Mental Health Services and Social Inclusion in Remote and Rural Areas of Scotland and Canada

: A Qualitative Comparison

Abstract

Mental health has become an increasingly importantly focus in the UK policy landscape because of its social and economic impact. However, most research to date has focused on living with mental health issues, or providing mental health services, in urban settings. There is limited understanding of the experiences of rural dwellers with mental health issues or the role of the voluntary sector in terms of its contribution to mental health service provision in rural areas. Thus, this PhD explores the experiences of rural mental health service users and providers in Scotland and Canada, and also considers the contribution of mental health voluntary organisations in helping to overcome the challenges of social exclusion for service users, as identified in previous research. Two theoretical lenses were used to frame the research questions. First, the concept of social inclusion provided a lens to analyse the processes by which service users achieve, or not, a sense of belonging and connection in society (Philo 2000). Second, Putnam’s (2000) theory of social capital provided a further analytical lens by which to explore the contribution of rural voluntary organisations. Social capital focuses on the features of populations such as social networks, trust and norms of reciprocity that shape the quality and quantity of social interactions (McKenzie & Harpham 2006). The aims of the research were to: To explore the impact of rural life for mental health service users’ daily life and access of services To understand the contribution of rural mental health services to tackling social exclusion for service users The five research questions used in this thesis were: What does it mean to experience mental health problems in remote and rural areas? What are the challenges that service providers face in remote and rural areas? What benefits are there for service users attending voluntary groups in remote and rural areas? Do voluntary groups offer something that other rural mental health services do not? Is social capital useful for understanding the benefits and role of mental health voluntary organisations in a rural setting? These questions were addressed using qualitative methods. The experiences of service users attending voluntary organisations in Scotland and Canada were elicited through a focus group method. The views and perspectives of mental health professionals in both countries were also obtained through in-depth interviews. The findings demonstrate that mental health stigma remains a considerable problem for rural service users in both countries but is more pronounced in Highland. Additionally, the close-knit nature of rural communities is challenging for service users in relation to maintaining anonymity and forging friendships. In terms of the policy of social inclusion, the findings demonstrate a ‘rhetoric-reality’ gap. A key finding from the study shows that the voluntary organisations facilitate and promote the process of recovery for members. Such findings are valuable given that there is an urgent need for qualitative work on recovery (Davidson et al., 2008). Using the analytical lens of social capital demonstrates the way in which service users can be connected to each other and their local communities by nurturing social ties. This element of the study is particularly important because it provides a detailed analysis of the relationship between mental health and social capital; demonstrating how positive mental health outcomes are achieved. The study contributes to new knowledge on rural mental health. It highlights the significant role rurality plays in shaping the experiences of mental health service users and adds to the knowledge base on the rural voluntary sector, particularly in relation to the emergent recovery paradigm.

Date of Award	5 Jun 2014
Original language	English
Awarding Institution	University of Edinburgh
Supervisor	Sarah-Anne Munoz (Supervisor) & Jennifer Cleland (Supervisor)