Last year, Centre for Mental Health co-hosted a roundtable with Rural Mental Health Matters, an organisation dedicated to improving mental health support in rural areas of the UK. We wanted to explore the specific challenges to people’s mental health in rural Britain, the support that’s available, and how well services are attuned to the specific challenges they face.
We heard from people with both lived and professional knowledge about mental health and rurality, in order to build a picture of the current situation and explore ways to meet people’s needs more effectively.
Risk and protective factors for mental health in rural communities
Isolation was a key theme for people who had experienced poor mental health in rural areas, as both children and adults. Isolation is not just physical (the distance from school and social relationships) but social and cultural – feeling that you are different to others at school because you’re from the countryside, and not having peers with similar experiences to turn to. In recent years, austerity policies have also seen the closure of community spaces in villages, eroding the ‘social infrastructure’ where mental health is nurtured.
Online communities can be a way of overcoming this isolation. But connectivity remains a challenge in many rural areas, limiting its scope to replace physical social connection, as well as a means of getting mental health support.
Access to nature and green spaces is widely accepted as a protective factor for mental health, and the countryside has plenty of it – but accessibility isn’t so straightforward, with limited walking options and poor adaptations for disabled people.
These factors all operate within the context of wider economic pressures that affect people’s mental health. Housing is a particular concern, with a lack of affordable homes in many areas, and communities that are ‘dying out’ without sufficient permanent residents to maintain them. Rural Britain is affected by the same economic and social determinants of health as anywhere else, but the ways they are experienced are quite specific and therefore require commissioners and service providers to think creatively about how they can be addressed.
Improving access to mental health support
We’ve known for some time now that mental and physical health are inextricably linked, and that physical illness increases our risk of poor mental health. Yet people being treated for physical conditions are often not asked about their mental health or offered support for it, despite the risks this creates.
Visibility, or rather a lack of it, is a key factor in the provision of mental health support in rural areas. Participants spoke of the importance of mental health support being seen, using examples of banks or other businesses that took their offer to rural communities through mobile services or by appearing at markets and community hubs. If the offer isn’t visible, it won’t be accessible.
It’s now widely assumed that young people are better at seeking help for their mental health than older generations, but this may be less so in rural areas where a culture of self-reliance and stoicism is still more entrenched and mental health literacy may be less strongly encouraged. Likewise, young people are assumed by service commissioners to be keener to use digital mental health services, but – once again – this only works if they are connected and are proactively encouraged to seek support online. Young people in particular need physical spaces to go where they will be welcomed, where they will not be judged, and where they can make emotional connections.
The issues we heard about in rural areas across the UK are not unique to this country. Across Europe, we heard that health services more generally are withdrawing from rural areas as more services are located in larger centres and remaining rural providers are left isolated, overstretched, and burned out.
We often say that mental health is made in communities, and this is at the heart of how mental health support can be better attuned to rural areas and the people who live and work there. Rather than doing everything on a larger scale, we need to create connections in the places people go and where they are at. The creation of ‘neighbourhood’ mental health services across England may provide an opportunity to adapt provision better to rural areas. It is also crucial for support to be culturally competent and trauma-informed in rural areas as much as in urban Britain – for example to meet the needs of people from racialised and marginalised communities that are too often overlooked.
Ways forward
Improving mental health support in rural areas is essential to provide equitable access to health care countrywide. Rurality changes how support can and should be provided, with the need for adaptations to make services visible, relevant, welcoming, and easily accessible to the people they seek to help. This cannot be left to chance: it needs dedicated funding to adapt services to rural communities and build a sufficiently sized workforce with the requisite skills and knowledge.
We hope to take this further by working with partners to develop an accreditation scheme for rural inclusiveness in mental health services.
