Mental Health Services in Rural and Remote SA – Overcoming Barriers to Access and Support

A range of community services are available for people living, working or travelling in rural and remote South Australia. These include telehealth and a variety of local support services.

Participants in three rural and remote regions of SA were asked to complete a computer-assisted telephone interview about their perceived barriers to seeking help for either a mental or physical health condition.

What is mental health?

Mental health is your ability to cope with and adapt to challenges, and it includes how you feel, think, learn and communicate. It is important for your general wellbeing and enables you to function at work, school and at home.

People with a mental health condition can live happy, productive and fulfilling lives. Treatment options can include a combination of medications, psychotherapy (such as individual, group and family therapy), support groups and community activities that promote recovery.

There are many factors that can affect your mental health, including: genetics, lifestyle and environment, traumatic events, stress and lack of sleep. It is important to recognise that your mental and physical health are closely linked, with positive emotions helping you to maintain a healthy lifestyle, which can reduce the risk of developing serious conditions such as heart disease, diabetes, and chronic illnesses like arthritis.

Serious mental illness, such as depression or bipolar disorder, can lead to distress and problems functioning in social, family and work activities. It is important to understand that having a serious mental illness is not your fault or due to any weakness of character, and most people who have a severe mental illness can be helped with treatment.

Talking about how you are feeling is important to your mental health, but it can be hard to do so when someone you know has a problem. You can get help by talking to a friend or relative, a teacher or pastoral care worker, a GP or call the mental health triage service 24/7 on 13 14 65.

You can also access specialist services via telehealth – more than 220 video conferencing units across the Digital Telehealth network in rural and remote South Australia provide telepsychiatry and telemedicine. These services can be more convenient and time efficient than travelling to Adelaide. Telehealth is available to all country South Australians, regardless of their location or income.

The mental health of country South Australians is often overlooked, with a Minister for Regional Roads and a Minister for Rural Health, but no minister for mental health or for remote and rural SA. In addition, there is a high level of competition between GPs and local health networks for funding and staffing. This can lead to delays in getting the right care at the right time.

How can I access mental health services?

People living in rural and remote areas can access a range of mental health services provided by both government and non-government organisations. These services are delivered through community health centres, hospitals and by consumers in their own homes. GPs can also make referrals to specialist mental health services. A number of free services are available to people in rural and remote Australia, including the Country SA PHN regional access phone line, which can provide up to three face-to-face sessions with a psychologist with a priority referral.

Despite the efforts to increase access to mental health services, barriers remain. The lack of mental health workforce in rural Australia is a significant factor, and the rate of help-seeking for mental illness is lower than that for physical ailments. Moreover, rural women and men report different barriers to seeking support for their health issues.

The Rural and Remote Psychiatry Workforce Strategy Review (RRPSW) has identified 30 recommendations to improve the mental health care system in rural and remote South Australia. These include increasing funding and training pathways, changes to governance and oversight, and setting up mental health beds outside of Adelaide. In addition, it suggests perks such as extra professional development leave and financial support for psychiatrists who relocate to the regions. The state government has accepted 23 of the 30 recommendations, and is considering the rest.

Research is needed to identify and address the barriers that prevent people from using mental health services in rural and remote Australia. Future studies should focus on older adults with mental health needs and explore what barriers they perceive when engaging in service use. They should also identify and compare the barriers that rural and urban people experience when seeking help for their mental health.

It is important to recognise that many of the barriers to service use are associated with poverty and social disadvantage. This is particularly true for Indigenous Australians, who have experienced significant social and historical disadvantage. As a result, they have higher rates of mental illness and other health problems, and are less likely to seek help.

What are the mental health services available in my area?

Despite the fact that people living in rural and remote communities have higher mortality rates, poorer mental health outcomes (as evidenced by their higher suicide rates) and higher prevalence of chronic diseases than metropolitan Australians, they are often less likely to access services. They also experience barriers to service use and have lower levels of social support and more limited economic resources. This is largely due to the lack of community-based mental health services, funding restrictions and the cost of travel.

In response to these challenges, the Country SA Primary Health Network has a range of free mental health services that are delivered to consumers at their local health centres and in their homes via telehealth. The Mental Health Triage Service operates 24 hours a day, seven days a week and can provide referrals for face-to-face services with an appropriately trained counsellor. It is accessible by calling 1800 002 222 or visiting their website.

There is a growing body of research demonstrating that telehealth interventions are equally effective in terms of outcomes and practitioner/client satisfaction as face to face appointments. In addition to reducing costs of travel, telehealth appointments can be made more quickly, preventing consumers from having to wait for a visit or take time off work. Increasingly, local practitioners are using telehealth for appointments, so that they can remain in the community and still be available to their clients.

However, the lack of available services and the high cost of accessing health care in rural and remote areas are significant barriers to service use. Further, many Indigenous Australians experience poor mental health and a lack of culturally appropriate health services. They are also more likely to be affected by socioeconomic disadvantage, which contributes to the intergenerational transmission of poor mental health and wellbeing.

This study used a mixed methods approach to explore perceived barriers to help-seeking among rural and remote South Australians. It recruited 208 people who had accessed a mental health service in one of the three country SA regions for the purpose of computer assisted telephone interviews. Participants were randomly selected from the White Pages electronic phone directory (non-commercial) and were asked to answer questions about their demographics, perceived barriers to help-seeking, personal factors and their use of a mental health service.

How can I get help?

A key challenge facing remote and rural Australia is how to support the mental health of residents. Despite high rates of mental illness, many people are still reluctant to seek help. This is often due to a combination of structural and attitudinal barriers, including perceptions of long wait times for services and the perceived lack of availability of appropriate treatments.

In response, a range of new services have been launched to make it easier for rural and regional residents to access specialist support. These include a 24/7 remote health monitoring service that allows patients to check their own vital signs, and connect with nurses or doctors who can assess the results ‘live on screen’.

The monitoring service is available to rural and regional South Australians with a GP referral and can be accessed via the internet or by phone. There are also a number of local community-based services including multipurpose services and the Country Referral Unit, which can connect people with the right support in their area. Healthdirect’s service finder is a good place to start and can help you find the services closest to you.

Other important supports for rural and regional SA residents are the GP services and community mental health services in hospitals and clinics, and through your general practitioner who can make referrals to other specialists. You can also call the Head to Health free phone service for advice, guidance and information about how to keep your mind healthy or get help with a problem, or visit a headspace centre in your area.

SA Health has a comprehensive network of public mental health services for children, adolescents and adults in rural communities. If you need help, talk to your GP, or contact the Rural and Remote Distance Consultation and Emergency Triage and Liaison Service (LETSS) on 13 14 65.

If you’re studying full time and are living in rural or regional SA, you may be eligible for a SA-HELP loan to pay some or all of your student services and amenities fee (SSAF). To apply, ask your higher education provider for a Request for SA-HELP loan form, which you must submit to them by the census date.