Coastal and Rural Mental Health Realist Study

Research questions RQ1. What strategies for providing mental health support and promoting wellbeing are being put in place in CAR areas? How, for whom and in what circumstances are they impacting on access, acceptability and inequality? RQ2: How do the features of CAR life affect residents’ experiences of mental healthcare support and services? In what circumstances and for whom do strategies to increase engagement with support work and why? In what ways and how do residents draw upon rural and/or coastal strengths and assets from their family, friends and the wider community to meet their mental health needs? Background Mental health services in remote coastal and rural areas present challenges both for the people who live in these areas and for the organisations who provide the services. For people who need the services, challenges relate to poverty, inadequate housing and transport links, and services that do not meet their social and other needs. For service providers, as well as responding to these issues, there are major difficulties related to staff shortages, poor digital infrastructure and transport infrastructure, and the need to provide standard services, including emergency responses, across large geographical areas. Aims To improve community mental health systems in CAR areas by assessing the impact of strategies (such as CMHF), implemented in CAR regions on improving the accessibility and acceptability of mental health care services for people living there. To facilitate a Community of Practice to co-produce a Guide to improving accessibility and acceptability of mental health care services in CAR areas. Methods Methodology: Realist qualitative multiple case study with embedded university Researchers-in-Residence working alongside Community Researchers supported by a Community of Practice. Sites: Integrated health care systems (ICS) in CAR areas (Cornwall, and the Isles of Scilly, Lincolnshire, and North East and North Cumbria) and six case study areas which include low income low population density neighbourhoods and which relate to Primary Care Networks. Fieldwork 1) Organisational ethnography examining what services do in six PCNs. Observation of teamworking and care. Interviews with staff. 2) 'Deep mapping’ to understand the relationship between mental health and CAR life. Including interviews, videos, exhibitions with the 6 case studies. Analysis: Within case realist analysis to create Local Programme Theory describing ‘what happens here, how and why’ (n=6). Cross case analysis to create an Overarching Programme Theory and Guide. Timelines for delivery Initiation and set up month 1-6. Fieldwork and analysis 2-24. Final Programme Theory and Guide shared month 24-28 Anticipated impact and dissemination Sharing locally at set time points throughout. Sharing nationally via webinars, networks and conferences, and local workshops.