Self-reported data from the Australian Bureau of Statistic’s National Health Survey, analysed by the Australian Institute of Health and Welfare (AIHW), indicates that the prevalence of mental and behavioural conditions, when compared by geographic region, is highest in inner regional Australia. The most recent reporting on suicide and self-harm, also from AIHW, continues to illustrate rates of hospitalisation and death that increase with geographic remoteness. The rate of death due to suicide in very remote areas is more than twice that of major cities.
While rural, regional and remote (hereafter rural) people are reported to be more likely to feel part of their community and less likely to feel lonely, life in rural communities brings unique challenges – including those due to extreme weather events such as droughts, floods and bushfires. These components of rural adversity can have a negative impact on mental health and wellbeing.
Stoic attitudes that value self-reliance are prevalent in rural areas. This is combined with concerns about privacy in small communities, the cost involved in travelling to access distant services (in the context of lower rates of employment and lower incomes), poor digital connectivity and lower educational attainment. These factors all create barriers to rural people seeking mental health care.
Rural Australians are less likely to access MBS-funded primary mental healthcare services than their city counterparts, yet more likely to utilise state and territory community mental health services. They are also more likely to present to an emergency department with a mental health concern and, in remote and very remote areas, they are more likely to be admitted to hospital for a mental health problem. When rural Australians access hospital-based mental health care, they are less likely to receive specialised psychiatric services.
The National Rural Health Alliance believes there is a lack of alignment between population need and access to primary mental health care outside of major cities. This results in a shift of care to more acute parts of the health system, where people are likely to present later in the trajectory of their illness or condition, with more severe symptoms. A lack of access to, and utilisation of, primary mental health care in rural areas not only costs the health system more in the long term but is likely to contribute to poorer outcomes for rural communities. A lack of access to specialised psychiatric services when admitted to hospital also has the potential to result in poorer outcomes for rural Australians.
The altered pattern of mental health service utilisation in rural Australia is related, in part, to the lack of an appropriate health workforce. In general, the health workforce reduces with increasing remoteness and is disproportionate to increasing need. The general practitioner workforce – the gateway to mental health care in Australia – is lowest in small rural towns, and remote and very remote areas. The mental health workforce (for example psychiatrists, psychologists and mental health nurses) in rural Australia is very limited, generally also reducing with remoteness.
The 2022 Rural and Remote Mental Health Symposium, convened in Adelaide in November 2022 by the Australian and New Zealand Mental Health Association, provided a forum for health practitioners, researchers, policymakers, consumers and other interested parties to share insights into how to improve the mental health and wellbeing of rural people and communities. Various interventions were presented that aimed to ensure those in rural areas with poor mental wellbeing were assisted to recognise their situation and employ appropriate strategies or connect with services.
Workforce innovations were highlighted, including work by the Royal Australian and New Zealand College of Psychiatrists to develop a rural training pathway, and an example of integration of peer workers with lived experience of mental illness into the public health system in rural Western Australia. The consumer perspectives reminded us that access alone is not enough – we must ensure the services meet the needs of those who require them.
More information on mental health in rural Australia can be found on the National Rural Health Alliance website: