Someone's postcode shouldn't determine their level of access to mental health support following instances of family and domestic violence. Here's how the psychology profession can help keep Australia's regional and rural communities safe and well.
This article mentions family and domestic violence. If you, or someone you know, needs immediate support, you can call 1800 RESPECT (1800 737 732) or visit the website for more resources.
Throughout this year, Australians have rallied in the streets to protest violence against women and children, following an alarming number of tragic deaths and attacks that have taken place across the country.
"Many women and children in our country are being killed or left with devastating mental ill-health issues following violent attacks," says APS CEO Dr Zena Burgess. "Family and domestic violence (FDV) also has devastating secondary effects for families, communities and society at large."
Eight million Australians have experienced some form of violence by the age of 15, according to data from the Australian Bureau of Statistics. While it's difficult to pinpoint the instances that occur in regional and rural parts of Australia – as many cases go unreported – research suggests that approximately 21 per cent of women living outside of capital cities have experienced violence from an intimate partner (compared with 15 per cent of women living in a capital city).
"Several factors can contribute to these higher rates, including geographical isolation, scarcity of resources, economic distress – particularly during troubling drought or bushfire seasons – and critical shortages of mental health support services."
Another factor that can make rates of violence in remote communities more challenging, says Dr Burgess, is the lack of anonymity afforded in small towns.
"There are often concerns about reporting perpetrators of violence in these tight-knit towns because everyone knows them and, in many cases, the perpetrator might have strong bonds in the community.
"This could lead the victim-survivor to feel as if they are severing ties with their entire community if they speak up, or they may feel they have nowhere to go should they choose to leave."
Regional and rural access issues
Regional and rural communities in Australia have historically struggled to attract psychologists.
"We know that the further away you live from a metropolitan city centre, the less likely you are to have access to affordable mental health support," says Dr Burgess. "Yet these are the communities with the highest rates of mental ill-health."
Even when care is available, it's often out of financial reach for many.
“In a cost-of-living crisis, our most vulnerable should only need their Medicare card, not their credit card, to access psychology services. If the Government made psychological care more affordable by reinstating the 20 Medicare-subsidised sessions, it would help clients and reduce pressure on GPs, first responders, and emergency departments.”
For those at risk of developing complex mental health issues, many will require access to up to 40 Medicare-rebated sessions within Better Access, she adds, particularly as instances of FDV can retrigger previous trauma in victim-survivors or lead to long-term mental health challenges.
“75 per cent of Australians report cost as one of their biggest barriers to accessing psychology services, and 76% of Australians agree that the number of sessions they require should be determined by their psychologist, not the government.”
APS also advocates for access to three Medicare-subsided psychology sessions without need for a GP referral. In the context of FDV, this measure would remove a barrier for victim-survivors who need direct access to psychological care.
"Australians should be able to access affordable psychology services to help them through challenging times – no matter their postcode. Victim-survivors shouldn’t be expected to deal with their mental health issues on their own, but this is sadly the case for so many."
The solution, says Dr Burgess, is to invest in more mental health care outside of metropolitan Australia. Doctors are incentivised to move into remote and regional parts of Australia to provide critical healthcare via government-funded initiatives, yet there are no similar programs provided to the psychology profession.
"While financial incentives for individual psychologists would make a significant difference, it's not the only way the Government could have an impact," says Dr Burgess.
"At the moment, Australia offers GPs’ patients bulk- billing rebates. We want to see this for psychologists too. This would not only encourage more psychologists into the regions, but it would also make mental health care more affordable for those in their communities. It's a win-win situation."
Another way to attract psychologists to regional Australia could be to remove HECS debts for those who choose to relocate, as is done with general practitioners, and invest in increasing training spots for psychologists in Australia.
"We're only meeting 35 per cent of our country's psychology needs and that's worse in our regional areas – only 2 in 10 of Australia's psychologists work in these parts of the country."
What psychologists can do to help
While government assistance is the only way to make the necessary seismic changes required to better respond to high rates of FDV in regional and rural Australia, there are small things psychologists can do to have a positive impact.
"Psychologists are critical players in developing both protective and responsive factors to lessen instances of violence in Australia," says Dr Burgess.
For example, they can:
1. Reach out to these communities to offer telehealth services
Better Access telehealth services can be delivered by psychologists to support clients outside of the city.
"All 10 Better Access sessions available to eligible clients in a calendar year can be delivered via telehealth," says Dr Burgess. "Even if your practice is CBD-based, consider promoting your psychology services to those in regional and rural parts of Australia."
APS members can access this checklist and guide of things to keep in mind when providing telehealth services, as well as this consent form template.
2. Learn how to take a recovery-oriented approach
Consider any new evidence-based therapeutic techniques that you might need to learn about, such as recovery-oriented CBT.
"We hosted a fantastic webinar with Dr Judith Beck last month, who has continued the research of her father – the late Dr Aaron Beck – in recovery-oriented CBT. It is available on-demand for those interested in learning more about it."
It's also important to take a trauma-informed approach when supporting victim-survivors of FDV. APS offers a CPD-approved course in implementing trauma-focused CBT.
3. Support culturally appropriate psychology practice
"Indigenous communities, for example, will require completely different approaches that align with their own cultural practices," says Dr Burgess. "Further investments are needed to fund Indigenous students seeking to practise psychology, so they can do so in accordance with their specific cultural values."
Psychologists can donate to APS's Bendi Lango bursary, which, since 2006, has helped provide financial support for 17 Indigenous postgraduate students to continue their psychology studies.
"So far, our members' donations have amassed $420,000, which we're so grateful for. This is an important initiative that we encourage the entire psychology profession to continue supporting."
4. Champion a multidisciplinary approach
For psychologists who are already supporting victim-survivors in regional areas, remember that mental health support is only one aspect of the recovery journey.
"Many will be in need of comprehensive, holistic support such as medical, legal, and social services. Consider how you could partner with other community service providers to ensure your clients receive well-rounded support to help them build resilience and return to a sense of normalcy."
5. Consider how you could work with communities
While individual therapies are critical in supporting victim-survivors, community-based programs can have significant impacts from a prevention standpoint.
"Psychologists could partner with local community groups, healthcare providers and educators to run programs aimed at addressing some of the underlying issues that drive family and domestic violence, or to provide information about how to seek help."
Group-based therapies can also be effective ways to support victim-survivors to see that they're not alone and to instil a sense of belonging in them.
"Joining a community support group can empower people to come to terms with their experience in a safe and understanding way," says Dr Burgess.
For more resources to support Australians experiencing FDV, see this list of support services.