Communities in rural Australia
Rural areas contain a diverse range of communities with differing mental health needs and health determinants. However, there are key ways in which the mental health picture in rural areas differs from that in urban settings.
Mental health epidemiology
The overall prevalence of mental illness is broadly similar in rural and urban Australia, but the suicide rate is considerably higher in rural areas, particularly among younger men, elderly men, and Indigenous people.
A large proportion of completed suicides involve a firearm – there is a higher rate of gun ownership in rural Australia – and suicide rates increase with the remoteness of the community.
Substance misuse rates are similar to those in urban areas, but alcohol misuse tends to be relatively more prevalent than in urban areas, and illicit drug misuse less so. Somatisation occurs at higher rates in rural areas.
A higher proportion of Indigenous people live in rural and remote areas of Australia, and Indigenous populations experience higher rates of psychiatric morbidity. This is especially true in the areas of depression, post-traumatic disorders and comorbidity (with either substance misuse or a physical condition). Rates of schizophrenia and bipolar disorders are similar to those in the non-Indigenous population, but suicide rates are on average three times higher.
Issues such as Government policy and legislation, the Stolen Generation, health and mental health morbidity, social determinants are all important. Indigenous patients may speak English as a second language.
The RANZCP’s Aboriginal and Torres Strait Islander mental health page addresses the issues specific to Indigenous people in more detail.
Availability of services
There is a shortage of health services of all kinds in rural areas of Australia, and particularly in specialist areas such as aged care and child psychiatry.
Small communities can provide a valuable source of support for their residents. However, the closeness of these communities can affect patients’ willingness to seek help and engage in treatment. The highly integrated nature of rural communities can also sometimes result in the exclusion of people who are seen as different or who are new to the community.
Important social structures in rural communities may include local sporting groups and service groups such as Rotary, Lions, Red Cross, the Country Women’s Association (CWA), and the Returned Services League (RSL).
The regional economy
In rural areas, the regional economy is a key influence on mental health. Events such as drought, flood and bushfire can have a heavy impact, especially in agricultural areas. The mental health consequences of regional economic recession can be long-lasting.
Like many countries, Australia has a trend of urbanisation, with young people moving to the cities and rural populations decreasing in size. Local businesses and services may be adversely affected by the decrease in population. The closure of a major local employer can have consequences for an entire community.
Distance and isolation
Social isolation as a result of distance is an important factor in the mental health and well-being of rural people. Geographic isolation can also affect access to mental health services: the closest mental health service may be several hours’ drive away.
A culture of self-reliance in rural areas can make people reluctant to seek help. Additionally, there can be considerable stigma attached to mental illness, even more so than in cities. Therefore, patients in rural areas are often less likely to report mental health problems.
The Royal Australian and New Zealand College of Psychiatrists has received Australian Government funding under the Specialist Training Program. This web page reflects the experience in Australia, however, the information may also be useful for psychiatrists and trainees working in New Zealand.