Living with a mental health disorder in a rural environment

Mental Health Catalonia compiles the obstacles and recommendations in a report.

Drafting

SOM Salud Mental 360

The relationship between mental health and rural life has been studied from various perspectives. Demographics over the last few decades have been evolving towards depopulation. The causes are diverse: a lack of job opportunities, unequal access to services, and an aging population. The loss of social and economic fabric and the impact on public services are major challenges that can negatively affect the quality of life of residents, especially when it comes to mental health.

The recent report "Mental Health and Rural Environment " by the Federació Salut Mental Catalunya addresses precisely the challenges and specific needs of mental health care in rural areas of Catalonia.

The starting point of the study is situated in a context marked by territorial inequality, with limited access to services and resources due to depopulation, lack of infrastructure and the concentration of resources in urban areas; and with aggravating factors such as stigma or transportation difficulties, as detailed in the same document.

'Storytellers of Lives', a documentary about mental health in rural areas

Through a participatory methodology involving around one hundred people from Central Catalonia, Lleida, and Tarragona, this study aims to:

Identifying obstacles and best practices in mental health in rural settings.
Promote equitable access to social and health services.
Generate proposals and strategies to improve the conditions of the affected people.

The report identifies the main obstacles affecting the care and recovery of people with mental health problems:

The lack of affordable housing resources.

According to the report, acquiring decent housing for people with mental health conditions presents additional challenges compared to urban areas. Specifically, it points to a higher incidence of stigma due to closer relationships among residents. This translates into greater discrimination and prejudice from landlords and a stronger sense of rejection towards people living in supported housing. Adding to this difficulty is the limited availability of housing due to the impact of tourism and the prevalence of second homes.

The report highlights that "in most areas there is a lack of access to social rental housing, supported living arrangements or residential care, and home support and care services." It also emphasizes that individuals are left to adapt to the services, and many are managed by third-sector organizations, which face their own challenges in maintaining them.

Shortage of local health and social care services.

The geographical dispersion of rural populations hinders effective and equitable care for people with mental health problems and their families. The report confirms the lack of social and healthcare services in villages, including both regular services and care during nighttime and holiday hours, and that professional interventions in rural areas are sporadic. This situation forces many people to travel long distances to receive in-person care. The lack of an efficient public transportation network is an additional obstacle.

Another critical issue is the inadequacy of emergency services to assist people experiencing a crisis. Maintaining privacy in these services is difficult, a factor that carries a heavy burden of stigma in environments where everyone knows each other, and where protocols and procedures are slow.

The impact of social stigma and self-stigma on emotional well-being.

As previously mentioned and as a recurring theme throughout the report, the stigma surrounding mental health issues is more pronounced in rural areas simply because residents are closer together. Furthermore, these areas are even more affected by a lack of information about mental health, which perpetuates stereotypes and increases discrimination. Rumors and labels attached to individuals and perpetuated over time (the village "weirdo" or the village "crazy one") create a hostile environment and involve preconceived notions of dangerousness, thus exacerbating exclusion and marginalization.

The lack of inclusive educational, employment and leisure opportunities.

The barriers faced by people with mental health problems in accessing educational, employment, and leisure opportunities are more pronounced in rural areas, which are already characterized by a lack of opportunities in these areas. Other factors mentioned earlier contribute to this lack of opportunities and spaces for socialization: deficiencies in the transportation network, leisure activities concentrated in regional capitals, a lack of awareness of the characteristics of rural life, and a more pronounced stigma.

Deficiencies in citizen participation and social support networks.

One of the obstacles identified in the report is the lack of resources for participation, with few inclusive activities or spaces. There is little family support network and even a certain lack of awareness of one's own rights when making decisions. Adding to this situation is the shortage of mental health professionals, which leads to misinformation and uncertainty, and a greater tendency to violate people's rights, according to the report.

As is generally the case, there is also an overload of caregivers, mostly women, with little social recognition and little space for self-care.

In addition to compiling various experiences and projects developed in the Catalan rural environment that are examples of good practices , the authors of the report put forward a series of recommendations to improve this situation, which include: