Field days and agricultural shows are big events in country Australia. Farming families travel for hours to see the latest in tractor technology, soil seeding, or water conservation techniques. They mostly travel just to meet others and have a chat.
In recent years, new exhibitors have established themselves among the livestock and paddock demonstrations also wanting to have a chat. These exhibitors, such as the Royal Flying Doctor Service, are providing mental health and wellbeing checks.
For some country residents, a mental health check at a field day may be the only face-to-face mental health care they encounter. The Council of Australian Governments’ Reform Council data tells us only half of remote area residents needing mental health care actually receive it, when compared to people accessing mental health care in cities.
One in five Australians in the past year encountered a mental health condition of some type, according to a June report of the Australian Institute of Health and Welfare. Myth suggests a disproportionate number of these one in five people live in rural and remote areas, fuelling incorrect assumptions that the act of living in a rural or remote area contributes to the risk of mental illness.
Research does not show higher rates of mental disorders in rural and remote areas, according to the journal of the National Rural Health Alliance. The alliance’s study found socioeconomic disadvantage, poor access to mental health services, high-risk occupations, exposure to environmental adversity, and variation in community resources each contributed to mental illness in rural and remote Australia, as opposed to living in country Australia per se.
These determinants of mental health risk are no different to risks that also exist in metropolitan areas. The difference is that responding to these determinants requires different city and country approaches; one size does not fit all in the bush.
The evidence in country Australia is that mental health care and prevention is simply not reaching as many people as it needs to. Old-fashioned resourcing, rather than how to apply that resource, is a key problem.
The Australia and New Zealand Journal of Psychiatry reports that rural and remote areas have fewer mental health services, fewer qualified professionals, and a narrower range of service options. The consequence is that people in country areas are less likely to engage in and complete mental health treatments than those who live in the city. For some, the consequences are fatal.
The National Mental Health Commission is at present finalising its review of Australia’s mental health services. It will hand its report to the federal government before month’s end. In proposing action for rural and remote Australia, the commission should focus on achieving city-country parity in mental health service utilisation, to in turn contribute to parity in nationwide mental health outcomes.
Achieving city-country parity will require new resourcing for country services. Such parity does not mean a mental health hospital in every country town. It does not mean a psychologist in every remote community. Parity does however require a universal service obligation guarantee of appropriate remote area access when mental health care treatment is needed, using existing and trusted community organisations in newly expanded prevention and treatment roles.
Future mental health care delivery into rural and remote Australia should build on existing health and community care access points, rather than trying to build new services from scratch. Again, the Australian Institute of Health and Welfare reported in June that 71 per cent of those seeking treatment for mental illness consulted their doctor.
With consumers asking their doctor for mental health care more than any other service provider, it is doctors in rural areas who should ideally be supported through the Mental Health Commission’s recommendations to take on, with proper support, expanded prevention, diagnostic, care, and mental health treatment roles.
Proposing a greater role for doctors in mental health care may be met by howls of protest from other interests. The nursing, psychologist, and broader allied health community working in country Australia also deserve more support than they get.
Yet the scarcity and workload of health professionals in country Australia means doctors, nurses, psychologists, and allied health staff work in effective collaborative teams in any case. It’s these to these teams that new resourcing should be directed.
With expert evidence that there is insufficient access to mental health care in rural and remote Australia, and with this resulting in large numbers of bush residents missing out on care and not completing treatment plans, it’s clear the Mental Health Commission should recommend that government expand mental health service access in rural and remote Australia.
Martin Laverty is the Federation Chief Executive Officer of the Royal Flying Doctor Service of Australia.
This article first appeared on ‘The Age’ on 11 November 2014.