Published: June 2023
The majority of the United Kingdom is rural, 90% of England and 98% of Scotland for example. Nonetheless, public facilities are concentrated in urban areas, such that the people living and working in rural areas, including those who manage our agriculture, forests, farms, and outdoor spaces, are far removed from life-changing services.
How did this happen, and what are you as a business owner legally obliged to do? First of all, it’s crucial we answer the “how”.
Not only are health providers more likely to practise in urban centres, and rural residents less likely to be able to afford to access mental health support services, rural residents are less likely to be able to get to mental health services, and providers are less likely to recognise a mental illness.
There is free statutory support for mental health as well as private but even accessing the “free” support requires running a car to reach the locations, greater time investment taking multiple buses to reach this vital care, as well as stress spent on public transport by already vulnerable individuals.
Moreover, private healthcare has waiting lists, so even those with the funds to do all the above may be waiting to gain access to a professional of the correct speciality. In cities, there’s an abundance of options available to those in need, so waiting lists might move faster or people can go to another area of their city, conveniently connected by public transport.
What does a person need, in order to access the same private or public services from a rural area? At a bare minimum, they need:
A vehicle or multiple public transport links
Flexible work hours to allow for time off
Child or dependent care
Money to fund the journey
On top of the financial load, Covid has worsened the gap. The significant deterioration in mental health during the first year of the pandemic has not returned to pre-pandemic levels.
COVID-19 mortality rates in the most deprived areas remain high, which notably impacts rural resident’s mental health in many ways. Rural areas are the most deprived, in terms of lacking even basic essential services and facilities.
Why is fair access an issue we must urgently solve? Even NHS England and the government recognise that the “low visibility of mental health service in rural communities can lead to a culture of self-reliance, which can prevent people from seeking support earlier, instead only seeking support when they have already reached ‘crisis’ stage.”
To ease the number of people reaching said crisis stage, which can often lead to tragic consequences, loss of life, the government and NHS England listed tackling geographical health inequalities as one of four priorities to resolve.
Legally, companies and organisations commissioned or contracted by the NHS, and local government (local councils) must join NHS England’s mission to tackle inequalities in rural areas.
“We’re not an NHS-run service, or a council-run company though,” you say.
Being realistic, the council doesn’t run everything, they outsource most of their services. Our taxes then, albeit indirectly, pay for your services. So, indirectly, this means that the laws are applicable to you and your business too.
Let’s explore different areas of mental healthcare that are available as well as the inequalities we must all be broaching together.
A fifth of the population of England — 20.9% — lives in what local authorities defined as ‘predominantly rural’ according to the UK Parliament.
The current support services available to all are:
NHS urgent mental health helplines
Free listening services
Zero Suicide Alliance
Liaison psychiatry services
Crisis resolution and home treatment teams
The latter is the most exclusionary. One person cited on Parliament’s website said: “I had a crisis at the GP surgery [...] so I saw the crisis team within four hours."
If a person waits 4 hours for attention at a GP’s office in a well
-connected town or city, how long might they wait in the rural countryside? Even those who seek medical support could wait days for lifesaving attention.
Let’s use Dorset as an example. Dorset has a much higher than average rural population. In fact, 46% of the county’s population lives in rural communities. On the upside, Dorset Mind is hosting wonderful events in the county, primarily in locations where public transport is in abundance. The association is based in Bournemouth, so the downside of these life-changing events is that it might take 2 hours and 30 minutes to reach them on public transport from rural parts of Dorset.
A Hidden Dorset report highlighted 66 Dorset neighbourhoods, mostly north of the county, lacking access to mental health care. The knowledge exists on similar public forums across the British Isles, indicating that there is a lack of geographical parity in all of Britain.
Today, ignorance of the issue is no longer an excuse, companies are feeding into geographical equality, which we can now label willful ignorance.
Private companies are able to offer specialist mental health treatments that may not be available through the NHS. There are of course inequalities in this private treatment offering, as many people will not be able to afford this.
There are many physical health challenges, disabilities and illnesses that can, and do, have a detrimental effect on people’s emotional and mental well-being. Cancer is one of the primary challenges, and Cancer UK points out that 1 in every 2 of us will get cancer in our lifetimes, so this is not a minority issue. Moreover, many cancer patients experience PTSD following diagnosis and treatment. Yet, mental health and well-being support is rarely considered when it comes to physical health.
Organisations and businesses are beginning to offer Employee Assistance Programmes ( EAP). However, Towergate Health and Protection’s 2019 research shows that only 10% of respondents feel employees valued their EAP service and only 5% said that staff actually use it. It is worth noting that, while 49% of employers say mental health is the biggest wellbeing issue they face, employees are distrusting of services, believing if they access EAPs, the information might be used against them.
Support is generally lacking in businesses and organisations or is just a token gesture – a tick box exercise. Whilst some entities are excellent in raising awareness and breaking down stigma – for example by having trained Mental Health First Aiders in the workplace – employers must be mindful that this does more than improve appearances.
There is a better way.
Our experts at RMHM have a unique proactive ‘whole self’ approach to wellbeing. We believe that the location in which people live and work should not be a barrier to accessing support, when they need it. What makes us unique is that we have both professional and lived experience of mental and physical disabilities and illnesses.
RMHM is also the only organisation that represents the rural voice for England and Wales, as a Dorset-based national social enterprise. This means we are a ‘business for good’ and our profits go back into making sure we support more people living and working in rural communities.
We would be thrilled to speak to your team and train them to ensure all support you offer is accessible, inclusive, visible, available, and equitable for all. We have packages available and can provide personalised quotes to interested parties.