Mental health in remote and rural communities
Mental health in remote and rural communities Report
- Author(s): Bishop, Lara, Ransom, Andy, Laverty, Martin, Gale, Lauren
- Published: 2017
- Publisher: Royal Flying Doctor Service of Australia
Abstract: Each year, around one in five, or 960,000, remote and rural Australians experience a mental disorder. The prevalence of mental disorders in remote and rural Australia is the same as that in major cities, making mental disorders one of the few illnesses that does not have higher prevalence rates in country Australia compared to city areas. Yet suicide and self-harm rates are higher in remote and rural Australia than in major cities, with residents of very remote areas twice as likely to die from suicide as city residents. Farmers, young men, older people, and Aboriginal and Torres Strait Islander (Indigenous) Australians face the greatest risk of suicide. The RFDS delivers mental health services to many remote and rural Australians experiencing mental disorders and collects data on the services it provides. The current report presents these data for the first time. When considered alongside data from other providers of mental health services, these data can be used to inform the development of evidence-based solutions to improve health outcomes for remote and rural Australians experiencing mental disorders. A number of factors exacerbate mental health acuity in remote and rural Australia, including: poor access to primary and acute care; limited numbers of mental health services and mental health professionals; reluctance to seek help; concerns about stigma; distance and cost; and cultural barriers in service access. In combination, these factors may have a detrimental impact on the mental health of remote and rural Australians, resulting in the need for an aeromedical retrieval to receive emergency hospital treatment for a mental disorder, in the most extreme circumstances. Several risk factors have been identified that may give rise to the onset and progression of a person’s mental disorder. These risk factors comprise family history, stressful events, physical health problems, substance use, personality factors, and changes in the brain. An additional set of risk factors have been identified as heightening the risk of suicide in remote and rural areas, including: economic hardship; easier access to means of death; social isolation; less help seeking; and reduced access to support services. With poorer service access that results in people in very remote areas accessing mental health services at about one-fifth of the rate of people in major cities, remote and rural health services are less able to intervene in response to signs of known risk factors. The mental health of Indigenous Australians living in remote and rural areas warrants particular attention. Many Indigenous Australians conceptualise mental health differently to non-Indigenous Australians—they take a holistic view of overall health, with cultural, spiritual, and social wellbeing acknowledged as integral components of overall health. The term ‘social and emotional wellbeing’ (SEWB) is the framework through which mental health of Indigenous Australians is often described. Indigenous Australians are 1.2 times as likely to die from mental disorders than non-Indigenous Australians, and are 1.7 times as likely to be hospitalised for mental disorders. Indigenous young people aged 12–24 years are three times as likely to be hospitalised with a mental disorder as a non-Indigenous young person of the same age. Mental disorders are also associated with other illnesses, such as cardiovascular disease (CVD), diabetes, cancer and preventable injury. People with mental disorders also experience disproportionally higher rates of disability than people without mental disorders and these rates are even higher in remote areas of Australia. The RFDS has provided an extensive emergency and primary health care service across remote, rural, and now metropolitan Australia, for almost 90 years. During this period, its primary care services have cared for large numbers of patients with mental disorders, and continue to do so. The RFDS also operates 13 separate and specific mental health and SEWB programs across Australia (summarised in Table i), that provide treatment services to remote and rural Australians with mental disorders or assist in improving mental health and SEWB. All of the programs are delivered in partnership, including with other health services, community organisations, federal and state/territory governments, Indigenous organisations, schools, universities, and/or research organisations. The RFDS also provides aeromedical retrievals of patients from remote and rural areas who experience an acute episode of a mental disorder. This research and policy paper presents, for the first time, aeromedical retrieval data of mental health patients cared for by the RFDS in the period from 1 July 2013 to 30 June 2016. During this three-year period, 89,053 aeromedical retrievals were conducted—of these, 2,567 were for mental disorders. Analysis of the 2,567 RFDS patient records for people retrieved for mental and behavioural disorders by the RFDS revealed: > Males (n=1,568, 61.1%) were 1.6 times as likely as females (n=998, 38.9%) to require an aeromedical retrieval for a mental disorder; > Retrieved patients ranged in age from less than 4 years of age to 85 years of age or older; > One in every two retrievals (47.8%) for a mental disorder was for a person aged 20–39 years; > The mean age at which patients were retrieved was 35–39 years (non-Indigenous Australians mean age 40–44 years; Indigenous Australians mean age 25–29 years); > Males were more likely to undergo an aeromedical retrieval than females for all age groups except 10–14 years and 60–64 years, when females were more likely to be retrieved than males of the same age group; and > 2.2% of retrievals for mental disorders were for children under the age of 15. Age-specific aeromedical retrieval rates were calculated and were higher among Indigenous Australians than non-Indigenous Australians. Indigenous Australians of all age groups were between 3.5 times and 40.6 times as likely as non-Indigenous Australians to be retrieved for a mental disorder. The age-specific retrieval rate was highest in Indigenous Australians aged 35–39 years (3.25 per 1,000 population), closely followed by Indigenous Australians aged 25–29 years (2.57 per 1,000 population) and 30–34 years (2.24 per 1,000 population). Age-specific aeromedical retrieval rates for non-Indigenous Australians ranged from less than 0.01 retrievals per 1,000 population (non-Indigenous children under 10 years of age) to 0.12 retrievals per 1,000 population (non-Indigenous Australians aged 20–24 years, 30–34 years and 40–44 years). The three main diagnoses that triggered a patient’s aeromedical retrieval for a mental illness were: 1. Schizophrenic psychosis; 2. Depressive disorders; and 3. Drug psychosis. Actions to improve mental health outcomes of remote and rural Australians require: > Stronger recognition in the Fifth National Mental Health Plan of the significant barriers and challenges, including the large geographic and travel distances, that are faced by those in remote and rural areas when seeking to access comprehensive mental health services, as well as consideration of how these can be overcome; > Implementation of innovative service models, including consideration of further use of RFDS infrastructure to deliver necessary, appropriate, and more comprehensive mental health and suicide prevention services more often; and > Appropriate resourcing by all levels of governments, to provide more long-term funding certainty. Finally, mental health and SEWB programs in remote and rural Australia need to incorporate ten key components. Programs should: 1. Be provided in identified areas of need; 2. Focus on prevention and early intervention; 3. Be evidence-based and evaluated; 4. Be locally relevant, address community risk factors and include input from the community, consumers, carers and Indigenous Australians in decisions about new services; 5. Take a social determinants of health approach and be holistic; 6. Be implemented in collaboration with other organisations delivering mental health and SEWB services; 7. Be implemented in collaboration with consumers, families and carers; 8. Be culturally appropriate and safe; 9. Be provided with a comprehensive primary health approach; and 10. Facilitate access by all members of the local community.
- Urls: https://files.flyingdoctor.org.au/dd/files/RN081_Equitable_Health_Research_Report_P4_Digital.725b.pdf
- Publisher Location: Canberra