Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe

Jose A Salinas-Perez; Mencia R Gutierrez-Colosia; Carlos R Garcia-Alonso; Mary Anne Furst; Hossein Tabatabaei-Jafari; Jorid Kalseth; David Perkins; Alan Rosen; Daniel Rock; Luis Salvador-Carulla

doi:10.3389/fpsyt.2023.993197

Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe

Front Psychiatry. 2023 Feb 6:14:993197. doi: 10.3389/fpsyt.2023.993197. eCollection 2023.

Authors

Jose A Salinas-Perez^{1

2}, Mencia R Gutierrez-Colosia³, Carlos R Garcia-Alonso^{1

2}, Mary Anne Furst², Hossein Tabatabaei-Jafari², Jorid Kalseth⁴, David Perkins^{2

5}, Alan Rosen^{6

7}, Daniel Rock^{2

8

9}, Luis Salvador-Carulla^{2

10}

Affiliations

¹ Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.
² Health Research Institute, University of Canberra, Canberra, ACT, Australia.
³ Department of Psychology, Universidad Loyola Andalucía, Sevilla, Spain.
⁴ SINTEF Digital, Health Research, Trondheim, Norway.
⁵ Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia.
⁶ Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
⁷ Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
⁸ WA Primary Health Alliance, Subiaco, WA, Australia.
⁹ Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia.
¹⁰ National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia.

Abstract

Introduction: Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas.

Methods: The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters.

Results: The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL.

Discussion: In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.

Keywords: DESDE-LTC; Integrated Atlas; health planning; healthcare ecosystem; mental health service; readiness studies; rural healthcare.

Grants and funding

This study used data from different research projects developed by researchers from ConNetica Consulting Pty Ltd., the Mental Health Policy Unit of the Brain and Mind Centre (University of Sydney), Universidad Loyola Andalucía, and PSICOST Research Association: (A) The “Integrated Atlas of Mental Health and Alcohol and Other Drugs of Western Australia” funded by the Western Australia Primary Health Alliance (WAPHA) and the Western Australia Mental Health Commission (WAMHC). (B) “The Integrated Mental Health Atlas of Western NSW” funded by the Western NSW Primary Health Network; (C) “Development of a health map of services and facilities for the integral care of people with mental illness and the application of geographic information systems for decision support in planning services in Catalonia” (Project: CPA 73.10.15) funded by the Health Department of Catalonia. (D) “The Research on Financing Systems Effect on the Quality of Mental Care - REFINEMENT project” (project number: 261459) received funding from the European Commission under the Seventh Framework Programme (7FP) from 1 January 2011 to 31 December 2013. (E) “Effect of Financing Systems in the Quality of Mental Health in Spain: REFINEMENT-Spain” (PI18/01521) funded by Carlos III Health Institute and FEDER funds.