Rural and urban older adults' perceptions of mental health services accessibility.

Objectives: Older adults have been recognised as a group with poor access to mental health services, particularly those in rural areas. Using a decision framework of recognizing psychological problems, deciding to seek help, and choice of help, this study investigated older adults' access to mental health services using a mixed methods design. Methods: Ninety-four older adults from remote, regional and urban Australia returned surveys and twenty-one of them participated in focus groups and in-depth interviews. Participants were asked to identify psychological problems, the decision to seek help including perceived barriers to accessibility of mental health services, and the choice of help including their understanding of mental health disciplines and their views of service use. Results: When regional differences appeared, inner regional older adults reported more access problems than either urban or outer regional participants. Although older adults have a good understanding of mental health disciplines and accurately identified depression and substance abuse, they had difficulty recognizing anxiety and were uncertain as to when symptom severity should indicate that one should seek help. Though stigma was largely dismissed as a thing of the past, self-sufficiency was implicated as a psychological barrier to accessibility. Conclusion: Older adults may have difficulty in recognizing anxiety and milder levels of mental health concerns. This may be further complicated by a high value of self-sufficiency. These barriers need to be considered by all professionals working with older adults, in particular GP's who were identified as expert health advisors.