title: The effect of context in rural mental health care: Understanding integrated services in a small town.
abstract: Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community-based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients' and stakeholders' needs and that build on success and increased trust may be more effective than those imposed from the 'top down' that pay insufficient attention to local contexts.
authors.affiliation: Centre for Rural and Remote Mental Health, The University of Newcastle, Locked Bag 6005, Orange, NSW 2800, Australia. Electronic address: scott.fitzpatrick@newcastle.edu.au.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Fitzpatrick
authors.affiliation: Centre for Rural and Remote Mental Health, The University of Newcastle, Locked Bag 6005, Orange, NSW 2800, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Perkins
authors.affiliation: Mudgee Community Health Centre, PO Box 29, Mudgee, NSW 2850, Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Luland
authors.affiliation: Mudgee Community Health Centre, PO Box 29, Mudgee, NSW 2850, Australia.
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.affiliation: Mudgee Community Health Centre, PO Box 29, Mudgee, NSW 2850, Australia.
authors.forename: Eamonn
authors.initials: E
authors.lastname: Corvan
mesh_terms: D001315:Australia; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006282:Health Personnel / Q000458:organization & administration; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012424:Rural Population
keywords: Integrated care; Mental health; Primary care; Qualitative research; Rural health