EDITORIAL

Abstract

This edition of the Australian Journal of Rural Health is a thematic issue with a special focus on rural mental health. In 1993, the Human Rights and Equal Opportunity Commission’s Human Rights and Mental Illness report (The Burdekin Report) focused public attention on many mental health problems including those in rural areas. 1 Two chapters of that report presented findings regarding people in rural and isolated areas and Aboriginal and Torres Strait Islander people. They highlighted issues including the distribution of services, difficulties for health professionals and historical and cultural issues regarding Aboriginal and Torres Strait Islander people. More recently, The Burden of Disease and Injury in Australia report found that mental illness is a major cause of morbidity and disability. 2 To date, there is little available research evidence detailing mental health morbidity and mortality patterns in rural and remote areas. As everywhere, environmental and cultural factors are likely to be key determinants of mental health in these areas. When asked, people in small rural communities describe a range of positive and negative aspects of the rural lifestyle that affect health and wellbeing. 3 Generally, however, they do not recognise the impact of the rural culture with its combination of close-knit communities emphasising mutual support, together with independence and self reliance. Often mental illness is seen as ‘weakness’ and those suffering more serious mental illnesses are stigmatised by the rural community. Three of the articles in this edition explore conceptual aspects of rural mental health. Wainer and Chesters 4 explore the distinction between mental illness and mental health in the rural context, drawing on historical perspectives and personal experiences of individual case examples. Subsequently, they describe the determinants of positive mental health in a rural context before concluding that there is a need for balanced social and economic developments as well as improved mental health services in rural and remote areas. Fuller et al. explore the ‘definition’ of mental health problems as perceived by people in rural and remote areas. 5 This research report confirms the reluctance of rural people to acknowledge mental health problems and the stigma associated with formal mental health services as well as the influence of rural and remote circumstances. The third conceptual article explores the gender roles and the emotional distress of women in urban, rural and remote areas of Queensland. 6 The study found that positive gender roles are more frequent in rural and remote areas and associated with lower levels of emotional distress. The authors’ conclusion is that an understanding of rural and remote mental health requires more sophisticated analysis than that based only on geographical location. The authors suggest that factors such as gender roles and other aspects of the rural culture may be important. Three of the articles are focused on clinical service delivery in rural and remote areas with a common emphasis on mutual support of rural health-care providers. Allison et al. evaluate a pilot clinical intervention in a rural setting. Their findings suggest that targeted short-term specialist interventions may often bring substantial improvements for mild to moderate mental health problems in rural and remote areas. 7 Malcolm, in her paper entitled A primary mental health-care model for rural Australia: Outcomes for doctors and the community, describes a successful mental health services delivery model with an emphasis on multidisciplinary teamwork in the rural setting. 8 Harvey describes the genesis and development of the rural psychologists’ network, which provides professional support and communication for counselling psychologists in rural and remote areas. 9 A recurring theme through several of the articles is the need for mental health service delivery models that are effective and successful in the context of rural community attitudes, geographically dispersed populations and serious workforce shortages. Local generalist nurses and doctors are the main providers of mental health care in small rural and remote communities. The quality and effectiveness of their services are likely to be enhanced where they are supported by distant specialist services and health-care providers. These specialist services and providers should fulfil a true consultant role, providing support, guidance and training to the on-the-ground practitioners in small communities. The final article in this thematic issue reports an initiative that is expected to assist workforce recruitment in the medium to long term. 10 The placement of nursing students in rural and remote mental health clinical attachments not only improves the students’ knowledge and understanding of rural and remote mental health issues, but is likely, in some cases, to raise the students’ interest in pursuing their careers in a rural setting. All the articles raise challenging questions that should stimulate considerable thought and discussion among readers. As always, letters to the editor responding to and debating issues raised by these articles are most welcome. I look forward to your comments.