Formal and informal support systems in a rural town and county : report of the research on mental health in Dannevirke Borough and County : a thesis presented in fulfilment of the requirements for the degree of Master of Philosophy at Massey University
The Dannevirke project was designed to provide a view into one rural borough and county in order to discern how that community provided services for those in need of emotional and psychological support. Professional human service providers and a representative sample, of the general population were interviewed to identify the formal and informal supports that were available to the community and to define mental health and mental illness. This project was based on two assumptions: 1) rural and small town life in New Zealand had networks of self-help and support and these networks were different from those found in the urban environment; 2) clinical and professional practitioners adopted unique responses to practice in a rural area. This study demonstrated that a rural community based on the romantic notion of a small homogenous, caring community was simplistic. Intrarural differences in the numerous settlements revealed a more complex fabric. The data did reflect an intricate and caring network of informal supports but it was unclear as to how different (e.g. more supportive) these rural networks were to those in an urban/suburban community. Respondents with low group membership and low visitation from family and friends reported a statistically significant low sense of psychological well-being using the Bradburn Well-Being Scale (1969). The actual roles these networks played in caregiving and prevention needed further inquiry. The pathways to service for people experiencing emotional/psychological problems were traced, including a ten year statistical analysis of inpatient psychiatric care. The general practitioner was identified by the respondents in the community and by other professionals as the primary gatekeeper for services, underlining the medical bias in their definitions of mental illness. Delivery of services by the professionals in the rural area was complicated by distance, minimal interprofessional coordination, shortage of specialist services, and a lack of ongoing professional education in the field of community mental health. Treatment in the community was favoured over sending the clients away for services and the local hospital was a unique resource for short-term respite care. The findings brought forth numerous questions including: What models of practice are effective for mental health care in the rural context? How do geographical distance and isolation affect community mental health practice? Does the urban base of most professional training prepare formal caregivers for life and practice in the rural setting? Specific recommendations for policy development and for further research were discussed.