The NHS Long Term Plan for England increases the funding that is made available for mental health services, recognising that it has historically been under-resourced. It seeks to expand the size of the community mental health workforce and improve integration with physical health services. More specific objectives include growing 24/7 services for those in crisis and creating more comprehensive mental health services for children and young people.
One challenge for health care providers is how to plan and design child and adult mental health services which are sustainable across larger rural geographies and are accessible to their dispersed communities. This may be true both for frontline support services and for referrals to specialist treatment.
The following questions are intended to help improve rural service planning and design:
- How accessible to rural communities are organisations or facilities which can promote public information (e.g. from the ‘Every Mind Matters’ website) and so help people to better understand and cope with common mental health conditions, such as stress and anxiety?
- How geared up are smaller rural-located GP surgeries or health centres to offer mental health prevention services? Are there professional development needs for their GPs or primary care teams to improve diagnosis and early intervention? Is there evidence of late presentation by patients in small communities and how are confidentiality issues addressed?
- Where is the nearest 24/7 service for those who have a mental health crisis and how can it be accessed or reached from rural locations? What other options could be adopted, such as an outreach crisis team or having access to facilities across administrative boundaries?
- In cases where individuals are referred on to specialist in-patient care services, how easy to travel to are those services, not least for visiting family or carers? Again, could there be cross-boundary solutions? Are there specific rural challenges if organising an admission under the Mental Health Act and how could they be addressed?
- How effectively do Child and Adolescent Mental Health Services work with rural based schools and colleges in the area and can any gaps in this provision be plugged? Is the service in rural areas consistent with the statutory framework for children and young people?
- How do local plans to improve mental health services address the needs of older people in rural communities, including care for those with dementia or co-morbid frailty? Rural areas (especially those on the coast) typically have a high proportion of older residents.
- What mental health or wellbeing initiatives or projects exist that seek to reach out to (often isolated) farming communities? How could they be promoted by working with the sector (e.g. the NFU) or at specific locations such as livestock markets?
- How is support delivered in rural areas to those seeking help for alcohol or substance misuse and how can that support be improved? How might it be better coordinated with other mental health services, so those needing support do not fall through a gap?
- Is there an Individual Placement and Support service (or equivalent) and how accessible is it to rural residents experiencing common mental health concerns, to help them to remain in or find employment? How could its rural delivery be improved?
- What are the locations of supported housing for vulnerable people of varying ages who have mental health problems or learning disabilities? Are any in rural towns or otherwise accessible from rural areas? How might gaps in provision be addressed?
- How does the Health and Wellbeing Strategy seek to analyse mental health needs and inequalities in rural areas? What does it use for measuring need, if a simple count of service take-up is likely to be affected by external factors, including poor accessibility in rural areas?
- When seeking to improve mental health services by consulting with patients, their families and carers, what effort is made to gather views from across the geographic area and to analyse responses such that any rural-specific findings can be identified?
- What recruitment or workforce challenges are identifiable (including specialist professions, such as psychiatrists and therapists, and generalists with mental health skills) which need addressing to maintain mental health teams able to operate across the area?
Case studies [not yet available]:
- Suicide prevention service in Norfolk
- Community Front Room in Bridport, Dorset
Other solutions to rural service delivery challenges could include:
- Providing intensive home treatment through Community Mental Health Teams, as an alternative to acute in-patient admission.
- Offering more anonymity for those using mental health services (for young people, in particular), by providing the option of video-conference or online chat facilities.
- Delivering mental health services within facilities which also host other types of service, so it is not obvious that those entering are there for mental health reasons.
- Using a ‘whole life approach’ to mental health service provision, which includes access to support on housing, money and employment issues, as appropriate.
- Enhanced working with rural-facing voluntary and community sector agencies, with resources allocated to help them deliver certain services. This could be especially suited to support for those with enduring mental health issues.
- Adopting a community asset-based approach to aid the provision of support to those with mental health needs. This would identify or map relevant support groups, skills and facilities that could improve support at a community level, and it would also identify gaps.
- Supporting Mental Health Champions who can raise awareness, change perceptions and encourage mental health initiatives in each rural locality.
- Seizing opportunities with organisations from the natural environment and outdoor leisure sectors, who can offer activities for those experiencing common mental health problems. This could include social farming, which offers activity of small farms as a support service.