By Kim O’Neill, CEO, On the Line.
July 21, 2019 marks the beginning of Farm Safety Week, an annual event that raises awareness of safety issues among farmers and agricultural workers.
Along with a strong focus on ‘hands on’ issues (like quad bike and tractor safety), Farm Safety Week also helps promote public awareness of the importance of mental health and wellbeing.
It’s a timely reminder when you consider the unique challenges faced by many people in regional Australia. It’s not just that they contend with drought, natural disasters, government legislation, globalisation and market forces (such as dairy prices) — people in rural, regional and remote Australia actually face significant challenges when it comes to accessing mental health support.
Is there a mental health crisis in regional, rural and remote Australia?
People in regional areas consistently record poorer mental and physical health outcomes across a wide range of health indicators than those in urban areas. There are various reasons for these disparities, but first, it’s important to consider whether this constitutes a mental health crisis, and if so, how we can respond appropriately?
Let’s consider just a few of the well-documented mental health and wellbeing issues facing people in regional Australia:
- The suicide rate is disproportionately higher in regional Australia — almost double that of major cities. In 2016, 47 per cent of suicides were outside of capital cities, yet these areas comprise 32 per cent of the population. Men are especially over-represented in suicide statistics.
- People in cities access on average 40 per cent more Medicare-funded mental health services than those in rural and remote areas.
- People in regional areas have access to just one-third the number of psychologists compared to major cities. There also appears to be a correlation between limited access to mental health services and negative mental health outcomes. The fewer the number of psychologists in an area, the greater the rate of mental health hospitalisations.
Barriers to mental health care
On the Line has long advocated for changes and reform to the mental health care system. Our position relating specifically to regional, rural and remote mental health was detailed last year in our formal submission to the Senate’s Inquiry into the accessibility and quality of mental health services in rural and remote Australia.
A significant challenge faced by the people in these communities is that mental health care is much harder to access than in urban areas. For instance, a lower overall availability of services (fewer psychologists and GPs) means travel distances can be immense — and this is when services are available at all!
In some communities there may also be a reluctance to seek care, due to concerns about privacy and discretion. People in close-knit communities may experience perceived embarrassment or shame at the prospect of their ‘business’ with a GP or psychologist becoming ‘known’ outside of a professional setting.
There may even be a reluctance to obtain care due to the perceived stigma associated with mental illness. For example, some farming communities have a tradition of self-reliance and are likely to view problems as being best solved via practical solutions.
In addition, the time-intensive commitment of farm work can make it difficult to make time for ‘self-care’, let alone making an appointment with a mental health professional that may require significant travel.
Another barrier to reaching out for help is that some people (such as some individuals experiencing severe social anxiety) may even find that the traditional mode of face-to-face consultations elicit strong feelings of anxiety or discomfort.
Does phone and online counselling make a difference?
In recent years I’ve had the opportunity to observe first-hand the benefits that free and easily accessible mental health care can bring to people in regional Australia.
Over the last two years, On the Line has launched two mental health services that provide free phone and online counselling specifically to people in regional areas.
- SA Regional Access. Launched in 2017 and funded by Country SA Primary Health Network, it provides 24/7 free mental health counselling to regional South Australia. Call 1300 032 186 for support.
- NQ Connect. Launched in 2018 and funded by Northern Queensland Primary Health Network, it provides 24 7 free mental counselling to the vast geographic area of northern Queensland, along with a range of other self-help support services. Call 1300 059 625 for support
To date, these services (along with our national and state-based services which cater to both urban and rural help seekers) have provided thousands of phone and online support sessions to people from these regions.
The user uptake of these services has been strong and they have been well received by local health care providers, as they can help ease pressure and demand. No referral is required to call these services and help from a professional counsellor is available 24/7 for the cost of a local call. Indeed, GPs routinely provide promotional cards and posters to clients, encouraging them to seek help from the privacy of their own home.
Strong uptake of these services suggests that free phone and online mental health counselling can be a viable mental health care option that can overcome many of the barriers to seeking help in regional Australia: travel distance, lack of services, and concerns of privacy.
A long-term solution
Although support for the expansion of more telehealth services is a key part of the response needed, these services will not solve the suicide and mental health crisis in rural Australia on their own. The success of these services depends heavily on a strong and reliable telecommunications infrastructure in very remote areas that can consistently support mental health telehealth services. Investment into both the supporting telecommunications infrastructure and the rollout of mental health services tailored to regional areas is crucial to reducing the issues.
Our focus on prevention and early intervention is an important component of any strategy that addresses the challenge of mental health care in regional areas. On the Line has long advocated for this fundamental change in the mental health care system, shifting from one which emphases addressing the symptoms and the outcomes. Taking this approach means that potential issues can be addressed earlier in the cycle and reduces impact on emergency services. Our position is outlined in our formal submission to the Federal Productivity Commission into Mental Health.
Whilst wider availability of telehealth services is not the only initiative needed to tackle this issue, services like SA Regional Access, NQ Connect, MensLine Australia and Suicide CallBack Service remain a cost effective, accessible and discreet option for providing mental health care to all Australians, regardless of their location.
The tyranny of distance and limited accessibility to mental health care is not new. We must act quickly and decisively, as we are indeed facing a mental health crisis. Please join me in advocating for new and innovative ways to provide free, accessible and cost effective mental health counselling and support for regional Australians.