Daly, Clare Louise

UHI Thesis - pdf download summary Mental Health Services and Social Inclusion in Remote and Rural Areas of Scotland and Canada A Qualitative Comparison Daly, Clare Louise DOCTOR OF PHILOSOPHY (AWARDED BY OU/ABERDEEN) Award date: 2014 Awarding institution: The University of Edinburgh Link URL to thesis in UHI Research Database General rights and useage policy Copyright,IP and moral rights for the publications made accessible in the UHI Research Database are retained by the author, users must recognise and abide by the legal requirements associated with these rights. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement, or without prior permission from the author. 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Sep. 2021 MENTAL HEALTH SERVICES AND SOCIAL INCLUSION IN REMOTE AND RURAL AREAS OF SCOTLAND AND CANADA: A QUALITATIVE COMPARISON A thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy at the University of Aberdeen CLARE DALY BA (Hons) Social Science (First Class), University of the Highlands and Islands 2014 DECLARATION OF ORIGINALITY I confirm that this doctoral thesis has been written entirely by myself and has not been submitted for any other degree. I confirm that the work reported in the thesis was conducted by myself and not collaboratively. All quotations have been distinguished by quotation marks and sources of information acknowledged. ………………………….. Clare Daly May 2014 i ACKNOWLEDGEMENTS There are many people I would like to give heartfelt thanks to. First and foremost, my humble pranams to my beloved Guru, without whom none of this would have been possible. I would also like to offer thanks and gratitude to my supervisors Dr Sarah-Anne Muñoz and Professor Jennifer Cleland, for their support, invaluable guidance and advice. To my wonderful mother, whose wisdom and strength have allowed me to be the woman I am today, thank you. To my father, for all of the enriching conversations, friendship and unfailing support. To my dear sisters Angela, Kirsty and Rachel for their encouragement and faith that they have always given me. To Andreas, for never failing to make me smile and for always believing in me. To my lifelong friend Jackie Kidd and her family, especially Keiran. To my wonderful friend, Matt Sillars, whose brilliance has not only helped to change my life but countless others too, thank you. To my dear friend, Ken Brown, for reading this entire thesis and providing invaluable comments, and for inspiring me to aim higher and believe in myself, thank you. To Fiona and Frank Ryan, for all of the reminders to breathe and ‘take breaks’, and for holding my hand when times got tough. To Brian Boag, for helping me get started all those years ago. To Buster, for making me go for walks and getting fresh air inside my lungs when I so desperately needed it. Last, but by no means least, to all my other friends and family who have helped me or offered kind words of support on my journey. I would like to thank the University of the Highlands and Islands (UHI) for funding this thesis, and the Centre for Rural Health where the study was conducted. Finally, I would like to thank the service users who took part in this study and shared their experiences with me. This thesis would not have been possible without such contributions. I dedicate this thesis to Rosie Mooney and Teresa O’Rourke, gone but never forgotten. ii ABSTRACT Mental health has become an increasingly importantly focus in the UK policy landscape because of its social and economic impact. However, most research to date has focused on living with mental health issues, or providing mental health services, in urban settings. There is limited understanding of the experiences of rural dwellers with mental health issues or the role of the voluntary sector in terms of its contribution to mental health service provision in rural areas. Thus, this PhD explores the experiences of rural mental health service users and providers in Scotland and Canada, and also considers the contribution of mental health voluntary organisations in helping to overcome the challenges of social exclusion for service users, as identified in previous research. Two theoretical lenses were used to frame the research questions. First, the concept of social inclusion provided a lens to analyse the processes by which service users achieve, or not, a sense of belonging and connection in society (Philo 2000). Second, Putnam’s (2000) theory of social capital provided a further analytical lens by which to explore the contribution of rural voluntary organisations. Social capital focuses on the features of populations such as social networks, trust and norms of reciprocity that shape the quality and quantity of social interactions (McKenzie & Harpham 2006). The aims of the research were to: To explore the impact of rural life for mental health service users’ daily life and access of services To understand the contribution of rural mental health services to tackling social exclusion for service users The five research questions used in this thesis were: What does it mean to experience mental health problems in remote and rural areas? What are the challenges that service providers face in remote and rural areas? What benefits are there for service users attending voluntary groups in remote and rural areas? iii Do voluntary groups offer something that other rural mental health services do not? Is social capital useful for understanding the benefits and role of mental health voluntary organisations in a rural setting? These questions were addressed using qualitative methods. The experiences of service users attending voluntary organisations in Scotland and Canada were elicited through a focus group method. The views and perspectives of mental health professionals in both countries were also obtained through in-depth interviews. The findings demonstrate that mental health stigma remains a considerable problem for rural service users in both countries but is more pronounced in Highland. Additionally, the close-knit nature of rural communities is challenging for service users in relation to maintaining anonymity and forging friendships. In terms of the policy of social inclusion, the findings demonstrate a ‘rhetoric-reality’ gap. A key finding from the study shows that the voluntary organisations facilitate and promote the process of recovery for members. Such findings are valuable given that there is an urgent need for qualitative work on recovery (Davidson et al. , 2008). Using the analytical lens of social capital demonstrates the way in which service users can be connected to each other and their local communities by nurturing social ties. This element of the study is particularly important because it provides a detailed analysis of the relationship between mental health and social capital; demonstrating how positive mental health outcomes are achieved. The study contributes to new knowledge on rural mental health. It highlights the significant role rurality plays in shaping the experiences of mental health service users and adds to the knowledge base on the rural voluntary sector, particularly in relation to the emergent recovery paradigm. iv CONTENTS CHAPTER 1 ..................................................................................................................................... 1 INTRODUCTION ............................................................................................................................ 1 1.1 Introduction to the thesis: rural mental health, social inclusion, recovery and social capital 2 1.2 Voluntary Sector ..................................................................................................................... 6 1.3 Rurality and Mental Health: Beyond the UK Context ........................................................... 7 1.4 Cross-National Comparisons .................................................................................................. 7 1.5 Aims and Objectives .............................................................................................................. 8 1.6 Thesis Structure ...................................................................................................................... 9 CHAPTER 2 ................................................................................................................................... 11 MENTAL HEALTH SERVICES AND SOCIAL INCLUSION (IN REMOTE AND RURAL AREAS): LITERATURE REVIEW .............................................................................................. 11 2.1 Introduction .........................................................................................................................

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