Peer Support Emerges as Lifeline for Rural Australians Facing Fragmented Mental and Physical Healthcare

People living with mental health concerns in rural and regional Australia often struggle to have their physical health needs met, and a new qualitative study published in Community Mental Health Journal offers a detailed account of why. Researchers led by Tessa-May Zirnsak of La Trobe University interviewed and held focus groups with sixty people—thirty-two who identified as consumers of mental health services, twenty-one carers, and seven who identified as both—to understand their experiences of clinical, allied health, and lived experience workforces. The study, part of a larger National Health and Medical Research Council-funded project that will co-design and test a health navigation model of care, found that participants overwhelmingly preferred working with professionals who acted in line with their wishes, and that peer workers grounded in lived experience were most often seen as providing this kind of support.

The stakes of this research are considerable. Individuals diagnosed with mental health issues have a well-documented mortality rate twenty to thirty years lower than the general population, and in Australia this includes preventable deaths from conditions with free screening assessments such as breast and bowel cancer and cardiovascular disease. Researchers have attributed this disparity to higher risk of cardiovascular and metabolic conditions due to medication side-effects, lifestyle factors, and poor access to and engagement with health services. Systemic flaws compound these risks, and they are intensified by infrastructure and service deficits in rural areas, where perceived barriers to accessing care and a lack of connection to community are dominant themes.

Discrimination in physical healthcare against people diagnosed with mental health concerns was identified as a contributing factor to treatment avoidance nearly twenty years ago, yet contemporary research suggests the problem persists. In SANE Australia’s National Stigma Report Card, more than 83 percent of participants reported experiencing some level of stigma or discrimination in accessing or receiving healthcare during the previous twelve months. Of the 501 participants who selected healthcare as one of their top three most affected life domains, 60 percent reported frequent or very frequent experiences of stigma and discrimination in this area. Distrust of medical practitioners, feelings of judgement, being told that physical symptoms are a result of mental health conditions, and the fragmentation of the healthcare system all contribute to premature morbidity, leading individuals to avoid seeking medical advice and to skip routine preventative care such as cancer screening.

The study recruited participants between November 2024 and February 2025 through online channels, word of mouth, social media, and snowball sampling. Eligible participants were over eighteen, self-identified as having both mental and physical health concerns or as a carer for someone in that position, and lived in a rural or regional area of Australia based on the Australian Statistical Geography Standard. Sixty people took part across seventeen focus groups and nine interviews, conducted and recorded over Zoom, with five focus groups held in person in Northern New South Wales, Cairns, and Western Australia. Interview participants received a one-hundred-dollar supermarket voucher and focus group participants two hundred dollars in recognition of their time. Transcripts were analysed in NVivo12 using a combination of deductive and inductive coding, with themes refined through Braun and Clarke’s reflexive thematic analysis approach by a team that included researchers employed in lived experience identified roles.

Four themes emerged from the analysis: fragmentation in health services, need for holistic support, experience of being cared about, and power and advocacy. On fragmentation, participants repeatedly described a health system in which mental and physical care operate in silos, leaving people with overlapping needs unable to get help from either side. One consumer described being shunted from a physical health service to mental health on the grounds that physical symptoms were attributed to mental health, waiting twelve months, only to be told by mental health services that the causation ran the other way and being sent back—another twelve months of waiting, with years passing and no help on either side. The participant called the splitting of mental and physical health, addressed separately, a fundamental issue across the entire system.

Rural geography sharpened these structural failures. Participants described service types and availability that varied widely, very long distances to travel, appalling public transport, massive waitlists that meant help arrived too late, and high turnover among general practitioners and clinicians that forced consumers to repeatedly re-tell their stories to new people. The lack of choice available in these areas also undermines opportunities for self-agency and self-advocacy. One consumer noted that even when they did gain access to care, they tended to be more knowledgeable than the clinicians about their own health concerns, saying they hated reaching out for help and then finding themselves educating the person who was supposed to be helping them.

The second theme, the need for holistic support, reflected participants’ desire for care that addressed physical and mental health together, along with the life circumstances affecting both. One consumer described feeling like a bother to clinicians, needing many questions, validations, and clarifications just to understand what was being done to them. Another emphasised that connection was what mattered most when navigating services. The value of whole-person care was illustrated by a consumer whose general practitioner helped them secure stable housing, which they described as a game changer and life changer that gave them the stability keeping them in recovery and out of jail. Participants saw a clear role for health workers who could connect people with the services they needed, though one carer noted that when clinicians heard the word holistic, they sometimes looked at her as though she were a hippie who did not believe in taking medicine or vaccines.

The third theme, the experience of being cared about, captured what participants wanted from health professionals—kindness, respect, and serious attention to their needs—and what they felt they rarely received from clinicians. One consumer compared psychologists unfavourably to their butcher, saying at least the butcher offered more support. A carer recounted how her daughter, who had attempted suicide at twelve, finally clicked with one mental health worker, stopped attending, and then received a heartfelt letter from that worker urging her to return. When the mother rang to make an appointment, she learned the worker had finished her job the day before, and her daughter concluded that the woman had not cared about her at all. By contrast, participants described peer workers as providing something really real, grounded in deep-seated empathy that comes from lived experience rather than qualifications or good intentions alone, and some said they would feel more rapport with someone who had experienced their condition even for physical health concerns.

The fourth theme, power and advocacy, addressed the hierarchies participants perceived in clinical care. One consumer observed that it takes years to learn that doctors do not know everything, can be wrong, and can be told no. Others described being stuck in a biomedical model where decisions are made by the person at the top of the tree, and mental health hierarchies so strong that the person receiving care was rarely at the centre of the conversation. Participants saw peer workers as better placed to provide advocacy support because of their knowledge of mental and physical health concerns and of the common pitfalls consumers face when accessing care. Carers similarly valued education that upskilled the person they supported and empowerment that helped people see their own strength, which one carer called invaluable and sadly rare.

The authors are careful about the limits of these findings. The study was qualitative and was not designed to produce statistically generalisable results, quantify the prevalence of themes, or validate relationships between participant characteristics and experiences. Participants were self-selected, meaning people with negative or distressing experiences of healthcare may have been especially motivated to take part, so negative accounts of clinical services may be overrepresented. Women were overrepresented in the sample, which matters because the life expectancy gap associated with mental illness is higher for men than for women. People not comfortable conversing in English were not represented, diagnostic information was optional and self-reported rather than verified against clinical records, and the interpretive nature of qualitative analysis means a different sample or research team might have produced different emphases. The findings should be read as an in-depth account of this sample’s experiences and preferences rather than a statistically validated portrait of all consumers and carers.

Within those limits, the study’s implications are pointed. The authors argue that stigma and discrimination in clinical and allied health service provision are not fuelled by under-resourcing alone, noting that peer workers are more impacted by under-resourcing than clinicians even within the same services, yet participants still viewed them more favourably. They do not suggest peer workers should replace clinicians, but that participants wanted support grounded in credibility, empathy, power-sharing, and respect for lived expertise, and that elevating lived experience knowledge may help address epistemic injustice by challenging structural assumptions about whose knowledge counts. The findings point toward health services co-designed with people with lived experience, reform in physical healthcare provision to address stigma and diagnostic overshadowing, and a pivotal role for peer workers in supporting clinicians to deliver treatment in genuine partnership with the people they serve.

Subject of Research: Consumer and carer experiences of mental and physical healthcare across clinical, allied health, and lived experience workforces in rural and regional Australia

Article Title: “She didn’t care about me at all”: A Qualitative Study of Consumer and Carer Reflections on Mental and Physical Healthcare Across Clinical, Allied Health, and Lived Experience Workforces

Article References: Zirnsak, T.-M., Spencer, T., De Niclola, J., Dasvarma, A., Rayner, A., Heffernan, T., English, L., Bentley, J., Lawn, S., Brophy, L., Maylea, C., & Roberts, R. (2026). “She didn’t care about me at all”: A Qualitative Study of Consumer and Carer Reflections on Mental and Physical Healthcare Across Clinical, Allied Health, and Lived Experience Workforces. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01714-6

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01714-6

Keywords: mental health, physical healthcare, peer workers, lived experience, rural health, qualitative study, stigma, diagnostic overshadowing, health navigation, carers, healthcare fragmentation, Australia