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Rural issues in mental health
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Introduction
What is a rural community?
Rurality, health and wellbeing
Mental health in rural areas – the issues
Provision of care and support services
Access to transport
Access to information
Stigma
High risk groups
Farmers and farm workers
Black and minority ethnic (BME), and lesbian, gay, bisexual and transgender (LGBT) groups
Women with children
Children and young people
Older people
Travellers
Migrant workers
Rural proofing
What is rural proofing?
What progress has been made so far?
Ways of working in rural areas
Further reading
Useful contacts
Introduction
This factsheet is aimed at people who live or work in rural areas and anyone who provides health or social care services in England or Wales. It addresses issues relating to mental health that are specific to, or more common in, the countryside. The factsheet also covers issues that may be found in towns and cities but carry different implications for rural areas and may require different solutions.
Throughout the factsheet, references are made to publications, organisations and services. Contact details for these can be found in 'Useful contacts'.
In 2004, the Department for Environment, Food and Rural Affairs (Defra) and the Countryside Agency published new definitions for 'rural' and 'urban'. These definitions are based on population figures for each 'settlement' (village, town or hamlet) and the district in which the settlement is located. Population sparsity is now the defining feature of a rural community.
The new definitions for 'rural' and 'urban' were developed for use by funders, policy makers and the Office of National Statistics. Defra admits that an area definition as either rural or urban may conflict with the 'look' or 'feel' of that area from the perspectives of local people.
Traditionally, rurality has been defined by a range of factors, including the rate of land use for agricultural activities. The agricultural landscape is still an important feature of many rural areas, yet only two per cent of the population in England and three per cent in Wales are currently employed in farming.
The Defra/Countryside Agency definitions were developed to encompass the diversity of rural England and Wales in the twenty-first century. Rural areas today include 'honeypot villages' that depend heavily on tourism, urban fringe commuter villages and former coal-mining communities.
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Rurality, health and wellbeing
In general, rural communities enjoy better health and wellbeing than their urban counterparts. On standard measures of health (such as life expectancy and infant mortality) rural communities consistently score better. Evidence suggests that levels of the most common mental health problems are lower in rural areas. Generally, rural residents make less use of health services and have a more positive view of the state of their own health.
Urban and rural communities agree on the main factors that make the countryside a healthier and more pleasant place to live - peace and quiet, the predominantly natural or agricultural environment, lower crime rates and close-knit communities. These perceptions are reflected in the fact that more people living in rural areas wish to stay in their community for the long-term compared to people living in urban areas. Moving from towns and cities to the countryside is a growing trend in England and Wales.
Unfortunately, the widely recognised benefits of life in the countryside have led to the concept of the 'rural idyll' - an idealised stereotype of country life that ignores the real difficulties faced by many rural communities. Such difficulties include poverty, lack of services, poor public transport and traumatic social or economic change at local level.
Poverty is a reality across rural England and Wales, especially in the most remote areas. Those living on low incomes may be dispersed over large, sparsely populated districts. They are often as geographically near to more affluent members of the community as they are to others on low incomes. This means that their poverty is less visible to community planners and policy makers, who use 'indicators of deprivation' that are more suited to the higher concentrations of poverty found in towns and cities.
This 'hidden' poverty has a major impact on the health of individuals and families. Issues that affect rural areas, such as lack of services and poor public transport, have the greatest impact on people living in poverty.
People who are more vulnerable to mental distress are also less likely to enjoy the same level of health and wellbeing as the rest of the population. See 'High risk groups' for further details.
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Mental health in rural areas – the issues
Although rural England and Wales have social, economic and cultural differences, they do share some issues that are likely to affect the mental health of both their populations.
Provision of care and support services
Economies of scale mean that most services are located in urban areas, which are more highly populated. This is especially true of specialist services, such as care and support services for people with mental health problems.
Not only are there fewer specialist services in rural areas, but those that exist are likely to be many miles from a patient's home. This has a serious effect on access to services in urgent or crisis situations, the availability of outreach services for those who cannot leave their homes, and response times for on-call doctors who serve large, sparsely populated areas. The right of all NHS patients to choose between service providers means little if there is only one specialist provider across a large geographical area.
The time, money and effort required to travel to specialist services can impede the recovery and good management of mental health problems. See 'Access to transport' below for more details about this issue.
Fortunately, many voluntary organisations work hard to ensure good coverage of rural areas and address issues that are important to people living in the countryside. You can find out more about these organisations as you read through this factsheet and find their contact details in 'Useful contacts'.
Access to transport
The quality of available transport is a major factor in whether urban-based care and support services are accessible to people who live in rural areas.
People in rural areas usually find that public transport does not meet their daily mobility needs. Only 50 per cent of the rural population have an hourly bus service within ten minutes walk from their home. The frequency, reliability and timing of rural public transport can make travelling to mental health services difficult or impossible. In many cases, a day return journey from home to a service outlet cannot be made using public transport.
Due to inadequate public transport, most people living in rural areas find that owning a car is essential to their daily life. Frequently, people who are already in financial hardship get further into poverty from the costs of buying, insuring and maintaining a vehicle.
People in rural areas who do not own cars are often reliant on private or voluntary arrangements such as taxis or lifts from family members and neighbours. However, these arrangements can be expensive or dependent on the willingness and ability of a small number of volunteers. The Institute of Rural Health has found examples of taxi fares (between £40 and £70 for a round trip) preventing patients in rural areas from accessing mental health services.
Those who suffer from poor transport are often those most in need of accessing services: older people, young people, women (often young mothers) living in one-car households, people living on low incomes and those with physical or mental health problems.
If transport problems are making it difficult for you to reach mental health services, it is worth asking your local hospital or health centre if they provide any transport services to patients. Other sources of information include your Rural Community Council (if you live in England) and your local branch of the Community Transport Association. 'Social car' transport schemes may operate in your area. For information about these schemes, contact your local Council for Voluntary Service, Women's Royal Voluntary Service or British Red Cross local branch. Contact details for these organisations can be found in your phone book or other local directory.
Some local Mind associations also provide transport to their services, either for free or for a small charge. You can find the contact details of your nearest local Mind association in the phone book, on the Mind website or by phoning MindinfoLine.
If you are aged 60 or over, or if you have a physical disability, you may be entitled to additional transport services and financial concessions. Age Concern and Mind have produced further information about these issues.
If your access to mental health services is affected by a physical disability, Dial UK is a good source of advice and support. They cover topics such as mobility and transport, independent living and local services. You can find your local branch of Dial UK in the phone book or other local directory.
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Access to information
Access to reliable, high quality information has a profound effect on mental health and wellbeing. It enables us, as individuals and as social groups, to make the most of our lives, fully aware of our rights and the resources available to us. This applies to local and national community information in general, as well as to information specifically about health.
In rural areas it may be more difficult to obtain information about mental health issues locally due to a lack of infrastructure. Often shops, post offices, libraries and GP surgeries are widely dispersed or run services that do not meet an individual's needs (for example, shop opening hours may clash with an individual's working hours).
Some information services do have coverage of the countryside. The Post Office is required by central government to maintain its rural network and to prevent avoidable closures. All public library services have mobile facilities for remote parts of their catchment areas and organise visits to housebound library users. The Citizens Advice Bureau has small outlets in rural areas that are linked to main offices in nearby towns.
Although the coverage of information outlets is inadequate, especially in rural areas, most organisations now use a range of media (print resources, telephone, email and Internet) to communicate. Mind runs its MindinfoLine through both telephone and email and maintains a comprehensive website that is updated daily. Other national organisations involved in health and wellbeing, such as Samaritans and Age Concern, also provide information by telephone, email and Internet. These methods reduce the need for 'physical' information outlets but do not replace them.
The barriers to accessing information faced by many people with physical disabilities can be greater in rural areas. Travelling long distances to information outlets can be difficult or impossible. Where small, local outlets do exist, they may be less likely to have had the 'reasonable adjustments' made that are laid down by the Disability Discrimination Acts (1995 and 2005) to make buildings accessible to disabled people.
For mental health information in accessible formats, Mindinfoline provides a textphone service to deaf and speech impaired enquirers and the Mind website has adjustable text size for visually impaired readers (adjustable text size applies to Mind factsheets and booklets that can be read online). All the main national organisations that provide information, advice or pastoral care are now committed to making their electronic resources accessible to disabled people.
People who do not have English as their first language may find it more difficult to find information on mental health in their first language in rural areas. MindinfoLine offers the Language Line service. Language Line is an organisation that provides interpretation services for non-English speakers and plays a 'third party' role between caller and a member of the MindinfoLine staff. (See 'Useful contacts' for details.)
In addition, Mind's information booklets have been translated into a range of languages. See the 'Information' section of the Mind website.
The Welsh-based information and advice service, Community Advice and Listening Line, provides web-based and telephone services in English and Welsh. The Rural Stress Information Network has full coverage of Wales and provides its publications in English and Welsh.
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Stigma
People with mental health problems are often stigmatised in our society, labelled as violent, unpredictable or dangerous. These negative images and ideas are often caused by confusion about what 'mental distress' actually is.
In many rural communities, the stigma can be especially strong – caused in part by social structure. The service user movement is weak owing to population sparsity and consequent lack of group support for those who speak out. This is often compounded by the lack of anonymity or confidentiality found in many small, close-knit rural communities.
In a wider sense, many rural communities have a deeply ingrained culture of stoicism and self-reliance. This can apply to all aspects of a person's life, including their health. Stoicism and self-reliance have proved great strengths in the countryside, enabling individuals and families to survive major financial and personal difficulties, to persevere and even prosper.
However, stoicism and self-reliance can sometimes have a negative effect on mental health. Where these qualities are highly valued, external intervention – especially from public, urban-based health services – is likely to be rejected in favour of trying to cope alone.
The consequences of stigma can have a serious effect on a person's willingness to access mental health services or confide in potentially supportive individuals and agencies. In this atmosphere, mental health problems are more likely to develop and recovery is more difficult. This can lead to chronic poor mental health.
Fortunately, attitudes to mental health have improved across the English and Welsh countryside over the past decade. High profile crises in agriculture, such as BSE and Foot and Mouth disease, have brought public attention to the stresses in farming communities that can lead to mental health problems. Rural organisations which have a mental health remit, such as the Farm Crisis Network and the Rural Stress Information Network, have been active across England and Wales. For more information on the work of these organisations see 'Farmers and farm workers' below.
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High risk groups
While anyone can develop a mental health problem, certain groups in rural communities are particularly vulnerable.
Farmers and farm workers
Farmers and farm workers have been identified as a high risk group for stress, depression and suicide. Economic difficulties and the social isolation of farming life can contribute to mental health problems. Two specific agricultural crises, BSE and Foot and Mouth disease, have had devastating long-term effects on agricultural communities. Currently, and for the foreseeable future, farmers face the stresses of conforming to UK and European legislation, including complex bureaucratic procedures, and financial uncertainty. Some have also experienced mental health problems as a result of exposure to organophosphate chemicals found in sheep dip and other products that farmers use in their work.
Farmers who develop mental health problems rarely approach mental health services due to the stigma attached to mental health problems and the shame of being seen as 'not coping'. Due to their geographical location, farmers are often at a distance from mental health services, which makes them difficult to reach. In addition, farmers work long hours and may not be able to take time off during 'office hours' to use mental health services.
One positive outcome of the BSE and Foot and Mouth crises is that public attention has been drawn to the experiences of affected communities, including the impact of these experiences on farmers' mental health. Organisations, working at local and national levels, have raised their profiles within rural communities providing information, advice and other forms of support.
The Farm Crisis Network recruits volunteers from the farming community (farmers, farmers' wives, agricultural chaplains) who understand the practical difficulties that farmers face. Volunteers offer technical and pastoral support and respond quickly and confidentially to requests for help. They suggest the use of other services where necessary and provide moral support while farmers resolve their own problems. Some counties have Farm Crisis Network support groups.
The Rural Stress Information Network is a national level 'umbrella' organisation. It works at local level with farming and rural support groups. It also provides a confidential telephone helpline, an information service and promotes research into the causes and effects of rural stress.
Other national organisations involved in health, wellbeing or personal finance have gained a deeper understanding of the issues facing farmers over recent years. Examples of such organisations are the Citizens Advice Bureau, Samaritans and Age Concern.
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Black and minority ethnic (BME) populations, and lesbian, gay, bisexual and transgender (LGBT) groups
Black and minority ethnic (BME) populations and lesbian, gay and bisexual and transgender (LGBT) populations, make up minorities in many parts of the UK. They make up even smaller minorities in the countryside. Negative attitudes towards BME and LGBT people, reported across rural England and Wales, are not tackled effectively, mainly because the groups affected are so small that they cannot easily build strong local support networks.
Often, those who plan services do not believe that members of BME or LGBT populations live in rural areas. This is not the case. As these populations tend to be small and isolated, individuals can suffer doubly from being visible within their local community but invisible to those who plan services. This situation can lead to culturally inappropriate services, expressions of racism and homophobia, and consequent mental distress.
Work in tackling negative attitudes towards BME and LGBT groups is currently taking place in rural England and Wales at national and local levels. Examples include:
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The Commission for Racial Equality is supporting local work across rural Britain as part of its 'Getting results' project.
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The Countryside Agency's Diversity Review (2005) is researching the diversity-awareness of service providers in rural England and the perceptions of groups who are under-represented in their use of rural services.
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Mind Out Cymru is an all-Wales support and information network for lesbian, gay and bisexual people who either have, or have had, contact with mental health services.
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Intercom in the South West of England is an umbrella organisation for LGB communities that are dispersed across rural areas.
Welcoming the development of such networks is an important part of Mind's work.
If you identify as a member of a BME or LGBT group and have experienced discrimination or a lack of sensitivity to your needs in a rural community, there are organisations that can offer social and emotional support and can help you to get the treatment you are entitled to. The Citizens Advice Bureaux and Age Concern have both highlighted the plight of BME and LGBT groups in rural areas. Both organisations have local groups across the England and Wales.
If your concern is with health service provision in your local area, or the treatment you have received, contact the Patient Advice and Liaison Officer (PALS) for your NHS Trust. For more general mental health information addressing the needs of BME and LGB groups, Mind produces factsheets and booklets on these issues. See 'Further reading'.
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Women with children
Poor public transport, lack of services and difficult access to information present challenges for women with children in rural areas. These women are at risk of developing mental health problems due to the isolation they face. Isolation is especially severe for women with children who are living on a low income, have no paid employment, are single, or are living in a sparsely populated area. Women living in one-car households may also have transport problems if their partner uses the car during the working week.
Due to isolation, the problems women face may be hidden from others in their community. Such problems may include lack of control of personal finances, relationship problems, difficulties with children or domestic violence. Farmers' wives have the additional strain of providing care and support to husbands who work in a highly stressful occupation. This can take its toll on the women's own mental health.
Networks and organisations exist throughout rural England and Wales to help women overcome these difficulties and look after their health and wellbeing. Churches and faith organisations provide a range of social activities, many involving parents and children. Many churches also offer pastoral care services and you do not need to be a Christian, or of any religious faith, to use these services. The Women's Institute has good coverage of the countryside. It provides opportunities to improve your skills, take up hobbies, meet new people or join campaigns on social issues. The Welsh-language equivalent to the Women's Institute is Merched y Waur.
Even in small villages, groups and services often exist for children that have the added benefit of bringing parents together. Examples include toddler groups, playgroups and car share arrangements around school and extracurricular activities.
The Government's Sure Start scheme provides services for children under four years old in areas that have been identified as deprived. The pockets of deprivation that exist in rural areas have been included in the scheme: 15 standard and 45 'mini' Sure Start programmes are currently operating in rural England. (In Wales, Sure Start operates within an organisation called Cymorth). Sure Start services include crèches, health advice, playgroups, toy libraries and help with childcare costs.
Both the Farm Crisis Network and the Rural Stress Information Network exist to serve both men and women in mental distress. Women are also active in the running of both these organisations, providing information, running self-help services and contributing to campaigns.
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Children and young people
There are clear social and environmental benefits for children and young people who live in rural England and Wales. See 'Rurality, health and wellbeing'.
In comparison with their urban counterparts, rural children and young people are generally in better health, living in higher income households and have higher levels of educational achievement. However, these generalisations hide huge disparities within and between rural communities. Children and young people in lower income families or in the most sparsely populated rural areas are more vulnerable to the full range of social problems that are likely to affect their mental health.
According to social trends, young people (those aged between 16 to 29) are a declining population in rural England and Wales. The number of rural households that include children aged 15 or under, is below the national average. This can lead to inadequate provision of age appropriate services, which may increase isolation and mental distress.
Studies show that young people in rural areas face a more limited range of education, training and employment opportunities, poor access to recreational, advice and counselling services and a shortage of affordable housing, making independence difficult. There is growing evidence that anti-social behaviour, including alcohol and drug problems, is on the rise among young people in rural England and Wales.
Children and young people in rural areas have the same rights to health services as those based in urban and suburban areas. Details of these rights for those aged 16 and under are described in the Department of Health's and the Welsh Assembly Government's National Service Frameworks for Children and Young People. All children and young people have the right to specialist, age appropriate mental health services, flexibility as to the location at which they are seen by health professionals and, if necessary, emergency referrals within 24 hours. In practice, many services are less available in rural areas. Access to specialist services may involve out-of-area referrals which will mean longer waiting times for appointments and longer travelling times to service providers.
YoungMinds run an information service for parents and carers, and another for children and young people. The service covers all aspects of mental health including diagnoses and conditions, NHS services and legal issues. Mind also produces some publications that give further information (see 'Children' under 'Further reading').
To find out which organisations are available for young people in your area, check the telephone directory, information outlets such as libraries and post offices and your local Council for Voluntary Service. Some local Mind associations provide services for children and young people. For contact details of your nearest local Mind association, check the telephone directory, the Mind website or call MindinfoLine on 0845 766 0163.
Many mental health charities run telephone and email support services for children and young people. Examples include Samaritans, Childline and the Eating Disorders Association. Such services are particularly important for young people in rural areas who do not have access to face-to-face support services.
The National Children's Bureau maintains a Forum for Rural Children and Young People. The forum aims to change policy and work with partners across the UK to improve outcomes for children and young people who live in rural areas. Membership is free to any organisation that shares this goal.
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Older people
A higher proportion of people aged over 65 live in rural rather than urban areas. Evidence shows that this proportion is continuing to grow.
Older people in rural areas are less likely than their urban counterparts to have relatives nearby to support them and are more likely to live alone. These factors can lead to feelings of isolation. Studies have also shown that older people make up the largest group of people living in poverty in rural areas which, combined with the higher cost of living in the countryside, can cause considerable stress.
Despite their numbers, older people in rural areas are disadvantaged in terms of health service provision compared with their urban counterparts. Where mental health is concerned, the problems experienced by older people are more likely to be misdiagnosed and neglected at primary care level and are less likely to be referred to mental health services. Yet mental health problems affect a significant minority of older people.
Mind's campaign, Access all ages, is aimed at improving the treatment older people receive from mental health services – no matter where they may live. Mind also produces a factsheet on older people's mental health.
Of the various networks and services that may be of interest to older people living in the countryside, Age Concern is the largest and best known. Age Concern is active in all parts of the country, with many groups located in rural areas. Age Concern produces a range of useful publications including factsheets, guides and reports.
Contrary to the stigmatised view of older people as 'dependent', evidence shows that older people make a significant contribution to community life in rural areas. They are more likely than other age groups to participate in organisations such as parish councils, village hall committee and religious groups and to use community facilities such as shops and post offices. Older people are also most likely to provide unpaid care to others, including those with physical or mental health problems.
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Travellers
Travellers have been part of rural communities since the fourteenth century, when the first Romany Gypsies arrived in England and Wales. Since the nineteenth century Irish Travellers have joined this population, as well as former house dwellers who have adopted the traveller life through choice or circumstance. Although economic change has forced many to seek work and accommodation in urban areas, Travellers still make up part of the migrant worker population that takes seasonal employment in the countryside.
Historically, friction has occurred between settled and Traveller populations and this is often the case today. Tensions are further fuelled by the shortage of well-run, authorised sites for Travellers and the negative representation of Travellers in the mass media. This takes its toll on Travellers' mental health and wellbeing.
Travellers face huge barriers in their access to health and related services, such as social care and education. This is largely because they are subject to frequent evictions from unauthorised sites. As temporary residents in a health authority's catchment area and lacking a fixed abode, it can be difficult for Travellers to register with a GP. This can also make it difficult for them to receive long-term treatment provided by a health authority.
There are two main sources of information on Travellers' issues that are relevant to mental health. The Travellers Times magazine and the Friends, Families and Travellers website, which gives information on law, planning and evictions as well as health, education and community information.
Traveller communities identify with a holistic concept of health as opposed to medical models that are rooted in concepts of disease and medication. The holistic approach emphasises social and environmental factors as 'key determinants' of health. Using research and outreach into Traveller health undertaken over the past decade, the Department of Health is currently working with Traveller communities to: “establish a model of Traveller participation in the promotion of health, and to assist in the dialogue between Travellers and Health service professionals”.
The promotion of good mental health is integral to this project.
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Migrant workers
British farmers depend on migrant workers to perform a range of seasonal tasks. The 60,000 migrant workers who work on British farms today come from local towns and villages, as well as Traveller and Gypsy communities.
Many also come from further afield, for example, from Asia and the Middle East. With the expansion of the European Union, the number of eastern European migrant workers has increased sharply, from 20,000 to 111,000 over 2004/5. Some migrant workers are in the UK illegally and this group is at particular risk of exploitation and abuse.
The mental health of migrant workers, and especially illegal migrant workers, presents particular challenges to service providers. Workers may speak little or no English (nor any of the languages spoken by groups established over a longer period in the UK). They may find British mental health services difficult to understand and even threatening, particularly if they have received hostile treatment from settled, local communities. If employed in seasonal work, a migrant worker may not be resident in a NHS Trust catchment area long enough to receive the treatment they need.
Over the past few years, organisations involved with health and wellbeing have begun working with rural migrant workers. The Citizens' Advice Bureau has undertaken many outreach projects with migrant workers through its Rural Bureaux Network. The Arthur Rank Centre, the national focus for rural churches in England, has identified migrant workers as a priority group for pastoral care and has published a leaflet on this issue in partnership with Defra.
Migrant workers' language needs can sometimes be met by a local or national organisation that offers information and support services to a particular national or cultural group, for example, the Chinese Mental Health Association. For signposting to such services, phone MindinfoLine and use their Language Line facility.
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Rural proofing
What is rural proofing?
If you work for an organisation that covers a rural catchment area, you may have heard of the term 'rural proofing'. The concept of 'rural proofing' was first used in a Government publication in 2000. To 'rural proof' a policy or a service is to make sure that it takes account of the needs of rural communities. This requires an awareness of the needs of those living in the countryside, and distinct from those in towns and cities, as well as the needs and rights we all have to essential services and a healthy environment.
The aim of rural proofing is to overcome the disadvantages that people living in rural areas may experience in their access to services.
What progress has been made so far?
There has been progress at central government level in rural proofing policies. The Commission for Rural Communities has a responsibility to monitor the rural proofing activities of all Government Departments and Government Offices for the Regions. An annual report is then written on progress made. However, there is no legal requirement for rural proofing in either England or Wales at central, or local, government level. In Wales, there is no monitoring system for rural proofing because the Welsh Assembly Government states that all policies are rural proofed as a matter of course.
Encouragingly, high quality research has been commissioned into rural proofing and how this may be achieved. Resources, such as guides, checklists and examples of good practice have been produced to help service providers better meet the need of their rural communities.
One major example of this kind of research can be found in Mind's 2004 Rural Proofing Report. This project was set up to assess the impact of the National Service Framework for Mental Health on rural England and Wales. It examined the particular demands of service delivery in rural areas, highlighted examples of good practice and made recommendations to the Department of Health.
Increased awareness of the needs of rural communities has proved a welcome outcome of the rural proofing years. It is now widely accepted across the public and voluntary sectors that people living in rural areas have the right to the same service standards as people living in towns and cities. It is also recognised that different ways of delivering services, and more resources in terms of time, money and staffing are likely to be needed in rural areas.
If you are living in a rural area and feel you do not have access to the health and social care services you need, there are national and local level organisations that can inform you of your rights and the different ways you can use the services available. See 'Useful contacts' for details.
Ways of working in rural areas
If you are involved in policy, planning or service delivery in a rural area, there are several sources of support and information available that can help you to develop your work; see 'Further reading' and 'Useful contacts' for details.
Pilot projects into different ways of delivering mental health care and support services give examples of good practice, as well as revealing the challenges service providers may face. One recent example is the teleconferencing study whose results have been published in Mind's Rural Policy Toolkit. This study shows how telephone conferencing can be used in rural areas to bring together people in widely dispersed locations who have a common interest or need. Teleconferencing was successfully used to deliver training to staff in separate rural locations and to facilitate support groups for people across wide geographical areas.
One form of delivering services in rural areas that has proved successful is the Multi Service Outlet (MSO). The rationale behind MSOs is that single services in rural areas (such as village shops) often find it difficult to survive financially, leading to a gradual decline in the quality of the service and eventual closure. However, where several services share the same physical location, they can share running costs and pool resources – including money and expertise. MSOs can prosper in the countryside and provide a high quality service to their catchment area. However, to date there are very few MSOs operating in England and Wales.
There are ways you can make a difference to mental health and related services in your rural area, whether as a service provider, service user or simply as a member of the rural community. Church groups, village hall committees and the Women's Institute are examples of 'grass roots' organisations that can bring people together to work at local level towards a common goal. Parish and Town Councils are useful contacts because they have a role in 'community profiling' so that services can be provided to meet local needs. Details for these groups should be listed in your phone book and other local directories.
If you are representing an organisation, it is worth getting involved in your Local Strategic Partnership and contacting your county's Rural Community Council for advice and support.
Local campaigns around service provision in health and social care have made a real difference throughout the English and Welsh countryside. Such campaigns, for example, may be aimed at preventing the closure of a local hospital. Some local Mind associations have experience of campaigning. For advice and support on how to get involved in a local or national campaign, contact Mind's Campaign Support Unit.
Throughout its work, Mind aims to promote better mental health for rural communities. Mind provides information materials, supports frontline services delivered by local Mind associations and highlights the implications for rural communities of all its policy work and campaigns. Mind has a Rural Network, made up of organisations and individuals with an interest in health and wellbeing in rural communities in England and Wales. An Advisory Panel has been elected from this Network to monitor and influence Mind's work.
If you would like to know more about Mind's rural work, or contribute to it in any way, contact a member of Mind's Rural Team (see 'Useful contacts').
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Further reading
Children and young people
Mind, 2004, Understanding childhood distress, Mind.
Mind factsheet, 2005, Children and young people and mental health.
Mind factsheet, 2004, Young person's introduction to mental health.
Diversity
Mind, 2003, Disabled people and mental health support services, Mind.
Mind, 2003, How to cope with doubts about your sexual identity, Mind.
Mind factsheet, 2003, Lesbians, gay men and bisexuals and mental health.Mind produces a range of factsheets and booklets on mental health issues for different BME groups. See under 'Diversity' in the 'Information/factsheet' section of the Mind website.
General
Age Concern, 2005, Travel and Transport, Age Concern.
British Medical Association, 2005. Healthcare in a rural setting, BMA.
Commission for Rural Communities, 2005, The State of the Countryside 2005.
Defra, 2004, Rural Strategy, Defra.
Countryside Agency and others, 2004, Rural and Urban Area Classification 2004: An Introductory Guide, Defra, London.
Mind factsheet, 2004, Public attitudes to mental distress, London.
Mind, 2002, Rural Mind's response to the 2001 FMD outbreak, Mind Website.
Mind, 2004, Understanding mental illness, Mind.
Older people
Department of Health. 2001, National Service Framework for older people, HMSO.
Mesurier, N. 2004, Older People's Involvement in Rural Communities, Age Concern.
Mind factsheet, 2005, Older people and mental health.
Rural proofing
Commission for Rural Communities 2005, Rural Proofing Report 2004-2005, London, Commission for Rural Communities.
Elder, K. 2004, Rural proofing the National Service Framework for Mental Health, Mind.
Mind 2005, Rural Policy Toolkit, Mind.
Swindlehurst, H. 2005, Rural Proofing for Health: A Toolkit for primary care organisations, Institute of Rural Health.
Travellers and migrant workers
Travellers' Times, http://travellerstimes.org.uk
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Useful contacts
This list is not exhaustive and contains only national and umbrella organisations. Many other useful organisations may exist in your local area; check your phone book or other local directory for details.
Children and young people
Childline
Tel: 0800 1111
Email: www.childline.org.uk
Free helpline for children and young people in the UK.
Eating Disorders Association (EDA)
First Floor
Wensum House
103 Prince of Wales Road
Norwich NR1 1DW
tel: 0845 634 7650 (Youthline)
email: talkback@edauk.com (Youthline email service)
website: www.edauk.com
National Children's Bureau (NCB)
8 Wakely Street
London EC1V 7QE
tel: 020 7843 6000
website: www.ncb.org.uk
YoungMinds
48-50 St John Street
London EC1M 4DG
tel: 020 7336 8445
email: info@youngminds.org.uk
website: www.youngminds.org.uk
Diversity
Commission for Racial Equality
St Dunstan's House
201-211 Borough High Street
London SE1 1GZ
tel: 020 7939 0000
email: info@cre.gov.uk
website: www.cre.gov.uk
The Intercom Trust
PO Box 285
Exeter
Devon EX4 3ZT
tel: 0845 602 0818 (LGBT Helpline)
email: lynx@intercomtrust.org.uk
website: www.intercomtrust.org.uk
Support for isolated and vulnerable LGBT people living in the rural South West of England.
Mind Out Cymru
PO Box 78
Carmarthen SA31 3XB
email: contactwales@mind.org.uk
website: www.mind.org.uk
All Wales network for lesbians, gay men and bisexuals who have had contact with mental health services through being users or workers, paid or unpaid.
Minority Ethnic Women's Network (MEWN)
1st Floor
Coal Exchange
Mount Stuart Square
Cardiff CF10 5EB
02920 464 445
email: administration@mewn-cymru.org.uk
Wales-only information, support and campaigning organisation for BME women.
Stonewall
46 Grosvenor Gardens
London, SW1W 0EB
tel: 020 7881 9440
email: info@stonewall.org.uk
website: www.stonewall.org.uk
Campaigning and lobbying organistion working to achieve equality and justice for lesbians, gay men and bisexual people.
Farming and agriculture
Farm Crisis Network (FCN)
Manor Farm
West Haddon
Northampton NN6 7AQ
tel: 0700 232 6326
email: mail@fcn.org.uk
website: www.farmcrisisnetwork.org.uk
Provides help to families in farming and related activities who are experiencing problems.
Farming Help
website: www.farminghelp.org.uk
A web-based resource bringing together the main organisations that provide support, information or advice to farmers.
Royal Agricultural Benevolent Fund
Shaw House
27 West Way
Oxford OX2 0QH
tel: 0186 572 4931
website: www.rabi.org.uk
The national farming charity for England, Wales and Northern Ireland.
Mind Campaigns Unit
tel: 020 8215 2424
email: action@mind.org.uk
MindinfoLine
tel: 0845 766 0163 (Mon to Fri 9.15am to 5.15pm)
For details of your nearest local Mind association and local serices. Speech-impaired or Deaf enquirers can contact the same number (if you are using BT textdirect, add the prefix 18001). For interpretation they can put you through to Language Line.
Mind Rural Team
Keith Elder
Rural Development Manager
tel: 0190 285 0060
email: k.elder@mind.org.uk
Gareth Jones
Rural Policy Officer
tel: 0197 428 2459
email: gareth.jones@mind.org.uk
Rachael Twomey
Rural Information Officer
tel: 020 8215 2322
email: r.twomey@mind.org.uk
See the rural pages of the Mind website.
Older people
Age Concern
Age Concern England
Astral House
1268 London Road
London SW16 4ER
tel: 0800 00 99 66 (Helpline)
website: www.ageconcern.org.uk
Rural organisations
Action with Communities in Rural England (ACRE)
Somerford Court
Somerford Road
Cirencester
Gloucestershire GL7 1TW
tel: 01285 653 477
email: acre@acre.org.uk,
website: www.acre.org.uk
Co-ordinates and supports the Rural Community Councils of England.
The Arthur Rank Centre
Stoneleigh Park
Warwickshire CV8 2LZ
tel: 0247 685 3060
email: info@arthurankcentre.org.uk
website: www.arthurrankcentre.org.uk
Leadership organisation for the rural churches of England.
Commission for Rural Communities
20th Floor
Portland House
Stag Place
London SW1E 5RS
tel: 020 7932 5800
email: info@ruralcommunities.gov.uk
website: www.ruralcommunities.gov.uk
Independent watchdog, advocate for rural communities and advisor to Government departments.
Department for Environment, Food and Rural Affairs (Defra)
Information Resource Centre
Lower Ground Floor
Ergon House
c/o Nobel House
17 Smith Square
London SW1P 3JR
tel: 0845 933 5577 (Defra Helpline)
email: helpline@defra.gsi.gov.uk
website: www.defra.gov.uk
The government department with responsibility for rural affairs.
Institute of Rural Health
Gregynog Hall
Tregynon
Newtown
Powys SY16 3PW
tel: 01686 650 800
website: www.rural-health.ac.uk
A research institute that works with academic bodies, communities and individuals to promote health and wellbeing in rural communities. Provides useful publications, some available free of charge.
Rural Stress Information Network (RSIN)
Arthur Rank Centre
Stoneleigh Park
Warwickshire CV8 2LZ
tel: 0247 641 2916
email: enquiries@rsin.org.uk
website: www.ruralnet.org.uk/~rsin/
The umbrella organisation for the rural support sector.
Travellers and migrant workers
Friends, Families and Travellers
Community Base
113 Queens Road
Brighton
East Sussex BN1 3XG
tel: 0127 323 4777
email: fft@gypsy-traveller.org
website: www.gypsy-traveller.org
An advice, information and training organisation providing a wide range of services to Travellers.
Women
Merched y Wawr
Canolfan Genedlaethol Merched y Wawr
Stryd yr Efail
Aberystwyth
Ceredigion SY23 1JH
Ffôn: 01970 61 16 61
Ebost: swyddfa@merchedywawr.com
Gwefan: www.merchedywawr.co.uk
National Federation of Women's Institutes
104 New Kings Road
London SW6 4LY
tel: 020 7371 9300
website: www.womens-institute.co.uk
The largest organisation for women in the UK.
Women's Aid
Head Office
PO BOX 391
Bristol BS99 7WS
tel: 0808 200 0247
email: helpline@womensaid.org.uk
website: www.womensaid.org.uk
Runs a helpline and has refuges across England and Wales for women and children who experience domestic violence.
Other services and organisations
British Red Cross
UK Office
44 Moorfields
London EC2Y 9AL
tel: 0870 170 7000
email: information@redcross.org.uk
website: www.redcross.org.uk
Provides a transport service for those who find using public transport difficult for health reasons and a home care service to assist with independent living and prevent unnecessary hospital admissions.
Citizens Advice
Myddelton House
115-123 Pentonville Road
London, N1 9LZ
tel: 020 7833 2181
website: www.citizensadvice.org.uk
The national charity supporting Citizens Advice Bureaux (CAB) in England, Wales and Northern Ireland.
Community Advice and Listening Line (CALL)
tel: 0800 132 737
website: www.callhelpline.org.uk
Offers a confidential listening and support service and information/literature on mental health and related matters. (Wales only).
Community Transport Association (CTA)
London Office
Unit 1S Leroy House
436 Essex Road
Islington
London N1 3QP
tel: 0870 774 3587
email: CTAUK@CommunityTransport.com
website: www.communitytransport.com
Welsh Office
Unit 21
Morfa Conwy Business Park
Ffordd Sam Pari
Conwy LL32 8HH
tel: 0870 774 3593
email: CTAUK@CommunityTransport.com
website: www.communitytransport.com
Membership organisation for the UK community transport sector.
DIAL UK
St Catherine's
Tickhill Road
Doncaster
South Yorkshire DN4 8QN
tel: 0130 231 0123
website: www.dialuk.info
A national organisation for a network of local disability information and advice services run by and for disabled people.
National Council for Voluntary Organisations (NCVO)
Regent's Wharf
8 All Saints Street
London N1 9RL
Tel: 020 7713 6161
Email: ncvol@ncvo-vol.org.uk
Umbrella body for the voluntary sector in England; has a network of rural members and conducts research into rural policy and practice.
Samaritans
tel: 08457 90 90 90
email: jo@samaritans.org
web: www.samaritans.org.uk
Confidential emotional support for people who are experiencing feelings of distress or despair, including those which may lead to suicide; available 24 hours a day.
Wales Council for Voluntary Action (WCVA)
Head Office
Baltic House
Mount Stuart Square
Cardiff Bay
Cardiff CF10 5FH
tel: 0870 607 1666 (helpline)
email: help@wcva.org.uk
web: www.wcva.org.uk
Umbrella body for the voluntary sector in Wales.
Communities First
tel: 0800 587 8898
email: enquires@communitiesfirst.info
web: www.wcva.org.uk/content/all/dsp_text.cfm?display_sitetextid=141
Programme run by WCVA giving funding, advice and support to the most deprived communities in Wales to tackle social disadvantage.
Women's Royal Voluntary Service (WRVS)
Garden House
Milton Hill
Steventon
Abingdon OX13 6AD
tel: 0123 544 2900
web: www.wrvs.org.uk
Provide a range of services to people in need who might otherwise feel lonely and isolated.
This factsheet was written by Rachael Twomey, Mind Information Unit,
March 2006.
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