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Mental health problems can lead to stigma and isolation in remote and rural areas due to limited understanding within local communities and inadequate support services, according to new research sponsored by the ESRC. The report of a study led by Professor Chris Philo, of the University of Glasgow, and Dr Hester Parr, of the University of Dundee, calls for a range of measures to correct the situation. These include a sustained and localised awareness campaign throughout the Scottish Highlands, where the research was carried out.
Professor Philo said: "There is a perceived 'culture of silence' around mental health issues in rural and remote communities, with many people who cannot and will not discuss emotional issues.
"Many attempt to hide their mental health problems because of the fear of negative community attitudes and the stigma associated with them. The result can be social and physical isolation, with some people not accessing the services available to them."
For the study, researchers interviewed 107 people with mental health problems in the Inverness area, Easter Ross, Skye and Lochalsh, and in north-west Sutherland. The views of professionals and volunteers providing services for the mentally ill were also taken.
The study found that there are few places in these areas where people feel supported, valued and able to talk freely about their experiences. And unlike in cities, where people can merge into the crowd, the lack of anonymity in rural Highland communities makes it harder for many to take advantage of services even where available.
The lack of formal 'places of safety' to which people in rural and remote areas can go during acute phases of illness was of great concern to those interviewed.
Drop-ins, which play a key role in combating social and physical isolation experienced by those with mental health problems, are non-existent in some parts of the Highlands, says the report.
Whether people are 'local' or 'incomers' can also shape the response of the community to mental illness. And the relative acceptability of alcohol misuse in rural communities means that drink is frequently used as a cover for mental health problems.
The report says that many users of mental health services feel both included in and excluded from their local communities. It points out, also, that as newcomers move into the Highlands and change the make-up and characteristics of local communities, traditional understandings about mental health issues are being challenged.
The study reveals an East-West divide in provision of support and specialist mental health services. The west Highlands has poorer provision than the east; with secondary care services based mostly in Inverness.
Professor Philo said: "A key problem is the distances that both users and, in particular, community psychiatric nurses, are expected to travel. The work done by these nurses is a much valued aspect of mental health care in the rural and remote Highlands. Often they represent the only form of specialist support available and outlet for 'mental health talk'".
Lack of support services means that residents of remote areas are heavily reliant on GPs, who often see themselves as working in isolation as the providers of mental health care.
The report urges development of more collective support services through statutory or voluntary organisations, improved transport links throughout the Highlands, and more specialists available with whom people can talk through their problems.
It says special clinics based in GP practices in local areas, involving psychologists, counsellors and psychiatrists, would both improve support services and ease transport difficulties.
For further information contact:
Professor Chris Philo, Telephone: 0141 330 4787 or Email: cphilo@geog.gla.ac.uk
Dr Hester Parr, Telephone: 01382 345445 or Email: h.parr@dundee.ac.uk
Or Iain Stewart, Lesley Lilley or Becky Gammon at the ESRC, Telephone: 01793 413032/413119/413122
NOTES FOR EDITORS
- The research report 'Social geographies of rural mental health: experiencing inclusion and exclusion' was funded by the Economic and Social Research Council (ESRC). Professor Philo is head of the Department of Geography and Geomatics, University of Glasgow, GLASGOW G20 0BG. Dr Hester Parr is senior lecturer in Human Geography at the University of Dundee, DUNDEE DD1 4HN. The project website can be found at: www.geog.gla.ac.uk/Projects/WebSite/main.htm
- The ESRC is the UK's largest funding agency for research and postgraduate training relating to social and economic issues. It provides independent, high-quality, relevant research to business, the public sector and Government. The ESRC invests more than £76 million every year in social science and at any time is supporting some 2,000 researchers in academic institutions and research policy institutes. It also funds postgraduate training within the social sciences to nurture the researchers of tomorrow. More at www.esrc.ac.uk.