The available picture of rural mental health across England is complicated and incomplete due to gaps in health data, the suppression of demand by over-centralised services, and the under-reporting of rural deprivation which is inextricably linked to poor mental well-being. While our evidence did not point to a mental health crisis in rural England or the agricultural community, there are several areas of considerable concern—as well as sufficient doubt over the efficacy and granularity of the available data—to make urgent and meaningful Government action on rural mental health essential.
Our evidence highlighted a very consistent set of concerns, risks and exacerbating challenges to rural mental health in England—often with reference to the on-going impacts of Covid, Brexit, the economic ramifications of Russia’s invasion of Ukraine, labour shortages, retailer power, shock events, uncertainty over future finances and business succession plans, isolation, trade liberalisation and the cost of living.
While access to nature and the countryside is consistently identified as beneficial for people’s mental health in general and often prescribed through ‘green social prescribing’, our evidence is clear that the isolation inherent in rural living represents a significant challenge to the mental health of adults, children, and young people living in rural areas. It also demonstrates that there are additional and unquantifiable negative pressures on mental well-being within rural communities and amongst farmers, farm workers and veterinary surgeons.
Our inquiry’s key findings and recommendations are:
- Rural communities’ needs are not fully reflected in mental health policy and services and national NHS planning. The Department for Environment, Food and Rural Affairs and (DEFRA) and the Department of Health and Social Care (DHSC) should establish a new joint rural mental health policy and delivery team to: lead and improve on current “rural proofing” of health policy; and work with NHS England (NHSE) to set targets to measure and improve outcomes for rural mental health services and support rural health providers. In the longer term, a national working group is urgently required to move the approach to policy and planning in this sphere from retrospective ‘proofing’ to fundamental redesign. This joint DEFRA/DHSC rural mental health team should consider how best to prepare and make effective and integrated interventions with (i) the Department of Transport, and (ii) the new Department of Science, Innovation and Technology, in respect of achieving new levels of accessibility to rural mental health services from new joined-up working, starting with the emerging rural transport strategy and Project Gigabit for rural broadband.
- The Government’s announcement of a new approach to suicide prevention—refreshing the 2012 national strategy and reporting against the 2019 cross-government workplan—provides a welcome opportunity to include a focus on agricultural and related veterinary sector workers amongst vulnerable or high-risk groups. When the national strategy is revised DEFRA must advocate effectively for attention and resources for rural and agricultural mental health priorities; and establish a mechanism—perhaps under the national working group we recommend above—to identify the immediate concerns and actions in relation to these groups. To enable resources to be allocated where they are needed, the Government should confirm and ringfence additional funding, beyond 2023/24, for local suicide prevention to allow local authorities to contribute effectively to delivery of the national strategy.
- NHS mental health services are often not fairly accessible for rural communities, with services largely centred in towns and cities creating barriers to access, compounded by the limitations and weaknesses of rural public transport and digital connectivity. By August 2023, the new joint policy and delivery team we recommend should launch a consultation on how effective the integrated care systems (ICSs) have been at providing rural communities with access to mental health services. By the end of March 2024, proposals should be published for how the new statutory ICS boards and partnerships must address shortcomings, focusing in the first instance on better outcomes and reduced inequalities.
- Far too much avoidable demand ends up at the door of Child and Adolescent Mental Health Services (CAMHS) in rural areas because of a fundamental lack of social infrastructure and youth services. DHSC, NHSE and DEFRA must consult on how to relieve this pressure by accelerating the expansion of preventative mental health support for children and young people by prioritising the roll-out of Mental Health Support Teams to cover 100% of schools and colleges in rural areas by 2026/27; and commit to establish and fund “Early Support Hubs” for children’s mental health’ in rural areas by 2024/25.
- DHSC and DEFRA must identify supporting and improving the mental health and well-being of those within farming and the agricultural veterinary sectors as high priorities and by September 2023, develop a work programme with NHSE, local public health and occupational charities to identify how to improve mental health outcomes for these occupational groups. Health Education England should work with charities to develop a training programme for rural NHS providers and staff, to be launched by Autumn 2023, to improve mental health care for these occupational groups.
- We recommend that DEFRA and the Department for Levelling Up, Housing and Communities set out a timeline and process by which to review and revise the Index of Multiple Deprivation with the aim of more accurately capturing rural deprivation. The Government should commit to reaching a position by the end of this year, 2023, whereby it can commence a consultation on draft changes to the Index and guidance for decision-makers, and how the Index should be used to support funding decisions.
- By December 2023, the Government should fund and roll-out mental health first aid training aimed at creating a critical mass of front-line personnel dealing with farmers and those working and living in rural industries and areas—i.e. in auction marts, agricultural organisations and charities and educational settings—who are able to identify and respond to the need to signpost sources of mental health support.
- Government schemes, associated bureaucracy, and regulatory requirements appeared to be key sources of stress for the farming community. DEFRA has tried to mitigate the burdens of dealing with new agricultural programmes through its Farm Resilience Fund, it is unclear if it is reaching people in most need; if mental health is integrated enough with business resilience; or if it makes best use of established and trusted support groups. The Fund’s next round must prioritise mental health support to the farming community alongside business resilience.
- The Government needs to address some of the challenges of rural daily life which can have a significant impact on mental wellbeing. As indicated above, rural transport is a key issue entwined with mental health in terms of both prevention (mitigating isolation and loneliness) and treatment (access to and by services). The Government is currently considering responses to a call for evidence on a future rural transport strategy. The Department for Transport must work with Defra, the DHSC, and NHSE to ensure the prioritisation of access to health services can be maximised to provide rural communities with services and customer experience, whose efficacy is comparable to those within urban areas. The DCMS should be included in this strategic overhaul to ensure the integration of digital connectivity into this picture but without allowing it to be treated, inappropriately, as a panacea, proxy or alternative to face-to-face consultation with a clinician.
- The Government’s flagship levelling up agenda includes over-arching reference to the ‘rural proofing’ of policy that we mention above, and states that: “… government departments are working to support levelling up in rural areas, through targeted approaches where needed, and how we are strengthening the rural economy, developing rural infrastructure, delivering rural services and managing the natural environment.” The fundamental need to provide equitable access to effective services for mental health and well-being must be part of this picture. As a start, the Government should consider bringing forward amendments to the Levelling-up and Regeneration Bill, in the House of Lords, to include a mission on young people’s mental health and wellbeing and youth services. The DCMS and DEFRA should also issue a call for evidence to assess current and planned new rural youth services against need, and by the end of this year, 2023, develop proposals to fund and make up for any shortfall for the next five and ten years.