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

1. Myths & Challenges of Mental Illness in Rural Communities: the Australian Perspective Professor Judi Walker University of Tasmania

3. Australia –some comparisons • Smallest continent • Largest island

4. Vast difference in population size Europe, USA, Canada and Australia are all similar in size

5. Europe has twice USA’s population & far greater population density • UK has 244 people per sq.km • Other European countries also densely populated

6. Australia has only 2.5 people per square km • 6% arable land • 19 million people • 6 states & 3 territories • Two thirds covered by desert

7. Our spread of population • 40% live in the tropics • 85% live in cities

8. We are very BIG • 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

9. Australia still the lucky country • Resource rich • High standard of living • Sound economy • Politically stable • Sparsely populated • Welfare safety net • Aussie rules football !

10. Unusual population characteristics-post war migration & multicultural population mix Immigration contributed between 1/3 and ½ of our population growth

11. 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

12. 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

13. Mental Health Services • 1993 HREOC findings • Two 5 year Strategic Plans for reform • Significant effects on service delivery • Significant shift away from psychiatric institutions • Integration with existing health services • Main changes have been to basic infrastructure • More change needed to ‘special needs’ populations including rural and remote

14. 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

15. 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)

16. Tasmania The most rural state in Australia (58% population live outside Hobart)

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Rural Community-based training for students • Changing face of medical/health professional education • Rural Clinical Schools • Better balance between hospital and community-based clinical training • Vertical and horizontal education • Inter professional practice and education

25. 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)