Rural Psychiatry: Special Issues and Models of Service Delivery
The commonly occurring psychiatric disorders, anxiety and depression, have a combined community prevalence rate of 15-30% and are associated with significant clinical and economic cost. Although a number of effective pharmacological and psychological treatments are available for the management of these disorders, many people do not have access to, or do not receive, these treatments. An important factor associated with the lower rates of use of specialist services is rural, particularly remote, residence. This review discusses the problems of delivery of services to rural areas in countries with formal mental health services, and where the availability of psychiatrists and specialist mental health practitioners approximates that recommended by the World Health Organization. Relevant data were collected via a literature search using Medline and PsychLit and supplemented by material from key textbooks and by articles recommended by local experts in the field. A variety of special issues in rural areas, which make mental health service provision problematic, were identified. These relate to the characteristics of the rural location and community, demands upon and availability of mental health clinicians, and the changing role and focus of mental health services. These features, together with limited access to services by patients, necessitate models of service delivery different from those provided in urban areas. Important features include a shift from the `specialist as direct provider of care' role to one of consultation, education, and indirect service provision and the use of a variety of outreach arrangements to enable patient access to essential specialist services.
Community care, Evidence based medicine, Health services accessibility, Psychiatric disorders
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