Healthism, rural individualism and self-help: youth mental health in Northwest Tasmania

ABSTRACT

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people’s lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths’ help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

KEYWORDS:

• Rural mental health
• youth mental health
• individualism
• healthism
• health policy

Introduction

Mental illness is a significant issue for today’s youth. Recent statistics show that two in five young Australians experience mental illness (Australian Bureau of Statistics, 2022), with suicide the leading cause of youth mortality (Beyond Blue, 2022). Although many young people experience mental health issues, rural and regional youth experience significantly greater rates than their urban counterparts (Australian Institute of Health and Welfare [AIHW], 2021). For example, youth living outside of metropolitan areas are twice as likely to complete suicide (Beyond Blue, 2022). Scholars suggest that structural disadvantages in rural communities, such as restricted educational and employment opportunities, adversely impact mental health (Garbacz et al., 2022; Quine et al., 2003). Due to inequities in health provision in rural Australia, limited mental health services further exacerbate the issue, alongside the cost, location, and reduced hours of the few available services (Brown et al., 2015). Much empirical exploration of rural mental health has concentrated on structural and cultural barriers and limited mental health literacy within rural communities, often with a focus on adults and service providers (Bennett et al., 2023; Black et al., 2012; Handley et al., 2018). In contrast, surprisingly few Australian studies have involved rural youth themselves as participants (for an exception, see Savaglio et al., 2023). This is likely due to difficulties engaging rural young people in research about mental health due to associated stigma and confidentiality concerns. Therefore, in this article, we draw on data from two qualitative focus groups with eight young people aged 19–23 to explore their lived experiences of mental health and mental healthcare access in the island state of Tasmania. Through thematic analysis, we identify key challenges for youth in this area and offer practical solutions for improving mental healthcare access in rural communities.

Context: health and wellbeing in rural Tasmania

Mental health issues are prevalent among Tasmanian youth, with rates of suicide and mental illness both being higher than the national average (AIHW, 2021). Tasmania’s poorer mental health outcomes for youth likely stem from significant social disadvantage. According to the Index of Relative Social Disadvantage, Tasmania has the highest proportion of young people living in the most socio-economically disadvantaged areas of the country (Savaglio et al., 2023). Tasmania also has the most rurally and remotely dispersed population of young people in Australia (State Growth Tasmania, 2022). Despite this context, Tasmania’s community-based youth mental health services are significantly under-resourced, limiting capacity to support young people experiencing mental illness (Savaglio et al., 2023). Northwest services in particular have long struggled to keep up with demand (Le et al., 2012), with many mental health specialists unable to take new clients for several years (Fromberg, 2021).

The rural Northwest region of Tasmania includes some of the state’s most remote communities, facing a range of social, health, and economic challenges. Northwest Tasmania has a population of approximately 113,000, with a population density of just 4.93 per square kilometre, compared to 148.3 per square kilometre in the state’s capital city, Hobart (State Growth Tasmania, 2020). The Northwest is characterised by many small townships and is over 100 km from the closest central business district. The primary industries are agriculture (dairy/beef farming and crop growing), fishery, and timber production (State Growth Tasmania, 2020). In addition, the Northwest has a low educational attainment rate and a severe dearth of social and health services (ABS, 2021). In this context, this article explores the lived experiences of rural youth through two small focus groups with eight youth leaders from Northwest Tasmania.

Theoretical framework: individualisation, healthism and mental health in rural Australia

Some sociologists explore how, by destabilising traditional social order, the processes of reflexive modernity and individualisation have reshaped society, producing dominant narratives that idealise individual agency (see Bauman, 2001; Beck, 1992; Giddens, 1991). We operationalise agency here as an individual’s ability to act and alter the social structures and conditions that affect their lives (Coffey & Farrugia, 2014), noting that this is always exercised in contexts of social relations which can be both enabling and constraining (Rikala, 2020). In reflexive modernity the significance of structural factors such as place, gender, race, and class are arguably de-emphasised, as individuals are freed to cultivate their own identities on the basis of personal choice (Rikala, 2020). Thus, contemporary young people are increasingly expected to situate themselves as cosmopolitan global citizens and consumers, without strong geographical ties, in favour of embracing hyper-mobility, often in the pursuit of economic benefit (Farrugia, 2020; 2016). However, some scholars have argued that a reinstatement of class, gender, and racial hierarchies is often implicit in individualist discourses (Mulinari & Sandell, 2009). For example, the ability to embrace the cosmopolitan mobility imperative is arguably shaped by a range of economic and social advantages, the absence of which continues to constrain individual agency (Farrugia, 2020; Yoon, 2014). Within such frameworks, young people must navigate ongoing structural inequities alongside paradoxical imperatives to establish their lives free from structural constraints. One’s ability to assert their individual agency may be critical to navigating the complexities between structural inequality and detached individualism.

Rural communities may experience the effects of individualisation in specific ways due to how these social processes have restructured rural and remote regions. For example, the rise of neoliberal policies has seen subsidisation and equity arrangements replaced with policies that emphasise self-sufficiency, competitiveness and, ultimately, individualism in rural communities (Brijnath & Antoniades, 2016; Tonts & Horsley, 2019). Higgins et al. (2012) have explored how Australian natural resource management policies increasingly position farmers as self-responsible entrepreneurs not in need of external support. Such emphasis on economic policies that encourage self-reliance means the social support structures that traditionally protected Australia’s rural agricultural regions have been replaced with approaches that promote individual entrepreneurialism and success (Higgins et al., 2012). Self-sufficiency, hardiness, and stoicism, an ability to endure without complaint or help-seeking, are qualities that have long been associated with rural communities, perhaps making individualism appealing in these contexts (Cheshire & Lawrence, 2005; Kaukiainen & Kõlves, 2020). As neoliberal policies have seen the winding back of social services, rural communities experience significant socio-economic decline leading to poverty, poor mental health, and high youth unemployment and out-migration (Farrugia et al., 2014).

Neoliberal policy approaches can individualise risk by relocating responsibility for handling risks from the state to rural individuals themselves (Brown et al., 2013). This is especially the case in the context of health, where healthism, the idea that individuals have a moral obligation to manage their own health, has become increasingly widespread (Crawford, 1980). For example, through patient consumerism an emphasis on ‘collecting and sharing medical and health-related data and bestowing responsibility upon lay people to manage their own health’ has emerged (Lupton, 2013, p. 257). This includes the use of smartphone applications and technologies such as wearable mobile devices (Lupton, 2013). Whilst these technologies can be a part of maintaining good health, the focus on the ‘digitally engaged patient’ (Lupton, 2018, p. 42) also reinforces the imperative on individual responsibility and ‘reduces health problems to the micro, individual level’ (Lupton, 2018, p. 43). Policy regimes that expect citizens to be self-governing, self-reliant, and self-responsible thus see risk increasingly individualised. For example, digital self-help apps are commonly promoted solutions for rural mental health (Marshall et al., 2020), particularly for young people (Lehtimaki et al., 2021), in the absence of providing place-based services. While these solutions are deployed for rural communities as a way to address access barriers due to distance, they also promote individualised approaches to mental health for rural communities.

Increased social pressures to ensure that individuals make responsible choices may be linked to rising rates of mental ill-health among young people (Eckersley, 2011; Franceschelli & Keating, 2018). This can be linked to findings that indicate that young rural people are particularly vulnerable to internalising the view that they are solely responsible for their own success and failure (Schmidt et al., 2022). For example, Schmidt et al.’s (2022, p. 101) finding that notions of ‘self-responsibility intersected with a traditional farming ideology of self-reliance resulted in a unique place-based version of responsibilisation which strengthened the message that making good decisions were the responsibility of the young people themselves.’ In this way, rural ideologies of self-sufficiency and stoicism in combination with messages of individualisation and healthism may increase the risk that young rural people internalise the pressure to make responsible choices; choices they may be unable to make because of structural disadvantages (Garbacz et al., 2022) and inequities in health provision (Brown et al., 2015). It is important to acknowledge that this context, young people should not be positioned merely as either passive victims of structural disadvantage or uncritical individualised health consumers. Instead, we suggest that contemporary young people may find nuanced ways to use their individual agency to potentially circumvent structural barriers to mental health and healthcare access.

For example, research on young people and mental healthcare access has found that young people value strong personal relationships, trust and loyalty. The development of trust between young people and their health professionals is essential for young people to talk about mental health issues (e.g. Bray et al., 2012; Gibson, 2021; Rickwood et al., 2007). For example, in her study of young people living in New Zealand, Gibson (2021, p. 97) found that young people valued the opportunity to develop relationships with mental health professionals, both online and face to face, before they discussed their concerns with them. While neoliberal approaches to health might emphasise that such help-seeking is an individualised act of health consumerism, by valuing and fostering ongoing personal connections with healthcare providers, contemporary young people could be seen as seeking to resist systemic causes of mental ill-health and structural barriers to healthcare through dynamic service engagement and community building. This article draws on focus groups with young people in rural Northwest Tasmania to explore these issues further.

Methods

This exploratory research was conducted as part of Author 1’s honours degree in sociology. The small qualitative study was designed to develop understanding of an under-served population and to pilot the project design for future research engagement with this rural community. Focus groups were chosen as a way to engage young people in a productive conversation about mental health and mental healthcare access in their region, with an emphasis on collective problem solving. A purposive recruitment strategy was employed targeting a pre-existing youth leadership group associated with a local council. This group was targeted specifically because it is a key group of youth representatives with a strong public interest in youth mental health in the region, including lived experience of mental healthcare access locally.

Following this recruitment strategy, we engaged a total of eight participants between the ages of 19 and 23, with an average age of 20.5 years. As outlined in Table 1, the majority of participants identified as women. Three of the eight participants are Aboriginal, while most described themselves as white Australians. All participants lived in Northwest Tasmania in small towns, characterised by limitations in education, health, and other service provision and reduced opportunities for social interaction (Australian Government, 2011).

Table 1. Participant demographics.

Participant	Age	Gender	Ethnicity
Focus group 1: In-person – youth group
Joey	20	Female	Aboriginal/Torres Strait Islander
Water	19	Female	Aboriginal/Torres Strait Islander
Kermit	20	Male	Aboriginal/Torres Strait Islander
Bruce	23	Female	White Australian
Jo	22	Male	White Australian
Ben	19	Male	White Australian
Focus group 2: Online
Rach	20	Female	White Australian
Laws	22	Female	White Australian

We conducted two focus groups, one in-person and a second group online with those who were unable to attend the first group. Considering the remoteness of some parts of the Northwest, the online platform made it easier for some participants to attend. The focus groups both lasted for 90 min and were conducted using a guide with specific discussion topics and questions, which we developed drawing from current literature and the project’s aims. Discussion questions included the following: ‘What kinds of things might be barriers to good mental health or getting support for mental health issues in the Northwest?’, ‘Some research says that online platforms can help overcome barriers to services in rural areas – what do you think? Are online resources/services as good as face-to-face services?’, ‘If you were the Minister of Health, what would you implement or what changes would you make to help improve mental health in rural areas?’. Participants were all familiar with each other, considering themselves friends, having grown up locally or having lived in the area for some time. Group confidentiality issues were addressed by establishing a shared agreement among participants to not discuss or share details about the content of the group discussion with those beyond the group in an identifying manner. Participants were informed prior to participating that as a focus group is a group discussion, the researchers could not guarantee that group members will not share the attendees’ names and discussion content beyond the session. Participants were invited into an open conversation about why confidentiality is important in their small community when discussing mental health. Participants were also encouraged to share only what they would typically be willing to discuss publicly with the group. In providing their informed consent, participants acknowledged the group agreement and confirmed that they would uphold it following the focus group.

This project was approved by the University of Tasmania’s Social Sciences Human Research Ethics Committee. In line with the committee’s recommendations, participant protection strategies were prioritised at all stages of the design, conduct, and reporting of the project. Data have been de-identified, and pseudonyms elected by participants are used in reporting of the data. The focus groups were audio-recorded and transcribed verbatim. The transcripts were then thematically analysed drawing on Braun and Clark’s (2006) six-phase technique, using a combination of deductive and inductive approaches. We coded the transcripts deductively, using themes inspired by the literature and our project aims (e.g. Boyd et al., 2011; Quine et al., 2003; Schmidt et al., 2022), such as structural barriers and rural culture. Additional codes were also developed to explore themes that we identified inductively, such as generational differences in approaches to mental health. The first author familiarised themselves with the data by surface reading focus group transcripts several times, highlighting any key points to begin developing initial codes, such as generational differences and the impacts of mental health stigma. Data were then scanned for recurring themes between the responses that related back to the research questions. The second author reviewed the initial analysis and provided critical feedback. A further iterative process involved re-analysing identified themes to explore implications they highlight for both the present study and the broader body of literature. This analytical approach was taken to address issues relating to Tasmanian youth mental health that we initially identified as important following our engagement with scholarly literature and the local community, while also allowing for any unexpected themes or insights to be explored.

Findings

Our analysis identified three major themes: structural barriers; social and cultural barriers; and the role of technology in mental healthcare. Subthemes include the impacts of individualism, healthism, stigma surrounding mental health, generational differences, and privacy and confidentiality challenges in a rural context that values strong interpersonal and community relations.

Going around in circles: structural barriers to mental healthcare access in Northwest Tasmania

Structural barriers to accessing mental healthcare in rural areas are well-established in both international and Australian literature (Boyd et al., 2011; Cheung et al., 2012). Unsurprisingly, the dearth of services and resulting access barriers were common discussion points amongst our participants. For instance:

[There is a] lack of support in small communities. It can be harder to get help when you do need help … You’re usually going to have to wait a while to see someone. From my personal experience recently, I tried to get help from the doctors down here, and they pretty much said you’ve got no hope of getting in to anyone around here anytime soon because the waiting list is so long … I think that kind of says something about where we’re at. (Water, Female, 19)

I was told it would be 12 months before I could be put on the waiting list to see someone. And that was on the Northwest Coast, not just in [small town]. They were like no one’s putting anyone on the waiting list … You build yourself up to ask for support, and then you’re told that … . (Bruce, Female, 23)

It’s the sort of thing that needs to be accessible when you need it. Like, you can’t have to wait months and months when you’re struggling with mental health. Like, if you had a failing heart and you had to wait six months before doing anything then … . (Ben, Male, 19)

In these extracts, participants identify key structural barriers, demonstrating the central issue of extensive waiting lists to see local mental health practitioners and highlighting a dearth of responsive services in the Northwest. Notably, these participants acknowledge that young people’s mental health can be further impacted when they spend time building the courage to seek support only to be denied care. By contrasting the response to mental health with heart failure, Ben shows how mental health crises are often not perceived as a legitimate emergency or need in the same way physical health is. However, in a neoliberal policy environment, delayed health system response may arguably serve the aims of systems that seek to discourage service use by encouraging self-help or seeking alternative services while enduring the wait. Therefore, these kinds of barriers to accessing mental healthcare in Northwest Tasmania may have an ongoing detrimental impact on young people’s mental health and likelihood of seeking help in future.

The inconsistent nature of mental healthcare in rural areas was another concern for participants and a primary barrier to their mental healthcare access. For instance, when participants could secure appointments, they were unlikely to see the same practitioner regularly due to service limitations in mental healthcare provision:

They pretty much fly-in-fly-out, so if you have something that’s gonna take a little while … you’re never going to see the same doctor … . (Water, Female, 19)

I'd like to see more consistency … From personal experience, I had three consultations through [local service] and every time, I saw a different person … if you're having three or four different people, it's gonna be hard to form any sort of relationship with that person and feel comfortable … It’s exhausting to explain it all too … you’re just going around in circles and not getting anywhere. And, sometimes as well, you get a lot of conflicting advice, which leaves you back to just like “well what do I do? Where do I go from here?”. (Jo, Male, 22)

I go to [location an hour away] now because I always had a different doctor. And every time I had a different doctor, they would change my medication … that doesn’t help your body at all when you’re always changing medication. (Bruce, Female, 23)

Participants’ responses to this ‘fly-in-fly out’ manner of rural service delivery reveal a nuanced interplay between structural disadvantage and individual agency. Here, participants actively seek mental health support and demonstrate adaptability in the face of structural barriers, which could be interpreted as evidence of good health citizenship and individualist self-responsibility. However, by actively critiquing the structural barriers they faced and identifying alternatives, we suggest that participants demonstrate a level of agency that goes beyond individualism. By expressing frustration and exhaustion with inadequate systems, the young people we spoke to arguably challenge both representations of rural youth as passive health consumers and as individualised neoliberal citizens (Eckersley, 2011; Farrugia, 2016).

I’ll give you something to cry about: generational attitudes to mental health and help-seeking in rural communities

Alongside the limited availability and accessibility of mental health services in Northwest Tasmania, participants also felt that mental ill-health remains stigmatised in their communities. For example, one participant shared the following experience:

I was like a really, really depressed teen … I couldn't say anything to my mum. She was like, “well, I’ll give you something to cry about” … I was having the hardest time in my life, and no one else cared. Like, Mum didn't care. It wasn't worth worrying about to her, so that made me feel like maybe I’m not worth worrying about … I think, for her, it was kind of embarrassing to have a kid that was upset. It made her feel like a bad parent … . (Joey, Female, 20)

Here, Joey felt that her mental ill-health brought shame on her family, particularly her mother. In Joey’s experience, her depression was viewed by her mother as relative to more legitimate life stressors. The statement ‘I’ll give you something to cry about’ implies a threat of violence, while also trivialising Joey’s hardship. This is similarly reflected in Joey’s description of her mother’s embarrassment that she was merely ‘upset,’ rather than experiencing a mental illness that requires treatment and familial support. Several participants described their parents’ similar responses to mental health. For example:

My parents … they probably don't fully understand [mental health] themselves … because they’ve been brought up differently to us, they don't comprehend what we're feeling or what we’re thinking, because when they were brought up, they were just told … to toughen up. (Rach, Female, 20)

I think you’re looking at a generation that was like … have a cup of cement and harden up … . (Jo, Male, 22)

I think also because they’ve used the words “toughen up”, the opposite of that is that you are weak. And so, us talking about our feelings is really weak … I think we are between generations … like we’re still trying to realise that mental health is important, and so you still got adults that think like, “Oh, we didn’t talk about that when I was a kid”, so it really doesn't matter. (Ben, Male, 19)

In describing generational differences in understandings of and approaches to mental health, these participants highlight how social expectations of hardiness, independence, and restraint from showing weakness can be common in rural communities, while also aligning with individualism (Bartik et al., 2015). The fear of judgment, combined with close-knit community dynamics and historical experiences, reinforces the value placed on resilience and self-sufficiency in facing challenges (Halpin & Guilfoyle, 2004). As with Joey’s mother’s response to her depression, these participants represent their parents as uncaring or ill-equipped to respond to the mental health challenges of their children because of the environment in which they were raised. By discussing their feelings and acknowledging the significance of mental health, participants importantly challenge older generations’ perceived emphasis on toughness and resilience.

Participants suggested that these generational differences in perceptions of mental health may be due to their generation's increased awareness of mental health compared to when their parents were young. For example:

I think mental health has always been out there, but … people just haven’t really talked about it … or known what it was. Now we're understanding more about how the brain works as well and the chemical imbalances … so people are more aware of it. (Bruce, Female, 23)

It’s … much more widely talked about. People are a lot more willing to either seek help or help others that, you know, display those sorts of symptoms. There’s not as much stigma around mental health as there once was, say 20 years ago. (Jo, Male, 22)

The younger generation coming through is a more acceptable generation. They are more willing to accept a person’s issues, problems, identities more than what the older generation is … I think the exposure … that's the main thing that has changed. And the ability to get help and get diagnosed … You’re not so much an outcast if you have it now … Even back when I was in high school, like I kept my diagnosis to myself because I was like, “Nah, I'm going to be kicked to the curb”. Now it's an open topic to talk about. (Laws, Female, 22)

These participants reflect on how they felt mental health stigma has reduced over time, with young people accepting mental illness as a significant issue and acknowledging the need for collective responses to mental health that move away from individualist and self-help approaches. Participants also suggest that their parents and older people in their communities may not have the same level of mental health literacy. This is consistent with previous research, which indicates that mental health stigma is more prominent within older generations and that older generations significantly lack knowledge and understanding of mental health (Pettigrew et al., 2010). By seeking to be active, informed health consumers, these young people align with Lupton’s (2013) framing of public health responsibilisation, because in actively working on their mental health, these young people attempt to transcend localised rural attitudes held by their parents, situating themselves as active health consumers rather than passive victims of structural inequalities.

While they acknowledged the generational differences in acceptance and awareness of mental illness, stigma remained a barrier to young people accessing support locally. For example, several participants expressed concern about privacy when accessing services in their small rural communities:

For me, I feel real awkward ‘cause I’m walking into [the support network] on the main street … and I'm like, is anyone looking, like who's around before I walk in … Your brain is saying “oh my goodness, I don't want these people to know I’m struggling and I’m walking into this place.” (Bruce, Female, 23)

That’s part of the issue being in a small community as well. Like, if you’re in a big city … you’re not gonna look at who's around because chances are no one’s going to know ya. Whereas up the main street, you walk 100 metres and see five people you know … If you don't want other people to know that you’re struggling with things … you don’t wanna go and walk in there. (Ben, Male, 19)

The participants’ experiences in seeking mental health services within a small rural community reveal a nuanced position within the context of healthism and individualised health. While healthism emphasises personal responsibility for health and encourages proactive engagement with healthcare services, participants’ feelings of embarrassment and discomfort highlight the complex interplay between individualised health ideals and the social dynamics of their close-knit community. Their concerns about being seen while accessing mental health support may reflect the unique challenges faced by health consumers in rural areas, where community visibility and social stigma can deter individuals from seeking necessary care (Bishop, 2013). This delicate position underscores the need to balance personal health needs with the desire to maintain a specific image or reputation within the community, adding an extra layer of complexity to their roles as mental health consumers. Furthermore, their experiences shed light on the potential adverse effects of healthism in settings where structural barriers and social norms intersect, potentially deterring individuals from accessing vital mental health services due to the fear of judgment. These findings emphasise the importance of recognising the collective dimensions of mental health, acknowledging the significant role that community support and understanding can play in addressing stigma and facilitating access to care within rural contexts.

You can’t come down through a screen: the role of technology in rural mental healthcare provision

Much of the current literature supports technology-based solutions to address rural youth mental health, as these are considered the most efficient ways to overcome many of the access and social barriers to care that rural youth experience (Handley et al., 2014; Nicholas et al., 2021). However, in contrast to Gibson’s (2021) study which found that participants were able to construct meaningful relationships with mental health staff online, our participants had mixed views regarding online services and the use of technology in mental healthcare provision. Some saw benefits, for example one participant noted that:

Some online platforms can be helpful. You don’t have to speak to someone face-to-face … and for some, that may be a lot easier than face-to-face as it makes some people feel uneasy. That also can be a positive way in getting help if you aren’t wanting people knowing … . (Rach, Female, 20)

For Rach, accessing mental health support online can address rural young people’s concerns about confidentiality discussed in the previous section. Seeking technology-based mental health supports could be interpreted as evidence of rural young people using their agency to circumvent structural barriers to health. In contrast with Rach, other participants were wary of online mental health supports:

When you are in that sort of headspace … they point you to something like Lifeline, but not necessarily towards that one-on-one support which I think can be much more helpful than something as broad as talking to somebody on the computer. (Jo, Male, 22)

If the online services give you access to real people and not machines, like if you’re not talking to like a robot or algorithm … would be more likely to get value out of it. But that very rarely happens with things that are online … . (Kermit, Male, 20)

I think there is … a very large part of counselling that involves … being present … what happens if somebody like has a bit of an episode … you can't come down through a … screen … I know a few people that need just like a hand on the shoulder … and they're fine. And I mean you can't really do that … it'll be a lot better to have like someone there present. (Laws, Female, 22)

For these participants, online services and helplines were seen as less effective than direct in-person support because they feel impersonal (‘talking to a robot or algorithm’). As these participants explain, they prefer face-to-face support with practitioners, which would allow them to form vital connections with the supporter and get more value from the help-seeking experience. Technology-based supports such as apps, online services, and helplines arguably appeal to the imperative of reflexive modernity to take individual responsibility for mental health through self-help rather than direct engagement with health systems. However, these rural young people find more value in mental health support that fosters strong connections and community bonds. By not wanting to be digitally engaged patients and calling for more in-person, community-based supports, our participants challenge dominant individualist health imperatives that ultimately encourage the do-it-yourself individualistic values of self-help, self-management, and self-reliance (Lupton, 2018; Orlowski et al., 2016). These findings contrast with previous literature that assumes youth are technology-loving, highlighting complexities in some rural young people’s relationship with mental healthcare access and structure-agency debates around contemporary health consumerism.

Discussion

This article explored rural young people’s lived experiences of mental healthcare access in Northwest Tasmania. Our findings shed light on the complex interplay between rural values, individualism, and the challenges faced by rural young people in accessing mental health services. We found that the self-sufficiency and hardiness often valued in many rural communities may discourage young people from seeking help, and how contemporary emphasis on self-help and personal responsibility for mental health may exacerbate this further for young people in rural Australia (Boyd et al., 2011; Farrugia et al., 2014). Yet, despite adopting some healthist discourse to navigate mental healthcare barriers, participants also demonstrated agency by challenging individualist approaches, advocating for more collective responses to mental health.

Contrary to policies and cultural narratives that portray rural youth as passive health consumers constrained by structural, social, and economic barriers (Farrugia, 2020), our participants demonstrated remarkable resilience within the challenging context of accessing mental health services in Northwest Tasmania. Despite their willingness to take charge of their health, deeply entrenched mental health stigma, concerns about privacy, and geographical constraints hindered their ability to fully embrace this imperative and engage as active mental health consumers. Thus, participants grappled with the paradox of desiring support while also being hesitant due in part to the resistance ingrained in rural values, where showing vulnerability is discouraged, and enduring without complaint is admired (Kaukiainen & Kõlves, 2020; Schmidt et al., 2022). In their efforts to distance themselves from prevailing local attitudes, some participants unconsciously adopted an individualist self-help approach to managing their own mental health (Lupton, 2013). However, at the same time, participants were critical of structural health inequalities and called for in-person and community-based mental health supports, notably in contrast with do-it-yourself approaches to mental health (Lupton, 2018; Marshall et al., 2020). These findings offer some new insights into rural youth and their engagement with mental healthcare, highlighting the complexity of their experiences and attitudes. These findings also indicate how standard approaches to health do not fit all segments of society (Handley et al., 2018). Whilst close social relations resulted in some challenges for the young people in this study, like findings from other studies on rural young people and mental health (Bray et al., 2012; Gibson, 2021; Rickwood et al., 2007), they continued to value close and trusting relationships and see them as the foundation of basic human interaction. Unlike previous research (e.g. Lehtimaki et al., 2021; Marshall et al., 2020), for some young people in this study the option to address personal health challenges purely through technical devices and unfamiliar health professionals was flawed. The challenge for health provision in rural areas is to not draw on local staff who the young people know personally and thus hesitate to confide in but to make sure there is regular, face-to-face access to health professionals who do not live in the local area.

Given the nature of this exploratory study, it is important to acknowledge that our findings are limited to the specific experiences of those who participated. Engaging rural Tasmanian youth on the topic of mental health proved challenging, which may be an illustration of the stigma still attached to mental health in these areas. A notable limitation of this research is that most participants were white Australian women. Due to the social stigma and challenges they face in rural communities, young men and youth of diverse cultural backgrounds may feel unable to participate in mental health research. In addition, as the young people we spoke to were local youth leaders, their experiences are unlikely to be representative of the broader population. The reality that active youth leaders were the only group volunteering for the focus groups indicates that barriers to mental healthcare may be heightened among those in positions of greater disadvantage. Our use of primarily deductive coding may have led to the oversight of some perspectives. For example, we intentionally focused on structural barriers and the role of technology in mental healthcare provision for rural young people due to the prevalence of these issues in Tasmanian policy responses and previous literature. Further research involving a more extensive community cross-section is vital. In particular, young men must be involved in the conversation as rural men have the highest suicide rate of any social group (Alston, 2012; Garrett & Stojcevski, 2021). Given stigma and identifiability issues in this small community, we recommend future research use quantitative or less-invasive qualitative methods to reach a more diverse range of young people and overcome these limitations. Additional research into generational differences in mental health attitudes in rural communities and community-based mental health approaches is vital to develop a comprehensive strategy to address the prevalence of rural youth mental health.

This article offers one interpretation of how individualisation and healthism operate within rural contexts. We found that while rural young people may adopt aspects of healthism, such as taking personal responsibility for their mental health, they do so within the context of rural values and societal pressures. Such insights contribute to the growing recognition of the complexity of mental health narratives within rural settings. It suggests that rural mental health experiences cannot be reduced to simplistic dichotomies of individualism versus collectivism or victimisation versus agency. Instead, we have sought to highlight the multifaceted nature of rural mental health experiences, where contemporary young people must navigate a complex web of cultural, structural, and personal factors.

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