Abstract
There is a growing burden of disease nationally and internationally from mental illness, both as a stand-alone problem and also comorbid with the growing epidemic of chronic, non-communicable diseases. The advent of the COVID-19 pandemic in early 2020 and ongoing climate change sequelae have exacerbated these mental health risks exponentially, creating massive service delivery dilemmas globally. In many countries, people in regional and particularly rural and remote areas, bear a greater disease burden from mental health conditions, due largely to the unique stressors inherent in rural life and inequitable access to appropriate services. This chapter canvases these issues and includes a brief discussion of optimally integrated care, risk factors and needs specific to rural people, the impact of Indigeneity, the role of socioeconomic factors in general and mental health, and inequity of access to primary mental healthcare services. These factors are illustrated by focusing on Australia as a case study, exemplifying both generic characteristics and those unique to that country that are relevant to service delivery in rural areas. The chapter was accepted for publication prior to Australia’s worst bushfires on record (in the summer of 2019–2020), subsequent floods in early 2020, and the advent of the COVID-19 pandemic in February–March 2020 (ongoing). Most of the highlighted factors, however, remain the same – albeit greatly exacerbated by these extraordinary events.
Information is provided in relation to the distribution of four relevant mental health specialties, with recommendations made – specific to Australia and also in the global context – with regard to optimally integrated primary mental health care.
Across the settled world, there is a huge need to systematically roll-out integrated mental health services, using a number of modalities, to meet rural need. It is recommended that changes include: interprofessional education to facilitate team-based care; co-location of multidisciplinary primary healthcare teams; development and integration of culturally appropriate health services for Indigenous clients; mapping of required services in regional, rural, and remote areas; and optimal and strategic use of available funding and telehealth options. It is also strongly recommended that integration of lifestyle interventions be included in all mental health treatment, to facilitate optimal outcomes. These initiatives are now particularly pertinent, given the post-COVID “mental health pandemic” predicted by health experts globally.
Similar content being viewed by others
References
Aikman A. Remote recognition: voice? What voice? Weekend Australian, p. 10. 2019. Retrieved from https://search.proquest.com/docview/2278104309?accountid=36155
Arriagada NB, Bowman DM, Palmer AJ, Johnston FH. Climate change, wildfires, heatwaves and health impacts in Australia. In: Extreme weather events and human health. Cham: Springer; 2020. p. 99–116.
Australian Bureau of Statistics. Population clock. 2019. Retrieved from https://www.abs.gov.au/ausstats/abs%40.nsf/94713ad445ff1425ca25682000192af2/1647509ef7e25faaca2568a900154b63?OpenDocument
Australian Government. Better access to psychiatrists, psychologists and general practitioners through the MBS (better access) initiative. Canberra: Department of Health; 2006. Retrieved from https://www.health.gov.au/mentalhealth-betteraccess.
Australian Government. Modified Monash model. 2018. Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/modified-monash-model
Australian Government. Primary health networks grant programme guidelines: Annexure A1 primary mental health care. Canberra: Department of Health; 2019. Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/Content/F4F85B97E22A94CACA257F86007C7D1F/$File/Annexure%20A1%20-%20Primary%20Mental%20Health%20Care.pdf.
Australian Government. Department of Health. Australia’s long term national health plan: to build the world’s best health system. Canberra: Department of Health; 2019. Retrieved from https://www.health.gov.au/sites/default/files/australia-s-long-term-national-health-plan_0.pdf.
Australian Government. Department of the Prime Minister and Cabinet. Closing the gap: report 2019. Canberra: Department of the Prime Minister and Cabinet; 2019. Retrieved from https://ctgreport.pmc.gov.au/sites/default/files/ctg-report-2019.pdf?a=1.
Australian Institute of Health and Welfare (2008). Rural, regional and remote health: Indicators of health system performance. https://www.aihw.gov.au/getmedia/68916c65-a5e8-4e7e-a821-374a9455ef0b/rrrh-ihsp.pdf.aspx?inline=true (accessed: 15.10.20).
Barbour L. Silent killer: the opioid addiction crisis that has crept up on regional Australia. 2017. https://www.abc.net.au/news/2017-09-03/opioid-crisis-creeping-up-in-regional-australia/8859996
Bishop L, Ransom A, Laverty M, Gale L (2017). Mental health in remote and rural communities. Research Report, March 2017, Royal Flying Doctor Service (pages:1–80); Accessibility and quality of mental health services in rural and remote Australia, Submission 22 - Attachment 1; Retrieved from file:///C:/Users/Robyn/Downloads/sub22a_RFDS%20(4).pdf (accessed: 15.10.20).
Boyd CP, Hayes L, Sewell J, Caldwell K, Kemp E, Harvie L, … Nurse S. Mental health problems in rural contexts: a broader perspective: response to Jackson et al. (2007) mental health problems in rural contexts: what are the barriers to seeking help from professional providers? Aust Psychol. 2011;43(1):2–6.
Commonwealth Department of Health & Aged Care. National mental health report: 2005: summary of ten years of reform in Australia’s mental health services under the National Mental Health Strategy 1993–2003. Canberra: Commonwealth of Australia; 2005.
Crayne MP. The traumatic impact of job loss and job search in the aftermath of COVID-19. In: Psychological trauma: theory, research, practice, and policy. No pagination specified. 2020. https://doi.org/10.1037/tra0000852.
Cresswell A. Rural heart of the nation suffering: rural Australians are increasingly losing patience with second rate services. The Australian, p. 15. 2008. Retrieved from https://www.theaustralian.com.au/news/health-science/rural-heart-of-the-nation-suffering/news-story/8baaff56e3c0bcab2dcd532a67789233
Crnek-Georgeson KT, Wilson LA, Page A. Factors influencing suicide in older rural males: a review of Australian studies. Rural Remote Health. 2017;17(4):4020. https://doi.org/10.22605/rrh4020.
D’Proff MJ, Mills D, Gray R. Expecting the unexpected? Improving rural health in the era of bushfires, novel coronavirus and climate change. Aust J Rural Health. 2020;28:107–9.
Eckermann S, Howard S. Health workforce crisis: how to achieve a work-life balance. Aust J Rural Health. 2008;16(2):117. https://doi.org/10.1111/j.1440-1584.2008.00974.x.
Gunnell D, Martin RM. Patterns of general practitioner consultation for mental illness by young people in rural areas. A cross-sectional study. Health Stat Q. 2004;21:30–3.
Henderson S. The National Survey of mental health and well-being in Australia: impact on policy. Can J Psychiatr. 2002;47(9):819–24. https://doi.org/10.1177/070674370204700902.
Hickie I, Groom G. Primary care-led mental health service reform: an outline of the better outcomes in mental health care initiative. Australas Psychiatry. 2008;10(4):376–82.
Hordacre A, Howard S, Moretti C, Kalucy E (2007). Making a difference: report of the 2005–2006 annual survey of divisions of general practice. Flinders University; https://researchnow.flinders.edu.au/en/publications/making-a-difference-report-of-the-2005-2006-annual-survey-of-divi (accessed: 15.10.20).
Hunter E. Disadvantage and discontent: a review of issues relevant to the mental health of rural and remote indigenous Australians. Aust J Rural Health. 2007;15(2):88–93. https://doi.org/10.1111/j.1440-1584.2007.00869.x.
Insel TR, Collins PY, Hyman SE. Darkness invisible: the hidden global costs of mental illness. Foreign Affairs. 2015.
Jackson H, Judd F, Komiti A, Fraser C, Murray G, Robins G, … Wearing A. Mental health problems in rural contexts: What are the barriers to seeking help from professional providers? Aust Psychol. 2007;42(2):147–160.
Jones R (2017). Slow Catostrophes: Living with Drought in Australia: Monash University Publishing (book) (see: https://publishing.monash.edu/product/slow-catastrophes/).
Kennedy AJ, Maple MJ, McKay K, Brumby SA. Suicide and accidental death in Australia’s rural farming communities: a review of the literature. Rural Remote Health. 2014;14(1):2517.
Looi J, Allison S, Bastiampillai T, Maguire P. Fire, disease and fear: effects of the media coverage of 2019–2020 Australian bushfires and novel coronavirus 2019 on population mental health. Aust N Z J Psychiatry. 2020; https://doi.org/10.1177/0004867420931163. 4.867420931163E867420931112.
Madanipour A, Shucksmith M, Talbot H. Concepts of poverty and social exclusion in Europe. Local Econ. 2015;30(7):721–41.
Matthews, R. (2011, October 2011). Profile of the regional, rural and remote psychology workforce. InPsych, Vol. 3; October, Issue 5; p12–13; https://www.psychology.org.au/for-members/publications/inpsych/2011/oct/Profile-of-the-regional-rural-and-remote.
McDaniel SH. Medical family therapy and integrated care. 2nd ed. Washington, DC: American Psychological Association; 2014.
Mitchell GK, Burridge L, Zhang J, Donald M, Scott IA, Dart J, Jackson CL. Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness? Aust J Prim Health. 2015;21(4):391–408. https://doi.org/10.1071/py14172.
National Health and Medical Research Council. Australian rural mental health study: ARMHS. 2019. Retrieved from https://www.crrmh.com.au/research/our-research/australian-rural-mental-health-study-armhs/
National Rural Health Alliance and Heart Foundation. Cardiovascular disease in rural Australia. 2015. Retrieved from https://www.ruralhealth.org.au/sites/default/files/publications/cardiovascular-disease-fact-sheet-may-2015.pdf
Naylor C, Das P, Ross S, Honeyman M, Thompson J, Gilburt H. Bringing together physical and mental health: a new frontier for integrated care. London: The King’s Fund; 2016. Retrieved from https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Bringing-together-Kings-Fund-March-2016_1.pdf
NSW Government. Glove box guide to mental health. In: The land, vol. 6. 2017, p. 4.
Nursing and Midwifery Board of Australia (2019). Nursing and Midwifery Board of Australia Registrant data; Reporting period: 01 January 2019 to 31 March 2019; file:///C:/Users/Robyn/Downloads/Nursing-and-Midiwfery-Board---Report---Registration-Data-Table---December-2019.PDF (accessed: 15.10.20).
Oxfam Australia. Close the gap: solutions to the indigenous health crisis facing Australia. National Aboriginal Community Controlled Health Organisation and Oxfam Australia. 2007. Retrieved from https://trove.nla.gov.au/work/26584187?selectedversion=NBD41528311
Parslow RA, Jorm AF. Who uses mental health services in Australia? An analysis of data from the National Survey of mental health and wellbeing. Aust N Z J Psychiatry. 2000;34(6):997–1008. https://doi.org/10.1080/000486700276.
Primary Health Care Research & Information Service (2008): Snapshot of Australian primary health care research; http://hdl.handle.net/2328/36270 (accessed: 15.10.20).
Psychology Board of Australia. Registration statistics, reporting period: 1 January–31 March 2019. 2019. Retrieved from https://www.psychologyboard.gov.au/About/Statistics.aspx
Rajkumar S, Hoolahan B. Remoteness and issues in mental health care: experience from rural Australia. Epidemiol Psychiatr Sci. 2004;13(2):78–82.
Roufeil L, Lipzker A (2007). Psychology Services in Rural and Remote Australia. https://www.semanticscholar.org/paper/Psychology-Services-in-Rural-and-Remote-Australia-Roufeil-Lipzker/93d7c2b5a033231a50e3976ef1dfdc33eb0ed941.
Rural Doctors Association of Australia. Submission to the senate economic references committee inquiry into regional inequality in Australia. 2018. Retrieved from https://www.rdaa.com.au/documents/item/453
Saunders P (2003). Can Social Exclusion Provide a New Framework for Measuring Poverty? (SPRC Discussion Paper No. 127); https://www.arts.unsw.edu.au/sites/default/files/documents/DP127.pdf (accessed: 15.10.20).
Simon-Davies J. Population and migration statistics in Australia. Canberra: Parliamentary Library; 2018. Retrieved from https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/6377182/upload_binary/6377182.pdf
Smith KB, Humphreys JS, Wilson MG. Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health. 2008;16(2):56–66. https://doi.org/10.1111/j.1440-1584.2008.00953.x.
The Royal Australian College of General Practitioners (2018). General Practice: Health of the Nation 2018. Retrieved from East Melbourne, Vic https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf?utm_source=Mem_land_page&utm_medium=web&utm_campaign=Health_of_the_nation_report (accessed: 15.10.20).
Vines RF. Clinical psychology in rural general practice: a national pilot of a new model of collaborative mental health service delivery. University of Sydney. 2009. Retrieved from https://ses.library.usyd.edu.au/handle/2123/6640
Vines RF. Equity in health and wellbeing: why does regional, rural and remote Australia matter? InPsych. 2011;33.
Vines RF. End Australia’s regional health workforce drought. InPsych. 2017;39.
Vines RF, Drent A (2010, August 2010). Focus on regional, rural and remote Australia. InPsych, 33 https://psychology.org.au/for-members/publications/inpsych/2011/oct/Equity-in-health-and-wellbeing-Why-does-regional, https://groups.psychology.org.au/Assets/Files/InPsych%20Rural%20Issue%20index.php.pdf.
Vines RF, Richards JC, Thomson DM, Brechman-Toussaint M, Kluin M, Vesely L. Clinical psychology in general practice: a cohort study. Med J Aust. 2004a;181(2):74–7.
Vines RF, Tonna A, Merrell T, Martin L (2004b). Support Scheme for Rural Specialists. RANZCP Tutorial Supported Refresher Program for Rural Psychiatrists. Cited in file:///C:/Users/Robyn/Downloads/rf-vines-2008-thesis%20(2).pdf (accessed: 15.10.20).
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, … Vos T. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013;382(9904):1575–1586. https://doi.org/10.1016/s0140-6736(13)61611-6.
Wikipedia. Overseas trained doctors in Australia. 2017. Retrieved from https://en.wikipedia.org/wiki/Overseas_trained_doctors_in_Australia
Wilks CM, Oakley Browne M, Jenner BL. Attracting psychiatrists to a rural area – 10 years on. Rural Remote Health. 2008;8(1):824.
World Health Organisation, Executive Board (1999). Poverty and Health: Report by the Director General; https://apps.who.int/iris/bitstream/handle/10665/78924/ee5.pdf?sequence=1&isAllowed=y (accessed: 15.10.20).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this entry
Cite this entry
Vines, R.F., Wilson, R. (2020). Integrated Primary Mental Health Care in Rural and Remote Contexts: The Australian Experience. In: Carey, T.A., Gullifer, J. (eds) Handbook of Rural, Remote, and very Remote Mental Health. Springer, Singapore. https://doi.org/10.1007/978-981-10-5012-1_9-1
Download citation
DOI: https://doi.org/10.1007/978-981-10-5012-1_9-1
Received:
Accepted:
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-10-5012-1
Online ISBN: 978-981-10-5012-1
eBook Packages: Springer Reference MedicineReference Module Medicine