Why do we need a Centre for Rural and Remote Mental Health?
Date: February 15, 2018
Author: PROFESSOR DAVID PERKINS, Director and Professor of Rural Health Research, CRRMH
Australia is huge and highly urbanised country. Most of its population lives in state capital cities or large cities such as Newcastle, Geelong, Gold Coast, Central Coast. While it has more than its fair share of the world’s leading Universities and is a technological innovator, it depends on primary industries of extraction and agriculture for much of its export income and wealth.
These primary industries are located in rural and remote areas and are subject to environmental, economic, technological and social changes which can happen suddenly. Questions of drought and water security affect the wellbeing and viability of industries and communities as the Murray-Darling basin challenge illustrates. Changes in world commodity prices are linked to boom and bust in mining and associated industries such as transport.
Technological developments and the use of machinery mean increased automation in the mining industries, changes to power generation, the loss of jobs and the need for new skills and capabilities. These changes can have adverse impacts for individuals, families, businesses and communities and can affect individual health and wellbeing for those unable to adapt.
It is fair to say that rural people experience similar physical and mental health problems to those who live in cities, but they often have relatively poor outcomes as demonstrated by life expectancy, burden of disease, and years of life lived with sickness and disability. This is particularly so in our Indigenous communities. Our experience of the Closing the Gap strategy for Aboriginal people is not altogether encouraging.
The conventional explanation and policy solution for these problems is to blame a shortage of rural health services and to shape clinical training programs and provider incentives to fill the gaps. Thus, increasing the number of medical students, and particularly those from rural backgrounds, is intended to increase access to services in rural communities deemed unattractive or uneconomic by doctors and providers. This may result in an economic trickle-down effect and increase access to rural health services, but will it result in improvements in rural health and wellbeing?
We need to adopt a variety of strategies to address inequalities in rural wellbeing whether physical or mental. At the individual level it is important that rural residents know how to look after their own mental health and support their friends, families and neighbours.
At the community level we need to support services to be more effective and we need to help communities build the resilience that will enable them to adapt successfully to change and to rural adversity. Rural health services, alongside other rural services and businesses, often experience a shortage of specialist staff and so others have to provide a wider range of services. This implies different service models compared with those in large metropolitan populations.
Helping communities respond to environmental, economic and social changes requires new collaborative activities that involve public, private and voluntary organisations working to build community wellbeing.
The CRRMH exists to help individuals care for their mental health, to support rural services and to assist communities addressing rural suicide. This requires using the best evidence to address problems and test solutions to see if they work. We need to be collaborative and smart if we are to ensure better mental health for people who live in rural Australia.
PROFESSOR DAVID PERKINS
Director and Professor of Rural Health Research
Centre for Rural and Remote Mental Health
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