myths & challenges of mental illness in rural communities: the australian perspective
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Myths & Challenges of Mental Illness in Rural Communities: the Australian Perspective. Professor Judi Walker University of Tasmania. Australia –some comparisons. Smallest continent Largest island. Vast difference in population size. Europe, USA, Canada and Australia are all - PowerPoint PPT PresentationTRANSCRIPT
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)