Description:
INTRODUCTION: There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities. METHOD: A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia. RESULTS: Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery. CONCLUSIONS: There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.
Description:
INTRODUCTION: There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities. METHOD: A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia. RESULTS: Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery. CONCLUSIONS: There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.
Description:
The objective of this review is to summarise the evidence for mindfulness and acceptance approaches in the treatment of adolescent depression. The article begins by summarising the outcomes of three broad approaches to the treatment of adolescent depression - primary prevention, pharmacotherapy, and psychotherapy - in order to advocate for advances in treatment. With regard to psychotherapy, we restrict this to comparisons of meta-analytic studies, in order to cover the breadth of the outcome literature. In the second half of this article, we introduce the reader to mindfulness and acceptance-based psychotherapy, with a particular focus on Acceptance and Commitment Therapy (ACT) and the applicability with adolescents. We provide an overview of the philosophical arguments that underlie this approach to psychotherapy and consider how each of these might contribute to treatment approaches for adolescents with depression.
Description:
Objective: This study aims to explore Australian rural adolescents’ experiences of accessing help for a mental health problem in the context of their rural communities. Design and setting: A qualitative research design was used whereby university students who had sought help for a mental health problem during their adolescence were interviewed about their experiences. Interviews were conducted face-to-face at the university. Main outcome measures: A semi-structured interview schedule was designed around the study’s main research questions. Audio-taped interviews were transcribed and thematically coded using a constant comparative method. Participants: Participants were first-year undergraduate psychology students between the ages of 17 and 21 years who sought help for a mental health issue during their adolescence and who at that time resided in a rural area. Results: Participants highlighted various barriers to seeking help for mental health problems in the context of a rural community, including: social visibility, lack of anonymity, a culture of self-reliance, and social stigma of mental illness. Participants’ access to help was primarily school-based, and participants expressed a preference for supportive counselling over structured interventions. Characteristics of school-based helpers that made them approachable included: ‘caring’, ‘nonjudgemental’, ‘genuine’, ‘young’, and able to maintain confidentiality. Conclusions: The findings support previous research that reveals barriers to help seeking for mental health problems that are unique to the culture of rural communities. The study raises questions about the merit of delivery of primary mental health care to young people via GPs alone and suggests that school-based counsellors be considered as the first step in a young person’s access to mental health care.
Description:
Objective: This study aims to explore Australian rural adolescents’ experiences of accessing help for a mental health problem in the context of their rural communities. Design and setting: A qualitative research design was used whereby university students who had sought help for a mental health problem during their adolescence were interviewed about their experiences. Interviews were conducted face-to-face at the university. Main outcome measures: A semi-structured interview schedule was designed around the study’s main research questions. Audio-taped interviews were transcribed and thematically coded using a constant comparative method. Participants: Participants were first-year undergraduate psychology students between the ages of 17 and 21 years who sought help for a mental health issue during their adolescence and who at that time resided in a rural area. Results: Participants highlighted various barriers to seeking help for mental health problems in the context of a rural community, including: social visibility, lack of anonymity, a culture of self-reliance, and social stigma of mental illness. Participants’ access to help was primarily school-based, and participants expressed a preference for supportive counselling over structured interventions. Characteristics of school-based helpers that made them approachable included: ‘caring’, ‘nonjudgemental’, ‘genuine’, ‘young’, and able to maintain confidentiality. Conclusions: The findings support previous research that reveals barriers to help seeking for mental health problems that are unique to the culture of rural communities. The study raises questions about the merit of delivery of primary mental health care to young people via GPs alone and suggests that school-based counsellors be considered as the first step in a young person’s access to mental health care.
Description:
The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help-seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in-depth understanding of the help-seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities.
Description:
The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help-seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in-depth understanding of the help-seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities.
Description:
The theory of evolution has transformed biology from a largely descriptive science to a causal one. However, few psychologists have a thorough understanding of evolution. As a result, psychologists tend not to consider evolutionary explanations for the phenomena they investigate, or they present flawed evolutionary arguments that violate fundamental principles of evolutionary theory. The primary objective of this article is to outline the basic principles of evolution as they relate to the study of behaviour in general. The article then goes on to demonstrate the application of evolutionary theory to the study of human behaviour in particular, and concludes with a discussion of problems that can occur when evolutionary theory is applied incorrectly.
Description:
The theory of evolution has transformed biology from a largely descriptive science to a causal one. However, few psychologists have a thorough understanding of evolution. As a result, psychologists tend not to consider evolutionary explanations for the phenomena they investigate, or they present flawed evolutionary arguments that violate fundamental principles of evolutionary theory. The primary objective of this article is to outline the basic principles of evolution as they relate to the study of behaviour in general. The article then goes on to demonstrate the application of evolutionary theory to the study of human behaviour in particular, and concludes with a discussion of problems that can occur when evolutionary theory is applied incorrectly.
Description:
The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised – including the nature of mental health issues for rural adolescents and barriers to seeking professional help – are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.
Description:
The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised – including the nature of mental health issues for rural adolescents and barriers to seeking professional help – are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.
Description:
Depression is a highly complex mental disorder that for many years was believed to be absent in children and adolescents. It is now accepted that depression not only exists in this age group, but also is a major mental health problem (Weller & Weller, 2000a). Research suggests that the prevalence of depression in Australian children and adolescents is around 14% (Boyd, Kostanski, Gullone, Ollendick, & Shek, 2000). As depression appears to be highly prevalent, it is essential that efficacious treatments are identified, and that effective treatment strategies are established that best alleviate depressive symptoms in children and adolescents. In light of this need, this article details the criteria used to identify depression in children and adolescents, and examines the available evidence for the use of pharmacological and psychotherapeutic approaches in the treatment of depression in children and adolescents.
Description:
Depression is a highly complex mental disorder that for many years was believed to be absent in children and adolescents. It is now accepted that depression not only exists in this age group, but also is a major mental health problem (Weller & Weller, 2000a). Research suggests that the prevalence of depression in Australian children and adolescents is around 14% (Boyd, Kostanski, Gullone, Ollendick, & Shek, 2000). As depression appears to be highly prevalent, it is essential that efficacious treatments are identified, and that effective treatment strategies are established that best alleviate depressive symptoms in children and adolescents. In light of this need, this article details the criteria used to identify depression in children and adolescents, and examines the available evidence for the use of pharmacological and psychotherapeutic approaches in the treatment of depression in children and adolescents.
Description:
The purpose of this study was to establish whether socioeconomic status would mediate the relationship between rurality and depression in a sample of Australian adolescents. Participants were 65 rural and 64 urban secondary school students from Years 11 and 12 who completed a survey that included a brief demographic questionnaire and the Centre for Epidemiological Studies - Depression Scale. Schools were selected for their degree of rurality as measured by the Accessibility and Remoteness Index for Australia, and the socioeconomic status of each individual was estimated via postal code using the Socio-Economic Index of Australia. Although a significant relationship between degree of rurality and depression was found, socioeconomic status did not mediate this relationship. These results suggest that the relationship between rurality and depression for young people is not due to simple differences in socioeconomic status between urban and rural areas. Other features of 'place' must be considered in accounting for rural-urban differences in adolescent depression.
Description:
In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process.
Description:
Objectives: The present study was a qualitative investigation of the impact of drought on rural families of southern New South Wales, Australia, with particular emphasis on the concept of resilience in times of stress. The aim was to provide insight, from a psychological perspective, into the experiences of rural farmers in a time of adversity, and to identify the coping resources utilized by these farming families. Method: Participants were 11 members of five families from Blighty, a small farming town in the Riverina district, experiencing drought and decreased water allocation to their local area. Family members were interviewed on two separate occasions at their farms. Results: Analysis of interview transcripts revealed that a wide range of coping strategies were being utilized by these families from problem-focussed coping, optimism and positive appraisal to less adaptive strategies such as cognitive dissonance, denial and avoidance of negative social influences. A significant finding was the discovery of a range of collective coping strategies used by the families in this study and the reliance on social capital as an adaptive resource. There were signs, however, that social cohesion of this community had become compromised due to competition for resources. Conclusion: The adaptive coping mechanisms traditionally employed by these farming families are starting to weaken and urgent work to enhance the individual coping strategies of farmers is needed. Furthermore, Government needs to recognise the importance of social capital as a coping resource that will enable farming families to adapt and survive drought conditions into the future. Providing financial assistance to support current community initiatives and collective coping strategies may prove more beneficial to farmers than allocating inadequate amounts of funding to individual farming families.
Description:
Objectives: The present study was a qualitative investigation of the impact of drought on rural families of southern New South Wales, Australia, with particular emphasis on the concept of resilience in times of stress. The aim was to provide insight, from a psychological perspective, into the experiences of rural farmers in a time of adversity, and to identify the coping resources utilized by these farming families. Method: Participants were 11 members of five families from Blighty, a small farming town in the Riverina district, experiencing drought and decreased water allocation to their local area. Family members were interviewed on two separate occasions at their farms. Results: Analysis of interview transcripts revealed that a wide range of coping strategies were being utilized by these families from problem-focussed coping, optimism and positive appraisal to less adaptive strategies such as cognitive dissonance, denial and avoidance of negative social influences. A significant finding was the discovery of a range of collective coping strategies used by the families in this study and the reliance on social capital as an adaptive resource. There were signs, however, that social cohesion of this community had become compromised due to competition for resources. Conclusion: The adaptive coping mechanisms traditionally employed by these farming families are starting to weaken and urgent work to enhance the individual coping strategies of farmers is needed. Furthermore, Government needs to recognise the importance of social capital as a coping resource that will enable farming families to adapt and survive drought conditions into the future. Providing financial assistance to support current community initiatives and collective coping strategies may prove more beneficial to farmers than allocating inadequate amounts of funding to individual farming families.
Description:
Little research has been undertaken into the barriers facing rural adolescents seeking help and support for mental health problems. This study presented students from rural secondary schools in Victoria with hypothetical scenarios of an adolescent living in a rural area with a mental disorder and posed questions inorder to create group discussion. The results revealed a range of perceived barriers to help-seeking that could be considered unique to rural settings. However, adolescents also expressed positive attitudes and identified a range of professional help sources available to them. The findings support recent moves towards providing school-based mental health services to young people in rural areas.
Description:
Little research has been undertaken into the barriers facing rural adolescents seeking help and support for mental health problems. This study presented students from rural secondary schools in Victoria with hypothetical scenarios of an adolescent living in a rural area with a mental disorder and posed questions inorder to create group discussion. The results revealed a range of perceived barriers to help-seeking that could be considered unique to rural settings. However, adolescents also expressed positive attitudes and identified a range of professional help sources available to them. The findings support recent moves towards providing school-based mental health services to young people in rural areas.
Description:
Introduction: In Australia, rural adolescents still face barriers to obtaining professional psychological help due to poor availability and accessibility of services in rural areas when delay in seeking help for mental health problems can lead to poorer treatment outcomes. The aims of this study were to: investigate the preferences and intentions of rural Australian youth towards seeking help for mental health problems; determine predictors of help-seeking intention among rural adolescents; and verify results from previous qualitative research on the barriers to help-seeking in a rural context. Method: Participants were 201 adolescents recruited from 8 rural schools in the state of Victoria, Australia. Participants ranged in age from 11 to 18 years. Using the Accessibility and Remoteness Index of Australia (ARIA+), approximately 149 participants were classified as currently living in an inner regional area of Victoria, whereas 52 participants lived in an outer regional area. Participants completed an open-ended survey of help-seeking intention. Results: Overall, 55.7% of the sample indicated that they would seek help for a mental health problem. The majority of participants, regardless of subgroup, indicated that they would seek help for a mental health problem from a school counsellor as their first choice. Gender differences were observed such that males had a higher preference for seeking help from a psychologist than females. Furthermore, older adolescents were more likely to prefer seeking help from a GP than younger participants. A multivariate analysis of help-seeking intentions revealed that ARIA was the only predictor of help-seeking intention; however, when extreme scores of depression and anxiety were also taken into account, these also predicted help-seeking intention. A content analysis of the barriers to help-seeking nominated by participants revealed that perceived limited availability of professional services in towns, perceived social proximity and fear of rural gossip, and difficulties associated with travelling to obtain help were the most significant concerns for these youth. Conclusions: These findings verify previous research on help-seeking among rural youth and reinforce that these young people face additional barriers to help-seeking by virtue of living in a rural environment. The availability of services for rural youth needs to be improved, as do young people's knowledge of service availability and access (especially travel options). It must be taken into account that rural adolescents of different ages and sex may differ in their help-seeking preferences. Finally, mental health promotion work with rural youth should consider the influence of rural culture on help-seeking intentions.
Description:
In this article we take up some of the challenges presented by non-representational theory (Anderson & Harrison 2010; Boyd, forthcoming); in particular, that offered by Nigel Thriftʼs leitmotif of movement – ʻof living as a succession of luminous or mundane instants … of movement as a desire for a presence which escapes a consciousness-centred core of self-referenceʼ (2008, p7). In response, we offer two alternate styles of rhythmanalysis based on an experimental work that explores the sonic geographies of shifting bodies. In doing so, we consider the habits of bodies in order to think on the intimate relationship between body, habit, subjectivity, and what it may give rise to in terms of ʻa politics of what happensʼ (Thrift 2008, p2). Our starting point is that of the body and habits. Habits comprise rhythmic sequences – pulse, heartbeat, breath, talking, gesturing, walking, eating, digesting and a myriad of other sequences that keep us going and keep us moving even at these imperceptible levels. Yet such rhythmic states are not merely structuring space-time into repeated and monotonous acts. As music theorist Christopher Hasty points out, “rhythm focuses our attention, not on time as a substrate or medium of events, but on the events themselves in their particularity, creativity and spontaneity” (1997, p7). Regular repetition in this sense is more than a rigid and constricted pattern or proportion of time. The ways in which we experience repetitive rhythms, i.e., that we feel these as soundwaves with our whole body, leads us to try and make sense of this experience in terms of a pulse. This is significant to an embodied geography of place; our bodily and cognitive response serve to interpellate the human body into place, a rhythmic attunement that helps in ʻforging body-space relationshipsʼ (Duffy et al 2011, p 17). Using rhythmanalysis as a tool, we contemplate the way in which bodies, habits and rhythms constitute the ʻsocialʼ, and how even the most banal of bodily movements speak to our sense of being in the world and the bodyʼs capacity to act. In many ways the principles and methods of rhythmanalysis we draw on in our work resonate with theories of non-representational geography. Proponents of non-representational theory advance a cause and desire for a form of social analysis which embraces ʻmore-thanʼ the terminations and operations of representational knowledge (Lorimer 2008). Non-representational theory highlights the failures of representational thinking to understand the palpable relevance of ʻthought-in-actionʼ as the foreground (rather than the background) of our lives. In non-representational research there is a focus on movement, action, and practice – the dynamic way that affect is folded within and between objects, spaces, and things (Thrift 2004). As radical constructivists, non-representational theorists go beyond social constructivism in sharing an approach to meaning and value as ʻthought-in-actionʼ (Anderson & Harrison 2010). As Dewsbury puts it: The non-representational argument comes into its own in asking us to revisit the performative space of representation in a manner that is more attuned to its fragile constitution … For me, the project of non-representational theory then, is to excavate the empty space between the lines of representational meaning in order to see what is also possible. The representational system is not wrong: rather, it is the belief that it offers complete understanding – and that only it offers any sensible understanding at all – that is critically flawed (2003, p.1911) Thus, non-representational theorists not only assert that all human life is based on and in movement, but that this movement captures the joy of living and an attitude towards life as potential. As such, the stream of activity that constitutes the social is seen to be constantly moving and changing. Within the ʻassemblages of lifeʼ, there is a kind of joint action between things and spaces which makes them inseparable from each other. As such, non-representational theories trade in modes of perception which are not individualised or subject-based (Thrift, 2008). It is this slippery nature of embodied geographies that is the focus of our empirical work
Description:
The aim of this study was to explore the prevalence of eating disorders in primary care in the Ballarat region and to highlight the role of GPs in the detection and management of eating disorders in regional Australia. We used anonymous data previously collated by the Ballarat and District Division of General Practice on the prevalence of eating disorders and patterns of referral of eating disorder patients among GPs in their Division. Over half of GPs surveyed indicated that they treat patients with eating disorders within their practice rather than referring patients to other services. In referring on, GPs were more likely to refer to mental health professionals and dietitians. A notable finding was that these regional GPs were more likely to refer to metropolitan specialist services than local hospitals if their patients required an admission. GPs in regional Australia do significant work to detect and manage patients with clinical eating disorders in the absence of locally-based, specialist services. In this context, we recommend the establishment of linkage partnerships between GPs and mental health practitioners to facilitate early intervention for rural and regional eating disorder patients. Further research into the current treatment practices of regional GPs is also needed to ascertain their specific training needs with respect to this patient population.
Description:
The aim of this study was to explore the prevalence of eating disorders in primary care in the Ballarat region and to highlight the role of GPs in the detection and management of eating disorders in regional Australia. We used anonymous data previously collated by the Ballarat and District Division of General Practice on the prevalence of eating disorders and patterns of referral of eating disorder patients among GPs in their Division. Over half of GPs surveyed indicated that they treat patients with eating disorders within their practice rather than referring patients to other services. In referring on, GPs were more likely to refer to mental health professionals and dietitians. A notable finding was that these regional GPs were more likely to refer to metropolitan specialist services than local hospitals if their patients required an admission. GPs in regional Australia do significant work to detect and manage patients with clinical eating disorders in the absence of locally-based, specialist services. In this context, we recommend the establishment of linkage partnerships between GPs and mental health practitioners to facilitate early intervention for rural and regional eating disorder patients. Further research into the current treatment practices of regional GPs is also needed to ascertain their specific training needs with respect to this patient population.
Promoting the psychosocial function of young adults through psychiatric residential rehabilitation: A qualitive evaluation of the making a significant change (MASC) program
Description:
This research evaluated the Making a Significant Change (MASC) program - the only residential psychosocial rehabilitation program for young adults in the Grampians region of Victoria, Australia. The program provides intensive support and rehabilitation services to young people aged 16 to 24 years who have a mental illness and are at risk of developing further mental health disabilities. This evaluation aimed to establish a holistic view of the program with a focus on the process descriptive data for key stakeholders in the service so that the impact of intervention approaches could be gauged.
Description:
This research evaluated the Making a Significant Change (MASC) program - the only residential psychosocial rehabilitation program for young adults in the Grampians region of Victoria, Australia. The program provides intensive support and rehabilitation services to young people aged 16 to 24 years who have a mental illness and are at risk of developing further mental health disabilities. This evaluation aimed to establish a holistic view of the program with a focus on the process descriptive data for key stakeholders in the service so that the impact of intervention approaches could be gauged.