. . . . . Mental Health . . . . . © 2006 National Rural Health Association 182 Vol. 22, No. 2 Family Perspectives on Pathways to Mental Health Care for Children and Youth in Rural Communities Katherine M. Boydell, MHSc, PhD; 1,2 Raymond Pong, PhD; 3 Tiziana Volpe, MSc; 1 Kate Tilleczek, PhD; 4 Elizabeth Wilson, PhD; 5 and Sandy Lemieux, BA 3 ABSTRACT: 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-à-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. C urrently, there are as many as 10 million Canadians who can be considered rural residents—one third of all Canadians. 1 Children and their families in rural and northern communities may face more obstacles obtaining health services and supports than their urban counterparts. 2,3 Problems of service access often result from geographic, economic, and cultural factors. 4,5 In sparsely populated areas, travel expenses increase the costs of both providing and obtaining care. In addition, children from rural areas often must be placed in residential care outside of their community because of the lack of resources within the community. 6 Geographic and professional isolation make rural communities less attractive to mental health workers. It is difficult to recruit and retain specialists, who tend to concentrate in larger urban areas. 7 Most rural communities are too small to sustain highly specialized personnel. Moreover, within the health research community, rural issues are often overlooked or dealt with generically. When rural perspectives are examined, it is frequently within the context of urban- rural differences, rather than as the sole focus of attention. 8 When mental health is the focus, there is little literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children and their families in particular. 9 The purpose of this study is to examine issues of access to mental health care for children and youth in rural Canadian communities from the family perspective. Canadian Health System. The Canadian health system is a publicly funded insurance program where 1 Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, Canada. 2 Departments of Psychiatry and Public Health Sciences, University of Toronto, Toronto, Canada. 3 Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada. 4 Department of Sociology, Laurentian University, Sudbury, Ontario, Canada. 5 Independent research consultant, Owen Sound, Ontario, Canada. The authors gratefully acknowledge the support of the funders, the Canadian Health Services Research Foundation and the Ontario Ministry of Health and Long-Term Care. The authors also thank the family participants who so willingly shared their stories with us. For more information contact: Katherine M. Boydell, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; e-mail katherine.boydell@sickkids.ca.