Australia needs more occupational therapists in rural mental health services.

Abstract

Mental health has been an Australian national priority since 1996 with the health of Australians living in rural and remote regions needing particular attention (AIHW, 2014). Recent government initiatives such as the ‘Mental Health Services in Rural and Remote Areas’ (Commonwealth of Australia, 2015) identify allied health as an essential service and offer strategies to increase access. The needs are immense. Some factors influencing the mental health of rural and remote Australians are at a global level but with local impacts: climate change is proposed to relate to the increased number of natural disasters being experienced in rural areas including enduring droughts, and the increased occurrence of floods and cyclones. Changed international and national economic conditions also affect rural and remote communities. These factors place enormous stress on individuals and communities living outside urban areas and can put mental health at risk. High rates of suicide for young males living in remote Australia (Kolves, Milner, McKay & De Leo, 2012), substance abuse particularly involving alcohol and methamphetamine (Hodges, O'Brien & McGorry, 2007), and higher rates of mental illness for rural indigenous populations (Hunter, 2007) highlight the need for mental health services in these areas. But access to mental health services, particularly specialist services for rural people is extremely difficult – the rural mental health workforce is inadequate or absent and distances to the services that exist create cost and time barriers to care. There is a need to expand the Australian mental health workforce. The Australian occupational therapy profession must make rural mental health a high priority. The time is right. Mental health services in rural areas have been criticised as lacking capacity and vision to ensure high quality care, particularly for people with low prevalence disorders (Harris, 2005). There are also problems in recruitment and retention of allied health staff including occupational therapists to rural and remote areas. But many positive developments are underway and occupational therapists have much to offer rural people with mental health issues. The directive by the Commonwealth Government for mental health services to take a recovery-oriented approach (Australian Health Ministers Advisory Council, 2013), is an opportunity for occupational therapists. Recovery-oriented care compliments occupational therapy philosophy and frameworks. A recovery-oriented approach can transform mental health services as it requires them to be consumer centred (Shepherd, Boardman & Slade, 2008). Occupational therapists working with people with mental illness can instil a sense of hope of recovery and a focus on their strengths rather than the chronic symptoms of mental illness that impede occupational performance and participation. Assisting those with mental illness to return to productive and leisure occupations is an important aspect of recovery-oriented service provision. Apart from the tyranny of distance, and the additional time and cost this implies to access mental health services, people living in rural and remote areas also face additional barriers (Handley et al., 2014). These include: stigma, concerns relating to confidentiality and not wanting to be seen attending a mental health service. Rural community attitudes to coping and stoicism can also prevent people seeking help when services are present, particularly in early or preventative stages. There is a dearth of occupational therapists working in regional and rural mental health services. The role of mental health occupational therapy is not fully understood or appreciated in rural health services and usual rural workforce issues of low recruitment and poor retention are also evident (AIHW, 2014). To overcome workforce shortages, the following strategies are being implemented but could be expanded: Retention of mental health occupational therapists in rural settings also requires consideration. Support for early career occupational therapists through the provision of quality supervision and continuing professional development is often lacking in rural settings. While occupational therapists may take up generic mental health positions, similar to other professions such as psychology and social work, occupational therapists need discipline specific supervision and ongoing education. Occupational therapists should be confident and comfortable enough to request this no matter what their work setting is. The Australian Occupational Therapy Journal is doing its part to raise awareness of mental health as a practice and professional priority by releasing a themed special issue (Volume 62, Issue 5). This issue showcases research relating to mental health practice, and highlights the significant contribution occupational therapists make to the individuals, families and communities experiencing mental health issues. What part will you play?