Mental health in rural communities: Supporting the needs of adults 50 and over Rural Health Services Research Symposium May 18, 2017 Nelly D. Oelke School of Nursing UBC Okanagan
Acknowledgement of Funders • Canadian Institutes for Health Research • Irving K. Barber School of Arts and Sciences, UBCO • South Okanagan Similkameen Research Foundation
Background—Mental health • Cost estimates are $51 billion per year • Mental health is a major concern for Canadians—1 in 5 individuals will have a mental health concern • Stigma continues to be a major concern
Background—Rural • Rural communities face unique social and environmental challenges • Older populations—out migration/in-migration • Lower SES and education levels • Higher rates of chronic physical disease • May have higher rates of mental illness • Decreased access to health care services • High turnover rates in health care providers • Geographic isolation
Background—Adults 50 and over • Mental health for older adults increasing • Over 20% of seniors in Canada report having a mental health concern • Impacted by life changes (e.g., retirement, relocation, death of partner or friends) • Individuals with chronic disease, particularly seniors, are at risk for mental health issues • Less than 50% of older adults receive treatment for their mental health concerns • Mental health is not well addressed in older adults nor in rural communities
South Okanagan and Similkameen Map: Elections Canada, n.d. Available from: http://www.elections.ca/res/cir/maps/mapprov.asp?map=59026&lang=e
Consultations Community Members 50 years+ • Mental health concerns • Osoyoos, Oliver, Okanagan Falls, Keremeos, Hedley, and Princeton Organization Representatives • Provide services and supports for adults 50+
Results • Access to services • Transportation, wait lists • Capacity/perceived lack of services and supports • Limited services and providers • Lack of collaboration among organizations providing services/supports • Poverty • Housing, income, lack of employment, and balancing needs and finances • Stigma • Gender differences, potentially higher in rural communities, and isolation • Purpose and meaning in life • Lack of being cognitively challenged, lack of value, and isolation from family • Community needs • Increased hours, social connection, and life skills
Research Planning Meeting • Two key priority questions identified: • What are best practices for integrated community-based mental health services and supports for rural communities? • What is the current state of interagency collaboration and how do we build on current capacities to provide integrated mental health services and supports for this community?
Understanding Collaboration through Social Network Analysis • 6 focus groups conducted with organization representatives to create netmaps of their connections with individuals/organizations • 15 people participated with over 200 connections to different individuals and organizations • Some individuals/organizations highly connected; others not • Preliminary analysis: • Fragmentation • Service delivery by not-for-profits • Specialization of services • Information sharing • Continuity of care
Best practices review of rural community-based mental health services for adults 50+ • Medline, CINAHL, PsychInfo, and Systematic Revs • 1124 abstracts • Duplicates removed = 669 • 49 articles met inclusion criteria • Quality ratings • Data extraction
Next steps • SNA • SNA analysis and share results in community meetings • Best Practices Review • Complete integrative review analysis • Conduct interviews with exemplars • Community meetings • Goal is to co-create a model of care that can be tested • Population-based survey • Photo voice study
Conclusions • Mental health is a major concern for this population • Hidden • Many gaps in services and supports • Underserved • Lack of community-based services and supports • Providers were also not well integrated • Increased awareness needed • Stigma • Support access • Innovative approaches • Informed by local perspectives • Unique to rural community • Effective allocation of valuable resources
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