Integrated primary mental health care in rural and remote contexts : the Australian experience

There is a growing burden of disease nationally and internationally from mental illness, both as a stand-alone problem and also comorbid with the growing epidemic of chronic, non-communicable diseases. The advent of the COVID-19 pandemic in early 2020 and ongoing climate change sequelae have exacerbated these mental health risks exponentially, creating massive service delivery dilemmas globally. In many countries, people in regional and particularly rural and remote areas, bear a greater disease burden from mental health conditions, due largely to the unique stressors inherent in rural life and inequitable access to appropriate services. This chapter canvases these issues and includes a brief discussion of optimally integrated care, risk factors and needs specific to rural people, the impact of Indigeneity, the role of socioeconomic factors in general and mental health, and inequity of access to primary mental healthcare services. These factors are illustrated by focusing on Australia as a case study, exemplifying both generic characteristics and those unique to that country that are relevant to service delivery in rural areas. The chapter was accepted for publication prior to Australia’s worst bushfires on record (in the summer of 2019–2020), subsequent floods in early 2020, and the advent of the COVID-19 pandemic in February–March 2020 (ongoing). Most of the highlighted factors, however, remain the same – albeit greatly exacerbated by these extraordinary events. Information is provided in relation to the distribution of four relevant mental health specialties, with recommendations made – specific to Australia and also in the global context – with regard to optimally integrated primary mental health care. Across the settled world, there is a huge need to systematically roll-out integrated mental health services, using a number of modalities, to meet rural need. It is recommended that changes include: interprofessional education to facilitate team-based care; co-location of multidisciplinary primary healthcare teams; development and integration of culturally appropriate health services for Indigenous clients; mapping of required services in regional, rural, and remote areas; and optimal and strategic use of available funding and telehealth options. It is also strongly recommended that integration of lifestyle interventions be included in all mental health treatment, to facilitate optimal outcomes. These initiatives are now particularly pertinent, given the post-COVID “mental health pandemic” predicted by health experts globally