Remoteness and issues in mental health care: experience from rural Australia.

Abstract

The island continent of Australia is the sixth largest country in the world (approximately 8 million square kilometres), larger in size than Western Europe, yet low in population density. 70% of the 20 million people are concentrated in capital cities and major metropolitan areas, mainly in urban coastal regions. This is in contrast to countries with vast rural populations such as India and China. The remaining six million (30%) people are scattered inland in areas referred as rural, the bush, the outback, and in remote areas often difficult to access and provide mental health care. Problems of distance and communication have led to inequities in health provision to rural and remote Australians, many of whom are Aboriginals and Torres Strait Islanders. The majority of health service providers are concentrated in the large cities and it is difficult for remote communities to recruit and retain health practitioners. The Aboriginal and Torres Strait Islander population suffer a morbidity and mortality rate that is far higher than that for other Australians. In addressing these health inequities, rural and remote mental health is emerging as a national priority in Australia with lessons for other countries with considerable remote populations. This editorial focuses on issues relating to remoteness and mental health care in these areas, based on impressions from rural and remote Australia. Why should we consider remote populations as conceptually ‘special’? Remote communities in Australia have small groups of people, vast areas; changing socioeconomic situations; unpredictable ecological issues (fire, drought, flood, salinity); lack of facilities; outmigration (i.e. younger people move to larger towns in