Family perspectives on pathways to mental health care for children and youth in rural communities.

Context: There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem. Purpose: This study examines issues of access to mental health care for children and youth in rural communities from the family perspective. Methods: In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders. Findings: Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-a-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews. Conclusions: The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.