New Strategy Needed to Address Rural Mental Health ‘Crisis’

The peak body for the mental health sector has called for a “carefully planned workforce strategy” to address a “crisis” in mental health service access in rural Australia, with rural and remote Australians accessing mental health services at a much lower rate than those in metropolitan areas.   

Frank Quinlan, the CEO of Mental Health Australia, told Pro Bono News this lack of access has led to an elevated suicide rate for those living remotely.    

“We know in rural and remote areas mental health issues occur at about the same rate as the rest of the community. One in five people experience mental health issues every year and almost half of all people experience mental health issues over the course of a lifetime,” Quinlan said.

“But in rural and remote areas people access those services at much lower rates, often as low as 20 per cent of their city counterparts.

“So what we see is that despite mental health issues occurring at a similar rate, we see suicide occurring at a much elevated rate and tragically that can be up to double the rate of suicides in remote areas compared to metropolitan areas.”

The Royal Flying Doctor Service highlighted data from the Department of Health that showed while the number of registered psychologists in Australia increased in 2015-16, 15 rural and remote areas had no registered psychologists at all.

“[This includes] parts like the west coast of Tasmania, in central Australia, in western Queensland, the Kimberley in Western Australia. That should be no excuse in a country of universal access to healthcare,” RFDS CEO Martin Laverty told ABC AM on Monday.

“Last year the Flying Doctors, in fact, saw 24,500 people to provide mental health counselling to. But we could double or triple that service tomorrow and still not touch the surface.”

Quinlan said despite the federal government investing in mental health programs recently, with an $80 million allocation for psychosocial support services in last year’s budget, there was still a “long way to go”.

“We’ve seen the federal government invest money in improving telehealth services, which is a very welcome initiative. [But] we’ve seen less investment in the planning and development of workforce in rural and remote areas and I think part of the problem is the approach to mental health funding has been so ad hoc, that it’s been very hard for people planning careers and families and so forth to [move] to places where they’re uncertain if funding will be forthcoming in 12 months or even less in most cases,” he said.

“I think we could do a lot by having a carefully planned workforce strategy. And I think we need to consider the workforce quite broadly, in terms of GPs and mental health nurses and psychologists and other clinicians, but we also need to consider the community-based mental health workforce and peer workers and others who can deliver services in rural and remote areas.

“And we need to find incentives to fill the gaps in our current service arrangements. Alongside that, I also think we need to exploit the opportunities that technology presents, in telemedicine opportunities and with the development of apps and other online programs that can also provide people with effective assistance.”

Building the strength and resilience of remote communities was also important, Quinlan said, because “it’s not always trained professionals required to avert mental health issues”.

“We know people do better in communities that are inclusive and vibrant and engaged. So some of the things we should do is building up the strength of those communities rather than just looking directly at [implementing] mental health initiatives.”

Quinlan warned that the National Disability Insurance Scheme was not a panacea for the problems afflicting mental health service access in rural and remote areas.

“We need to consider not just the NDIS but the other services that go with it. So I think what we’ve seen for a little while is people putting all their eggs in the NDIS basket and that’s simply not going to be the service system that responds to all the needs we’ve identified,” he said.

“So we need to get the NDIS right and we need to support it and make sure we deliver it appropriately. But we’re still going to need a whole range of services in and around the NDIS to support people who won’t receive NDIS services.”

“We’ve seen the Commonwealth government in the last budget make a welcome investment of $80 million to support programs and services in the psychosocial support space. But as yet we haven’t seen state and territory governments come on to match that funding and to develop those sorts of services. There’s a real eagerness to see that Commonwealth investment matched by states and territories so we can get on and start to deliver some of these services.”

These concerns come as the Australian Medical Association recently released its position statement on mental health in 2018.

It called for an overarching mental health “architecture”, and urged governments to address underfunding in mental health services and programs for people in regional and remote areas.

“The AMA Position Statement supports coordinated and properly funded community-managed mental health services for people with psychosocial disability, as this will reduce the need for costly hospital admissions,” AMA president Dr Michael Gannon said.

Labor’s shadow minister for ageing and mental health, Julie Collins, said the airing of these concerns should be a wake-up call for the federal government.

“The mental health gap between the city and country is already too wide and [RFDS’s] comments follow the Australian Medical Association’s position statement on mental health last week on the ‘gross’ underfunding of mental health services,” Collins said.

“The Turnbull government must prioritise greater funding for mental health services in the lead-up to the budget.

“It is only by working together that we will be able to finally reduce the impact of mental health issues in our society.”