People living in rural and remote areas face many barriers when trying to access mental health services. These barriers include a lack of resources, not enough services, difficulty finding and keeping staff, long distances, cultural differences, and low awareness of mental health issues. This scoping review followed the PRISMA-ScR framework and searched seven major databases: PubMed, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and CINAHL Complete. Studies were included if they used qualitative, cross-sectional, or cohort designs and followed JBI guidelines. A total of 30 studies from 11 countries were reviewed. Barriers were grouped into four levels: system/policy, social/community, family, and individual, which are based on the Socio-ecological Resilience Framework. At the system and policy level, common problems were insufficient resources, complex systems, technology challenges, privacy concerns, poor service quality, staff shortages, and high costs. The challenges at the social and community level included distance, cultural differences, stigma, low awareness, and environmental pressures. Family-level barriers were weak family or peer support, stigma within families, and poor education. Individual barriers included low quality of life, poor understanding of mental illness, and negative attitudes toward mental health services. Although the review only covered studies from 2007 to 2024 and did not include all populations, it offers important information. A socio-ecological resilience approach may help improve mental health services in rural and remote areas.

AIMS:To examine mediators and modifiable psychosocial factors associated with psychological distress, depression, anxiety and self-rated health among Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as 'Indigenous Australians') aged ≥18 years. METHODS:This was a cross-sectional study based on the analysis of the 2018-19 National Aboriginal and Torres Strait Islander Health Survey dataset (N = 3942). Odds ratios (OR) and 95% confidence intervals (CI) for associations and indirect effects for mediation analyses were computed. RESULTS:Our results showed that Indigenous Australians with higher levels of perceived social support were less likely to have psychological distress (OR = 0.36, 95% CI: 0.23, 0.56), depression (OR = 0.44, 95% CI: 0.29, 0.67), anxiety (OR = 0.43, 95% CI: 0.28, 0.65) and low self-rated health (OR = 0.52, 95% CI: 0.33, 0.82). Similarly, those with a high level of mastery were less likely to have psychological distress (OR = 0.14, 95% CI: 0.11, 0.19), depression (OR = 0.20, 95% CI: 0.15, 0.28), anxiety (OR = 0.26, 95% CI: 0.20, 0.36), and low self-rated health (OR = 0.37, 95% CI: 0.28, 0.50). Perceived social support mediated 33.7% of the association between removal from the natural family and psychological distress, 14.6% of the association between discrimination and psychological distress, 20.3% of the association between discrimination and depression, 14.8% of the association between discrimination and anxiety and 16.6% of the association between discrimination and low self-rated health. Both perceived social support and mastery mediated the association between physical harm and psychological distress, depression and anxiety. CONCLUSIONS:We believe that community-driven psychosocial programs that enhance social support, self-efficacy and cultural connection may significantly improve the mental health and psychosocial well-being of Indigenous Australians.

PURPOSE:This study examines differences between major city and regional and remote participants in engagement in a digital alcohol support intervention (Daybreak), risky drinking, and psychological distress and tests the mediating role of psychological distress. METHODS:This was a longitudinal, observational cohort study of Daybreak participants between January 2019 and December 2024 (N = 12,824). Outcomes were risky drinking and psychological distress. Ordered logistic regression examined associations between the outcomes and program engagement, and multilevel generalized structural equation modeling tested mediation by psychological distress. FINDINGS:At 6 months, risky drinking scores declined by 42% in major city participants and 57% in regional and remote participants. High engagement in reacting to posts reduced risky drinking in both metro (OR = 0.47, 95% CI 0.27-0.80) and regional and remote areas (OR = 0.42, 95% CI 0.18-0.99). High engagement in post sharing was associated with lower odds of high risky drinking only in major city participants (OR = 0.56, 95% CI 0.33-0.98). In regional areas, participants who aimed to quit drinking at registration had lower risky drinking (OR = 0.72, 95% CI 0.53-0.99), while longer program inactivity increased odds of psychological distress (OR = 1.95, 95% CI 1.13-3.38). Psychological distress mediated 56% of the association between post reactions and risky drinking in major city participants and 33% in regional and remote participants. CONCLUSIONS:Distinct engagement pathways across regional and remote and major city settings suggest the need for more flexible digital program designs. Psychological distress, as a partial mediator, should be both a treatment target and a mechanism of change.

Purpose Mental distress among adolescents is a growing public health concern, particularly for youth underserved by traditional mental health systems. This study evaluates the Human Nature program, a nature-based, trauma-informed, person-centred intervention designed to support adolescent mental health in non-clinical, rural settings across Northern New South Wales, Australia. Methods A pre-post observational design was used to assess psychological outcomes among 106 participants aged 14–18. Routinely collected data included measures of psychological wellbeing, life satisfaction, and engagement across diverse demographic groups. Outcome tools included the Outcome Rating Scale (ORS) and the My Mind Star (MMS) assessment, capturing changes across multiple domains of functioning. Results Statistically significant improvements were observed in symptom distress, interpersonal wellbeing, and social role functioning. All seven domains of the MMS scale showed positive change, with the most substantial gains in self-esteem, positive time use, and educational engagement. The program successfully engaged vulnerable populations, including Aboriginal and Torres Strait Islander youth, LGBTQIA + adolescents, and those facing multiple psychosocial challenges. Discussion Findings support the effectiveness of trauma-informed, nature-based interventions in enhancing youth mental health, particularly in rural and regional contexts. The Human Nature program demonstrates the value of flexible, relational models in reaching underserved populations. These results underscore the need for government investment in alternative mental health approaches that address service gaps and promote equity in access.

The Man Walk is a national, community-led initiative promoting men’s mental health, physical activity, and social connection through group walks. Since its establishment in 2018, no evidence has described participant characteristics, engagement, or health outcomes. This study aimed to describe participants’ characteristics, health status, factors associated with health and wellbeing outcomes, and perceived benefits of program. A mixed methods design was used, with an online survey conducted in March and July 2025 among Man Walk participants across Australia. Measures included EQ-VAS (self-rated health), PHQ-4 (anxiety and depression), De Jong-Gierveld (loneliness), and AUDIT-C (alcohol risk). Multivariable regression models examined associations between explanatory variables and outcomes. Open-ended responses were analysed using inductive content analysis. A total of 377 men completed the survey. Most were aged ≥ 55 years (66

INTRODUCTION:Cardiometabolic disease contributes to increased morbidity and mortality in rural and remote Australia. Digital health technologies offer a promising solution to enhance healthcare access and support self-management. OBJECTIVE:This systematic review examined the effectiveness, feasibility and acceptability of implementing digital health interventions to improve cardiometabolic health outcomes in rural and remote Australia. DESIGN:PubMed, MEDLINE, Embase, Scopus and CINAHL were searched from inception to end of July 2025. Eligible studies included interventional, observational and qualitative studies focused on digital interventions for cardiometabolic conditions. Due to heterogeneity among studies, a meta-analysis was not conducted; instead, a narrative synthesis was used to summarise outcomes. FINDINGS:Seventeen studies (7 RCTs, 1 quasi-experimental, 7 observational and 2 qualitative) evaluated digital health interventions including video consultations, telephone coaching, apps, wearables and web platforms. Telemonitoring significantly reduced HbA1c (MD = -5.5%), with modest reduction via telephone support (RR = 0.96). Telestroke programs were associated with lower stroke mortality at 6 months (HR = 0.53) and 12 months (HR = 0.58). The review also demonstrated the feasibility and acceptability of digital health interventions, particularly when culturally tailored and delivered by local providers, with successful remote adaptation and high initial engagement. Interventions such as tele-endocrinology and the "Healthy Weight" program were cost-effective, contributing to improved HbA1c and quality of life. However, challenges included limited physical assessments, technical barriers and declining patient engagement over time. CONCLUSIONS:Digital health technologies, ranging from telehealth to mobile and web-based tools, can enhance cardiometabolic outcomes in rural and remote settings, though barriers such as technology access and sustained engagement remain.

OBJECTIVE:To explore processes that engage rural men in a weekly, enduring, community-volunteer-organised walk for mental well-being, and compare with characteristics of Third Places (relaxing social places that are neither home nor work). SETTING:Bathurst, regional city population 44 939 (2024), New South Wales, Australia. PARTICIPANTS:Bathurst Men's Walk and Talk (BMWT) walkers tend to be older and in a married/defacto relationship. More than one-third score low on mental well-being indices. DESIGN:In-depth semi-structured interviews (n = 20) with walkers (13) and leaders (7) of the BMWT were thematically analysed, inductively and deductively. MAIN OUTCOME MEASURES:Interviewee descriptions of experiences of BMWT and its impacts reported against Oldenburg's (1989/1999) eight characteristics of Third place, and use of rituals. RESULTS:BMWT is more routinised but has essential characteristics of an ideal Third place. BMWT accentuates the essence of Third place including welcome, inclusion, conversation and belonging to the group. BMWT balances culture and structures that meet diverse needs for connection and enjoyment in the manner of a Third place, while communicating safety and reassurance required for men who seek or need support for mental well-being. Interviewees reported mood and well-being benefits from BMWT physical activity, social interaction and belonging. CONCLUSION:Thoughtful planning can increase health-giving social interaction and feelings of belonging consistent with Third place experiences. In rural areas where men often miss out on mental well-being support, Third place provides a framework to guide individual group and community planning.

BACKGROUND:Addressing wellbeing at the community level, using a public health approach may build wellbeing and protective factors for all. A collaborative, community-owned approach can bring together experience, networks, local knowledge, and other resources to form a locally-driven, place-based initiative that can address complex issues effectively. Research on community empowerment, coalition functioning, health interventions and the use of local data provide evidence about what can be achieved in communities. There is less understanding about how communities can collaborate to bring about change, especially for mental health and wellbeing. METHOD:A comprehensive literature search was undertaken to identify community wellbeing initiatives that address mental health. After screening 8,972 titles, 745 abstracts and 188 full-texts, 12 exemplar initiatives were identified (39 related papers). RESULTS:Eight key principles allowed these initiatives to become established and operate successfully. These principles related to implementation and outcome lessons that allowed these initiatives to contribute to the goal of increasing community mental health and wellbeing. A framework for community wellbeing initiatives addressing principles, development, implementation and sustainability was derived from this analysis, with processes mapped therein. CONCLUSION:This framework provides evidence for communities seeking to address community wellbeing and avoid the pitfalls experienced by many well-meaning but short-lived initiatives.

Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per-capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social-service-environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well-being of rural communities.

Introduction: Adverse childhood experiences (ACEs) are associated with health and social problems in later life, with an early intervention highly desirable for better outcomes. Description: The Family-Referral-Services-In-Schools (FRSIS) is an early-intervention case management program for children and families with complex unmet needs, providing access to family support, housing, mental health care, and/or drug and alcohol services. The in-school trial setting was aimed at improving service uptake which was low in its community counterpart. Discussion: FRSIS was a well-regarded intervention that reduced barriers to access for vulnerable families. The school setting and non-government agency service provision led to increased acceptability and trust. The program reached 5% of the student population. Support was tailored to family need, which was often complex and involved both children and caregivers. Initially, the multi-agency partnership and governance oversight group championed the service and enabled the pilot to be established, however funding uncertainty and competing priorities saw leadership support ebb away despite operational success. Conclusion: The FRSIS model breaks down numerous barriers to accessing care for vulnerable families by its generalist nature and tailored approach and represents a high-trust approach to brokering appropriate care. Consistency in leadership support was a missed opportunity for program sustainability.

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

Meeting the mental health needs of rural populations is challenging internationally, with few methods and scarce data available to inform site-specific planning. We developed a mixed methods approach that integrates Not-for-profit (NFP) organization data in a Geographic Information System (GIS) to explore interrelated understandings of mental health experiences in rural places. Integrating qualitative experience data from online forums with quantitative data from service search and emergency pickup locations via GIS demonstrates how NFP health service data can be ethically sourced, reused, integrated, analyzed, and ground-truthed to explore how mental health is experienced in rural places. This article contributes to the mixed methods literature an ethical approach that utilizes NFP health service datasets to inform research in contexts of data scarcity.

BACKGROUND:Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase access to health care for young people, particularly school-aged young people (12-18 years) living in small rural towns (<5000 people).OBJECTIVES:To determine the extent the Teen Clinic model meets its accessibility objective and to determine the barriers and enablers to sustainable delivery of the Teen Clinic service.DESIGN:A multimethod case study approach was used to assess access (multidimensional framework for patient-centred access) and determine the barriers and enablers to sustainable delivery. Data collection included a survey of young people in the included rural communities and key stakeholder interviews.FINDINGS:The survey of young people indicated Teen Clinic model was accessible across multiple dimensions. From a practice perspective, accessibility was achieved by varying from usual care to a nurse-led, young person-centred drop-in model. This required skilled nurses working at the top of their scope; however, unpredictable demand and patient complexity made accounting for the time and therefore funding somewhat complex.DISCUSSION:The Teen Clinic model meets its objective of increasing healthcare access for young rural people. Relational and cultural factors were more important facilitators of practice integration than organisational processes. A key challenge to the ongoing provision of Teen Clinic was dedicated sustainable funding.CONCLUSION:Teen Clinic is an integrated primary healthcare model that increases access for young people in small rural communities. Sustainable implementation would benefit from dedicated funding.

Objective:To conduct a systematic review of experimental or quasi-experimental studies that aimed to improve the nutritional status of children under 5 years of age in Ethiopia.Design:Embase, MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, and Academic Search Database were used to locate peer-reviewed studies, and Google Scholar and Open Dissertation were used to locate grey literatures. All searches were conducted between 2000 and November 2022.Setting:Ethiopia.Participants:Pregnant women and mothers with children aged 0-59 months.Results:Ten cluster randomised controlled trials (RCT), six quasi-experimental studies and two individual RCT were included. Out of the identified eighteen studies, three studies targeted pregnant mothers. Our findings showed that almost two-thirds of published interventions had no impact on childhood stunting and wasting, and more than half had no impact on underweight. Some behaviour change communication (BCC) interventions, food vouchers, micronutrient supplementation and quality protein maize improved stunting. Similarly, BCC and fish oil supplementation showed promise in reducing wasting, while BCC and the provision of quality protein maize reduced underweight. Additionally, water, sanitation and hygiene (WaSH) interventions provided to pregnant mothers and children under 2 years of age were shown to significantly reduce childhood stunting.Conclusion:Future childhood nutritional interventions in Ethiopia should consider adopting an integrated approach that combines the positive effects of interdependent systems such as BCC, food supplemental programmes (e.g. boosting protein and micronutrients), health interventions (e.g. strengthening maternal and childcare), WaSH and financial initiatives (e.g. monetary support and income schemes).

OBJECTIVE To explore the influences of rurality on small business owner mental well-being and approaches to managing stress and mental well-being. DESIGN Semistructured interviews with small businesspeople. Concepts of salutogenesis and pathogenesis were used to interpret rurality influences on business and mental well-being. A stress-coping framework was used to categorise approaches to managing mental well-being. SETTING Central Western New South Wales. PARTICIPANTS Eleven female and male rural small businesspeople across sectors, including farming, allied health, beauty care and retail businesses. MAIN OUTCOME MEASURES Interviewee descriptions of experiences of small business and rurality and approaches to managing mental well-being. FINDINGS Rurality influenced mental well-being in four main ways: Business integration with community and owner identity; Visibility and being known; Different financial pressures; and Options for specialised support and casual relief. Rurality can be salutogenic and pathogenic, depending on circumstances, and pressures arising from rurality may differ for 'locals' and recent arrivals. High visibility in a small community can lead to a satisfying sense of belonging and connection. It can also create unwanted feelings of obligation and being watched. Most commonly the interviewees used emotional supports or distraction to adapt to stressors. This may be due to limited options to change or disengage from stressors in rural contexts. CONCLUSION Rurality brings its own benefits and challenges to small businesspeople's mental well-being. Given the immense contributions of small business to rural society and economies, investments in understanding and supporting the mental well-being of rural small businesspeople should be a high priority for communities and all levels of government.

The Family Referral Service is a program designed to connect vulnerable families to appropriate health and social care. Through a multi-agency partnership, the Family Referral Service in Schools (FRSIS) program was trialled successfully in 2016/2017 on the Central Coast, NSW, and extended in 2018, to reach three learning communities (total of 13 schools, both primary and secondary), with a combined student population of over 10,000 children and young people.

This Perspective Paper explores the challenges of implementing local initiatives guided by the tenets of the Collective Impact (CI) approach. As such, it draws implications of CI for integrated health and social care efforts to improve and sustain health and social outcomes within a community-wide context, based on our efforts to deploy a CI intervention in the regional town of Muswellbrook, New South Wales (NSW) Australia. A program of health and wellbeing activities providing mental health and wellness messages and activities was implemented in the township over 2 years by the Family Action Centre (FAC), University of Newcastle, Australia. A key takeaway was the importance of authentic community engagement and active involvement as opposed to mere consultation.