Myths & Challenges of Mental Illness in Rural Communities: the Australian Perspective

Myths & Challenges of Mental Illness in Rural

Communities: the Australian Perspective

Professor Judi WalkerUniversity of Tasmania

Australia –some comparisons

Smallest continent

Largest island

Vast difference in population size

Europe, USA, Canada and Australia are all similar in size

Europe has twice USA’s population & far greater

population density

UK has 244 people per sq.kmOther European countries also

densely populated

Australia has only 2.5 people per square km

6% arable land

19 million people

6 states & 3 territories

Two thirds covered by desert

Our spread of population

40% live in the tropics

85% live in cities

One of world’s largest countries

Relatively low population which is highly urbanised with concentrations on eastern seaboard & capital cities

Even little Tasmania is 2/3 the size of England

Tyranny of distance

We are very BIG

Australia still the lucky country

Resource rich High standard of

living Sound economy Politically stable Sparsely

populated Welfare safety net Aussie rules football !

Unusual population characteristics-

post war migration & multicultural population mix

Immigration contributed between 1/3 and ½ of our population growth

Post war baby boom

Our population increased by 120% between 1950 & 1958

The baby boomers are now entering middle age & preparing to leave the workforce

Rural Australians suffer worse health than urban

residents

Rural communities provide Australia’s food & resources

Worse health status

Worse injury rates Higher road trauma Inequities in

distribution of mental health services

Mental Health Services

1993 HREOC findingsTwo 5 year Strategic Plans for reformSignificant effects on service deliverySignificant shift away from psychiatric

institutions Integration with existing health servicesMain changes have been to basic

infrastructureMore change needed to ‘special needs’

populations including rural and remote

Rural Mental Health Challenges

Risks of experiencing MH problems magnified – additional stressors

Main changes in MHS structures in metro areas/large regional centres

Lack of specialist MH practitioners MH care delivered by GPs/visiting MH

specialists - outreach Reduced access to adequate crisis response More people hospitalised away from home Services reflect funding constraints of metro

MHS rather than needs of communities Recent ‘projects’ to redress some inequities

Three Key Messages

People do better when treated by mental health professionals in their own community (Scottsdale Project)

Rural communities should develop solutions for mental health needs that best fit their circumstances (Tasmania’s Rural Mental Health Plan)

Training of medical practitioners and mental health professionals needs a strong community base & an interprofessional approach (Rural Clinical School)

Tasmania

The most rural state in

Australia (58% population live outside Hobart)

The Need for Evidence

Huge gap in the evidence base for rural mental health

Research can piggy back onto program evaluations (quasi experimental methodologies)

Requires networking among researchers, clinicians and communities

Integrate research with service development & delivery

Scottsdale Project

Study to evaluate the relative clinical effectiveness of a locally developed model of mental health service delivery

Study revealed that GPs were good at identifying psychological distress

Clients of local mental health worker improved to a statistically & clinically significant degree (symptom level, distress & QOL indicators) compared to other groups

Tasmania’s Rural Mental Health Plan

Emphasises mental health care being provided within a primary care framework (personal care/health promotion/illness prevention/community development/continuity of care/early intervention)

A Plan based on partnerships

Tasmania’s Rural Mental Health Plan

One approach does not fit all – imposed solutions are ineffective

Communities need to be involved in planning, development & implementation of services that suit the character of the community (community-driven)

Effective services translate into positive social, psychological & economic benefits

Key Learnings

Solving long-standing problems requires multi-level approach, which brings together decision makers and frontline service providers

Primary mental health positions are affordable but require specialist mental health support & information to be sustainable and effective

Key Learnings

Unique rural communities will develop unique solutions if resourced and supported by joined up government

Mental health and well being education to inform and reduce stigma requires a long-term population approach across agencies

Rural Community-based training for

studentsChanging face of medical/health

professional educationRural Clinical SchoolsBetter balance between hospital

and community-based clinical training

Vertical and horizontal education Inter professional practice and

education

Three Key Messages

People do better when treated by mental health professionals in their own community (Scottsdale Project)

Rural communities should develop solutions for mental health needs that best fit their circumstances (Tasmania’s Rural Mental Health Plan)

Training of medical practitioners and mental health professionals needs a strong community base & an interprofessional approach (Rural Clinical School)