A rural ecosystem of recovery: Lessons from substance users' experiences of accessing services in Western Australia's South West

Abstract

Introduction Substance use is a public health issue with a greater burden in rural areas. Barriers to accessing services are exacerbated for rural substance users, with confidentiality concerns, longer travel distances, workforce issues and limited availability of services. This paper presents results from a study exploring substance users' experiences of accessing services in Western Australia's South West. Methods This qualitative study was informed by phenomenology, and drew from social determinants and socio‐ecological theories. Data were collected through 22 semi‐structured telephone interviews with current and past substance users residing in the South West. Interviews were audio‐recorded and transcripts were subjected to thematic analysis. Results Two themes were identified: readiness to engage as a three‐way street; and building an ecosystem of recovery networks. Effective engagement with services required multi‐level readiness. Individual readiness was strongly influenced by the social environment, while service readiness required trustworthiness and responsiveness. A number of local access barriers were identified that hindered broader system readiness. Participants experienced recovery as on‐going and require an ecosystem of support with peer support at the centre and a network of healthy relationships established through meaningful connections. Discussion and Conclusions An effective ecosystem of support for alcohol and other drugs users in the South West should include expanded access to health, community and welfare services, with an emphasis on peer‐led support programs, and strong cross‐sector collaboration to mitigate the access barriers operating at the broader community level. Lessons from our study can inform the development of rural ecosystems of support for alcohol and other drugs users.

Rethinking Accessibility in Light of the Orange Declaration: Applying a Socio-Ecological Lens to Rural Mental Health Commissioning

“…The Orange Declaration calls for new service models tailored to context and better-aligned funding models that reward collaboration (9). Our experience and recent research on AOD and mental health services provide evidence that the current commissioning models are not aligned with the Orange Declaration, and remain largely metro-centric and reliant on a narrow conceptualization of service accessibility that does not take into account the heterogeneity of the rural experience (18,19).…”

“…In our recent research on substance users' experiences of accessing AOD services in WA's South West region, we applied a socio-ecological lens and identified service gaps and limited intra-and inter-sectoral collaboration, most notably between community-based state-funded services and primary healthcare providers and between the AOD and the mental health services sectors (18). We also found that existing local services were able to effectively respond to a crisis such as the COVID-19 pandemic by assertively and flexibly adapting their service provision to suit local needs, against urban-centric commissioning parameters (19).…”