This article is featured in The Daily Telegraph and is republished with permission.
Regional mental health care is the “worst it’s been” in a long time, a peak body has warned, after years of funding issues, workforce shortages, rising living costs and natural disasters.
The rate of mental health related emergency department visits – often a last resort indicating other options were not available – at remote hospitals has doubled in the last decade.
On a per capita basis, visits are more than twice as high as major cities.
National Rural Health Alliance chief executive Susi Tegen said rural health care, including mental health, was “chronically underfunded” and the “worst it’s been for a long time”.
“The thing that does surprise me . . is that nobody seems to care,” she said.
She said there had been some great community-led initiatives, but overall, Australia’s funding arrangements were inflexible and hindered good local work.
“Rural Australians with mental illness have up to three times the risk of premature death,” she said.
Royal Australian and New Zealand College of Psychiatrists chair of rural psychiatry Associate Professor Matthew Coleman said the prevalence of mental disorders did not change, but the outcomes were “always worse in rural and remote communities”.
“Suicide rates are twice than that in capital cities, in some locations it’s up to 14 times worse, places like remote locations and in Aboriginal communities,” he said.
“Access to services because of the lack of accessibility of general practitioners, specialists, psychiatrists and other mental health professionals, is just significantly worse.”
A third of Australians live in a regional area, but 85 per cent of psychiatrists are in a major city.
Australian Psychological Society president Dr Sara Quinn said regional Australians could “wait several months, or even up to a year” for an appointment.
“When we delay treatment, those issues can become chronic,” she said.
“[It] becomes far, far more risky and damaging for the individual.”
Mental Health Australia chief executive Carolyn Niokolski said the cost of care – particularly in a cost-of-living crisis – and stigma were also significant barriers.
“There are different social attitudes and levels of stigma across the country,” she said.
But all experts agreed solutions exist.
Dr Quinn said the Medicare cap for 10 psychology sessions a year was too low and led to a revolving door of patients, increasing demand long-term.
“It’s the equivalent of giving someone with cancer half the dose of chemotherapy and expecting them to recover,” she said.
She said increasing Medicare rebates for regional psychologists and improving training options and support for regional students would help workforce shortages.
“There is no incentive for [psychologists] to relocate and work in regional areas,” she said.
Dr Coleman said telehealth was not a solution and the psychiatrist shortage would continue until there was a “fundamental” shift in medicine’s city-centric training system.
“If telehealth was really that good, then people in the city would be using it and they’re not as much as we thought they would,” he said.
“We should be using technology to actually bring education and training opportunities to rural people.”
He said all health departments needed to do more to increase regional training options.
Ms Niokolski said authorities also needed to better use the existing workforce, such as Aboriginal and Torres Strait Islander community health workers and social workers.
The NRHA has been calling for a national rural health fund totalling $1bn over four years.
Ms Tegen said the money should be split equally between services and infrastructure, from clinical spaces to accommodation for healthcare students.
“And if it’s not spent, then it needs to go into a rural health fund,” she said.
A federal government spokesman said the government was investing in “immediate measures”, such as extra psychology internships, to grow the mental health workforce, “including in regional, rural and remote settings”.
“The Australian government works with states and territories to provide accessible and affordable mental health care to all Australians regardless of where they live,” he said.
A Victorian government spokesman said regional Victoria was a “major focus” of their mental health reforms, which includes expanding youth mental health residential centres and eating disorder and drug and alcohol services.