Assessment of barriers to accessing mental health services in rural or remote areas using a socio-ecological resilience framework: a scoping review

People living in rural and remote areas face many barriers when trying to access mental health services. These barriers include a lack of resources, not enough services, difficulty finding and keeping staff, long distances, cultural differences, and low awareness of mental health issues. This scoping review followed the PRISMA-ScR framework and searched seven major databases: PubMed, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and CINAHL Complete. Studies were included if they used qualitative, cross-sectional, or cohort designs and followed JBI guidelines. A total of 30 studies from 11 countries were reviewed. Barriers were grouped into four levels: system/policy, social/community, family, and individual, which are based on the Socio-ecological Resilience Framework. At the system and policy level, common problems were insufficient resources, complex systems, technology challenges, privacy concerns, poor service quality, staff shortages, and high costs. The challenges at the social and community level included distance, cultural differences, stigma, low awareness, and environmental pressures. Family-level barriers were weak family or peer support, stigma within families, and poor education. Individual barriers included low quality of life, poor understanding of mental illness, and negative attitudes toward mental health services. Although the review only covered studies from 2007 to 2024 and did not include all populations, it offers important information. A socio-ecological resilience approach may help improve mental health services in rural and remote areas.