General News Politics Rural — 17 December 2013
Transport cuts widen rural mental health divide

People with psychiatric illnesses are being treated like second-rate patients.”

This is what Bathurst-based consultant psychiatrist Andrew Frukacz told a metropolitan newspaper last week in response to the Western NSW Local Health District’s (LHD) decision to cut transport funding for fly-in, fly-out (FIFO) psychiatrists in Western NSW.

I agree with his statement, and offer my own: public regional mental health services are, to be frank, a joke, and it seems no one cares enough to speak up about it.Durum Wheat in Farmer's Hands

Full details of the LHD’s cost cuts haven’t been officially announced, but any reduced hours or job loss of any health worker in our district is a kick in everyone’s guts. Lack of health services compounds whatever illness you suffer from, strains emergency departments, leads to a lower quality of life, and in some cases, premature and preventable death.

There have been multitudes of published documents over the past decade highlighting the rural-urban dichotomy of illness prevalence rates and provided mental health services.

A 2002 report on rural life for youth in country Victoria stated that hospitalisation of people between 15 and 24 years old due to mental illness, the onset age for 75 per cent of mental illnesses, was higher than that of the same age group in urban areas.

In 2006, the Rural Doctors Association of Australia recommended FIFO mental health services to offset staff shortages in regional and remote areas. The Association’s president, Dr Ross Maxwell, said no government incentive schemes had attracted sufficient health providing numbers, therefore other options had to be considered to provide adequate services.

Specialists in Sydney and other urban areas don’t have to travel to practice, and because of the shortage of mental health specialists, those who do choose to relocate to a regional or remote area are the anomaly. Due to these announced transport cuts, the rural-urban disparity of mental illness and available services will be exacerbated.

In a May 2013 report, Health Workforce Australia, an initiative of the Councils of Australian Governments, stated that about 45 per cent of Australians will experience some form of mental disorder throughout their lifetime, and that “this is exacerbated in rural and remote locations where access to specialist supports and services is limited”.

There are consistent indicators that rural and remote areas need special consideration for the provision of mental health services, yet we are about to witness their reduction.

After this month, anyone in or around Dubbo who sees psychiatrist Dr Andrew Frukacz, a doctor who has traveled to Dubbo once a week for the past 16 years, will have to stop seeing him or go to his private Bathurst clinic at their own cost.

Dr Frukacz told local electronic media that Dubbo is an example of a place heavily reliant on visiting psychiatrists, and their absence due to these transport cuts will mean patients will risk not being effectively treated, or will miss out on treatment altogether if they are unable to travel. The consequences will be deterioration of their mental health, and in some cases death.

Never mind existing mental health patients, what about those who are yet to seek treatment, and those who haven’t yet had an onset of illness? Where will they go when alarm bells have been ringing for too long, or a critical episode hits for the first time?

Stigma surrounding mental illness is rife. Last month, a SANE Australia study of 1000 workers found four in 10 people taking sick leave for depression hid the real reason for their absence from their employer. I know how they feel. It’s tiresome to live with a condition you generally feel obliged to hide. And if you do hide your illness, it’s as if the stigma-constructed ‘shame’ falls back to the sufferer.

The LHD’s decision to cut mental health services funding is counter-intuitive, counter-productive and anachronistic. Mental disorder in young, adult, and aged populations is the most significant medical issue in developed countries this century, in both an economic and social sense. Rather than cutting mental health services funding in regional and remote areas, it needs to be increased.

This article first appeared on ‘Dubbo Photo News’ on 15 December 2013.

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