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Taking the service to the service user could improve access to mental healthcare in rural areas

Helen Oatham says roving clinics can help provide care in remote places  

Helen Oatham says roving clinics can help provide care in remote places     


Picture: iStock

In May, RCN congress voted for council to lobby governments across the UK for better rural healthcare provision (Jones-Berry 2019a).

While relevant issues around access, response times, loneliness and technology were raised, debate was largely in the context of physical health and did not fully address the relationship between physical and mental health and drivers for parity of esteem.

I am a registered mental health nurse working in primary care, in an improving access to psychological therapies (IAPT) service covering two counties with rural populations, where – like many rural areas – public transport to attend appointments can be a significant issue.

Telephone assessments

Most assessments are delivered by telephone, which brings its own challenges, but in the context of access and response times can provide many benefits.

Neither the individual nor the staff member is required to travel, which means that more appointments can be offered in the working day, potentially reducing waiting times.

Perhaps this telephone assessment and screening could work for GP surgeries? There would be the benefits of more timely access and no or less requirement to travel.

‘People who are socially isolated and experiencing anxiety and depression are less likely to recover and often have worse physical health as well’

If a service user is deemed unsuitable for the service, they can be referred on or signposted to another service or organisation, to their local pharmacy or other professionals in the practice. This fits with the model displayed by many practices – including the use of NHS 111 and 999 – and would support service users who are unsure or anxious about making the right healthcare decision, and potentially increase timely access to GPs where this is required.

Psychological interventions by the IAPT service are evidence-based and delivered in line with National Institute for Health and Care Excellence (NICE) guidelines for common mental health problems (NICE 2011).

Named therapist

As with assessment, these are provided by telephone as well as through computerised cognitive behaviour therapy and webinars. Access is easier because sessions can be completed from home and whenever is convenient for the individual, who still has a named therapist and telephone contact for review or if additional support is required.

‘The link between loneliness and mental health was also addressed at RCN congress’

One of the biggest drawbacks to this method is the variability of broadband provision, particularly in more rural areas. RCN action needs to address this variability to ensure equality of provision and access across the country.

Face-to-face interventions are also delivered, from GP surgeries and local health centres, but to increase accessibility from a range of other community venues too. These are often on better public transport routes or where there is greater access to parking. Could a model of roving clinics be a way of improving access to mental healthcare in rural areas?

'Social' pathway

The link between loneliness and mental health was also addressed at RCN congress (Jones-Berry 2019b). People who are socially isolated and experiencing anxiety and depression are less likely to recover and often have worse physical health as well.

The Norfolk and Suffolk Wellbeing Service offers a dedicated ‘social’ pathway, where staff support people to build their confidence in daily activities and social situations, again in their local community.

Clearly these methods are not suitable for all, but in rural areas can we be better at taking the service to the service user rather than expecting them to come to the service?


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About the author

Helen Oatham is a governance practitioner at the Norfolk and Suffolk Wellbeing Service, delivered by Norfolk and Suffolk NHS Foundation Trust and partner organisations

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