# Barriers and facilitators to establishing Early Psychosis Intervention (EPI) services in remote and rural communities across Canada

## TL;DR

This study explores the challenges and solutions for setting up mental health services for early psychosis in remote and rural Canadian communities.

## Contribution

The study provides new qualitative insights into adapting EPI services in rural and remote areas of Canada.

## Key findings

- Barriers include limited access to care, referral challenges, and funding issues.
- Facilitators include virtual care, standardized models, and strong leadership.
- Adaptive resourcefulness is key to addressing local needs in rural EPI programs.

## Abstract

There is a paucity of data on how Early Psychosis Intervention (EPI) services adapt to the challenges of rural practice, including geographical isolation and provider shortages. This qualitative study seeks to fill this gap by exploring the experiences of EPI programs in rural and remote communities in Canada.

An introductory email was sent to 117 EPI contacts, inviting them to first complete a survey and then participate in a semi-structured interview if their program contained a rural component. The interviews were conducted between June 2023-January 2024 via Zoom or phone by a member of our research team, while another member took detailed notes. Qualitative data was analyzed using thematic analysis.

Twenty-five representatives from seventeen distinct EPI programs with a rural and remote component across seven Canadian provinces and one Canadian territory participated in the interviews. Several barriers to establishing EPI programs in rural and remote areas were identified, including limited access to care, challenges in referral processes, geographical and technological constraints, and funding limitations. Facilitators of successful program delivery included the use of virtual care, standardized care models, strong leadership and teamwork, and adaptive resourcefulness in addressing local needs.

Identifying and addressing these barriers and leveraging facilitators can enhance the accessibility and effectiveness of EPI service delivery in rural and remote areas.