniques. Results of study one revealed that psycho social factors such as stigma were the most important barriers to seeking help. Seven main themes were found: stigma, self-reliance, lack of services, awareness, lack of psychological mindedness, General Practitioners (GPs) and need for change. Some evidence of psychological mindedness was found but this was not confirmed in study two or three. Indeed study two revealed a negative relationship between psychological mindedness and attitudes towards seeking professional help. Attitudes towards seeking help were the most important factor in help seeking intentions and actual help seeking behaviours. Intentions were predicted by being female and having more positive attitudes towards help seeking. Poor mental health and more positive attitudes were associated with having ever sought help for a mental health issue and those respondents with more positive mental health and more positive attitudes towards seeking help were less likely to have ever wanted or needed to seek help and not done so. More positive attitudes were predicted by being older, perceiving less stigma and having lower psychological mindedness. Study three had some similar themes to study one, awareness of services, stigma, and non-professional care. Other themes to emerge were locality issues and systemic disgruntlement. The results of this thesis have shown that attitudes towards help seeking and systemic disgruntlement are the most important and salient issues to rural help seeking behaviour. Stigma is still an important influence on help seeking and psychological mindedness should be further investigated to confirm its impact on help seeking behaviour. The lack of (adequate) services available, as reported by rural people themselves, inevitably contributes to the existing unmet need and has important implications for government policy and service delivery.