Community co-produced mental health initiatives in rural Australia: A scoping review.

INTRODUCTION: Inaccessibility of mental health services in rural Australia is widely reported. Community co-produced mental health and well-being initiatives could fill gaps and complement other services. OBJECTIVE: This scoping review summarises findings from peer-reviewed articles to identify the key features of co-produced Australian rural mental health initiatives that engage communities in their design, delivery or evaluation processes. DESIGN: Between 2009 and 2019 inclusive, 14 articles met inclusion criteria and were reviewed using Arksey and O'Malley's review methodology. FINDINGS: Communities co-produced initiatives through informing, collaborating and instigating them. Some initiatives operated in specific places, for example an art gallery, while others operated across regions. Only two initiatives involved community members in multiple activities targeting prevention, early intervention, education and service accessibility; other initiatives were more focused, for example designing a new service. Over half of initiatives found were targeted at Aboriginal and Torres Strait Islander Peoples. Most articles discussed evaluation approaches, though methods were diverse. DISCUSSION: Published peer-reviewed evidence about Australian rural community co-produced mental health initiatives appears scant. Evidence found suggests they generate a range of supports that could complement or mitigate for lack of, public health services. The overall lack of evidence, diversity of initiatives and inconsistent evaluation makes it difficult to assess effectiveness and which activities might be scaled-up for wider benefit. CONCLUSION: Rural communities have limited resources, and evidence of what constitutes best practice in co-producing mental health services would help to avoid 'reinventing the wheel.' Greater efforts in evaluating and publishing about initiatives would be helpful.

Indigenous Perspectives on Help-Seeking for Family Violence: Voices From an Australian Community.

Indigenous peoples experience high rates of family violence (FV) yet are said to access support at lower rates than their non-Indigenous counterparts. There is an absence of Indigenous voices regarding their help-seeking behaviors for FV, particularly concerning men's views. The aim of this research was to seek Indigenous perspectives on their help-seeking behaviors for FV. Individual, face-to-face semistructured interviews took place with 23 Indigenous Australians (14 women and 9 men) recruited from one large community in Victoria, Australia. Interviews were audiotaped and transcribed verbatim. Data were categorized and organized, and themes were identified using thematic analysis. Five main themes emerged from the data. "You're Aboriginal, so that's just how it is" describes the experiences with discrimination and judgment that create general barriers for Indigenous peoples to access services. The second theme "putting a big blanket over it" articulates the role that shame plays in deterring support-seeking for FV. "How do you trust somebody?" defines the fear in the hearts and minds of Indigenous participants who contemplate help-seeking. A further main theme of "someone that they could have a yarn with" explores what occurs when participants initially decide to seek support. Their thoughts on what participants want from interactions with formal services are explored in the final theme "a safe space." Significant barriers to seeking support for FV exist for Indigenous peoples, including discrimination, shame, and fear. Service providers need to work on addressing these barriers through an increased understanding of Indigenous experiences and beliefs in an effort to encourage help-seeking behaviors. Interventions to assist kin in dealing with FV and for service providers to create safe spaces are urgent. More research informed by Indigenous voices is needed.