Complete rethink needed to address rural mental health crisis

Friday, 15 June 2018

“There are just 2 psychiatrists for every 100,000 country people in very remote areas," said Mark Diamond, CEO of the National Rural Health Alliance.

The National Rural Health Alliance has released new analysis to show just how few mental health professionals work in rural and remote Australia.

Built from a number of data sets from the Australian Institute of Health and Welfare the new analysis paints a striking picture of the difficulty of accessing mental health workers in country Australia.

It shows if you live in a major city there are 16 psychiatrists for every 100,000 people, but in very remote areas there are just 2 per 100,000. 

For every 100,000 people in major cities there are 120 psychologists. In very remote areas that number drops to just 25. There are 94 mental health nurses per 100,000 in cities, yet just 29 per 100,000 people living in very remote areas.

Figure 1 Prevalence of specialist mental health professionals, by Remoteness, 2015
Data source:

Very remote areas include Bourke and Cobar in New South Wales, Ceduna and Kangaroo Island in South Australia, Kalgoorlie in Western Australia, and Cunnamulla and Charleville in Queensland.

“This analysis reveals that the further you live from a major city, the more trouble you will have finding mental health care,” said Mark Diamond, Alliance CEO.

“We need to overhaul the way we think about mental health workforce in rural areas.  It’s about both attracting country kids to the professions, and training them in rural areas to maximize the chance they’ll stay and work in the country."

The lack of workers is forcing country people into hospital emergency departments.

Nearly twice the number of people in remote areas attend emergency for a mental health issue than in major cities.

Emergency presentations for mental health issues increase by around 30 per cent outside metropolitan areas.

“If emergency is the only service available, country people are more likely to delay seeking help, especially if they have to travel long distances to reach a hospital,” said Mark Diamond.

“The upshot is their mental illness has probably reached crisis point by the time they try to access care - making it much harder to recover.”

 Figure 2 Mental Health Emergency Department presentations, 2015-16
Data source: AIHW 2018 - Mental Health Services Australia

The National Rural Health Alliance welcomes recent announcements by the Federal Government to fund extra online and phone counselling services for country Australia.

The Alliance supports technology as a part of the solution.  But significantly more mental health workers are needed on the ground to address the disparity in funding, services and workforce. They also need extra training to prepare them for the particular needs and challenges of working in a rural or remote setting.

Some mental health workers are in allied health, and as such do not have access to Medicare funding.  In another Partyline article by Alliance member the Services for Australian Rural and Remote Allied Health (SARRAH), one of the major barriers to the more effective use of allied health in rural areas is the lack of an appropriate funding model. 

That article says that while a Mental Health Plan may include limited access to some allied health, out of pocket costs deter many country people.

The analysis, and graphs in this article, are part of the Alliance’s submission to a Senate Inquiry into the accessibility and quality of mental health services in rural and remote Australia.

The submission makes seven recommendations which include:

•    Overhauling the way mental health professionals are trained and supported to both attract and retain them in country areas.  
•    Ensuring mental health workers have additional generalist skills required to address the unique needs of rural and remote Australia.
•    Ensuring country Australia receives the same mental health funding per capita as major cities.  Medicare expenditure on mental health is $52.42 per person in cities, and just $8.26 per person in very remote areas.
•    Evaluating the effectiveness of current federal and state mental health programs. 
•    Ensuring guidelines are used to decide whether or not telehealth services are appropriate.

Figure 2 Per capita Australian Government expenditure on mental health specific services, 2016-17

Data source: AIHW 2018 - Mental Health Services Australia  *Note: per capita state and territory expenditure is not available by remoteness

The National Rural Health Alliance submission has just been accepted by the Senate Committee and can be found here:


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