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Mental health care and the tyranny of distance


Matt Woodley


16/12/2022 3:25:10 PM

People outside metropolitan cities face higher rates of suicide, worse mental health, and greater barriers to care, new research suggests.

Man at sunset on remote beach
The RACGP has responded to the findings by calling for more government support for general practice.

Patients encounter increasing disadvantages related to mental health care the further out of town they live, according to new research out of James Cook University.
 
The study, published in Australasian Psychiatry, found a 1% increase in distance from hospital was associated with a 0.37% decrease in bed days per person, while in Queensland and Western Australia, it was also associated with a 0.05% decreased incidence of admission.
 
Lead author Dr Andrew Amos, Chair of the Queensland Section of Rural Psychiatry, said Australians outside metropolitan cities have higher rates of attempted and completed suicide, worse mental health, and greater barriers to accessing mental health care.
 
‘Both community and hospital care are less available in rural locations, with private and NGO providers often operating at capacity, with limited ability to accept new patients and limited integration into public health networks,’ he said.
 
‘Our study aimed to estimate exactly how much of a barrier distance from the nearest mental health inpatient unit is to gaining access to hospital-based care and what sociodemographic factors came into play.
 
‘Our conclusion is that rural Australians face limited service provision and a reduced likelihood of admission to a mental health unit proportional to their distance from a hospital, in addition to a high mental illness burden and socioeconomic disadvantage.’
 
RACGP President Dr Nicole Higgins has responding to the findings by calling for more government support for general practice, describing GPs as crucial to improving mental health care outside of metropolitan areas.
 
‘More must be done to improve mental health outcomes in rural and remote areas,’ she said.
 
‘The solutions are right in front of us, we just need the political will to make it happen.’
 
Dr Higgins, who practises out of Mackay, said the college’s pre-Budget submission includes a series of timely reforms that would make an ‘enormous difference’ for people in rural and remote areas experiencing mental health issues.
 
‘We believe an increase Medicare rebates for longer consultations, the creation of a new Medicare item for GP consultations longer than 60 minutes, as well as support for longer telehealth phone consultations lasting more than 20 minutes, and increased investment in rural healthcare are all sorely needed to arrest the nation’s mental health crisis,’ she said.
 
‘Following the Budget, we warmly welcomed the $143.3 million investment in funding for healthcare in rural and remote areas, but we have a long way to go. By boosting Medicare rebates, we can support longer consultations so that GPs have the time to get the bottom of what is really going on.
 
‘As things stand, we have everything back to front, because patient rebates decrease the longer a person spends with their GP.’
 
RACGP Rural Chair Associate Professor Michael Clements echoed Dr Higgins’ comments.
 
‘We must do more to boost mental health care in the bush,’ he said.
 
‘GPs are often the first port of call for many people with mental health issues and outside of metro areas GPs play a particularly important role in helping these patients given there is often a dearth of other specialists including psychiatrists as well as psychologists.
 
‘Even if patients can obtain a referral and are willing to pay to see another specialist, they often face a long drive to access the services they need. That is why we must be given a helping hand to do even more to help those with mental health concerns, including in the rural and remote areas.’
 
Associate Professor Clements says GPs’ capacity to help is being limited by the fact that Medicare rebates have not kept pace with the cost of providing care and that there are only so many hours in a day.
 
‘If government is serious about arresting poor mental health outcomes in rural and remote areas, we must equip GPs to help those in need,’ he said.
 
‘Let’s get this done without delay, there is too much at stake to kick the can down the road.’
 
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