Dr Kate Davies

Objective: Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking. Design: Data were gathered through a cross-sectional survey distributed by a social media boosted post. Setting: A total of 349 ¿small¿ rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5. Participants: A total of 765 adult, rural residents completed the survey. Main outcome measure(s): Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder. Results: Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress. Conclusions: Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness.

Objectives: Globally, Indigenous people have lower-health status compared to non-Indigenous people due to unequal access to health care. Barriers or enablers to accessing maternal health services by Indigenous women are not well researched. This review aims to determine accessibility and utilisation of maternal primary healthcare services among Indigenous women in lower- and middle-income countries. Methods: We conducted a systematic integrative review of published and grey literature published between 2000 and 2017. Studies on maternal healthcare service utilisation by Indigenous women in lower- and middle-income countries were included. From 3092 articles identified, 10 met the eligibility criteria. Results: The most prominent barrier to accessing maternal primary healthcare services was the top-down nature of intervention programmes, which made programmes culturally unfriendly for Indigenous women. Distance, cost, transport, accommodation, language barriers and lack of knowledge about existing services also impacted access. Conclusions: Findings provided insights into understanding the gaps in existing policies for Indigenous women and their access to maternal health services. Results suggested that efforts be made to ensure appropriate programmes for Indigenous women¿s maternal health right.

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community-based mental health service. This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community-based mental health service. Interviews with 19 peer and non-peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non-judgemental way. However, peer support workers tended to ¿fill service gaps¿ within intensive, administrative case-management environments. These findings highlight the importance of an organisational-wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: ¿ Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; ¿ The roles of peer support workers were poorly understood by team members; ¿ Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.

This paper draws on findings from an Australian study of mental health service users' perspectives on service user participation to examine the challenges for translating recovery policy into practice. It considers the ways in which national mental health policies and developing welfare reforms reflect and/or contradict the highly personal mode of recovery important to service users; though they seemingly signal potential wins for service user empowerment, they are accompanied by losses for those who do not fit neatly into clinical categorisations. The service users (n = 11) and service providers (n = 6) interviewed for this exploratory qualitative study revealed that recovery was a lifelong process of fluctuating capacity and described a system poorly equipped and often unwilling to move beyond tokenistic modes of participation. The analysis of service user perspectives against the backdrop of policy reform reveals the ongoing tensions between personal and clinical definitions of recovery.