Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey

Abstract

BackgroundThe patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia.MethodsA stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables.ResultsThe overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose–response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services.ConclusionsAn examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.

Acknowledging Rural Disadvantage in Mental Health: Views of Peer Workers

“…The Obsessive Hope Report (Mendoza et al, 2013) identified people diagnosed with mental illness living in rural and regional areas as among the most vulnerable. This view is supported elsewhere with evidence of higher prevalence of significant mental health issues (Hauenstein, 2008;Perkins et al, 2013), less access to services than metropolitan areas, greater costs (Health Workforce Australia, 2013), and low rates of satisfaction when services are accessed (Hauenstein, 2008;Perkins et al, 2013).…”

Alcohol consumption in the Australian coal mining industry

“…Most mines operate 24 hours, 7 days per week, and employees often work long hours (ie, 12 hours or longer shifts),13 with rosters that are both rotating (work periods that consist of both day and night shifts)13 and compressed (a high number of shifts over consecutive days). Mines are often located in isolated regions, where employees are separated from family and social support networks, and the availability of professional support services is limited 14. Consequently, employees typically face challenges such as: long working hours, shift work, geographical isolation, limited contact with families and social supports, and a highly demanding role.…”

Lifetime Affective and Alcohol Use Disorder: Impact of Comorbidity on Current Functioning and Service Use in a Rural Population

“…In Australia, only 35% of respondents to the NSMHWB with mental disorders reported having consulted a health professional for their disorder in the 12-months prior to survey [17,18,39]. Despite being at a reputed geographical disadvantage in terms of service provision, our rural/remote participants reported higher rates of service utilisation for AD (75%) and comorbid AD+AUD (78%) over their lifetime.…”

“…Participants were selected for interview based on their level of psychological distress using Kessler 10 scores [26] in order to obtain a reasonable representation in each category of psychological distress. Interviews were offered to 100% of those with a high-range score (25+), 75% of those with a moderate-range score (16)(17)(18)(19)(20)(21)(22)(23)(24), and one-sixth of those scoring in the low range (10)(11)(12)(13)(14)(15). A total of 636 (73%) participants completed a WMH-CIDI-3.0.…”

“…The Australian Rural Mental Health Study found that 47% of rural and remote residents with estimated high service needs had not utilised any form of professional services [18]. Internationally, Hauenstein et al identified that residents of rural areas receive 47% less mental health treatment than metropolitan residents [19].…”