NACCHO Aboriginal Health Alert : Download @RoyalFlyingDoc Report : Looking Ahead: Responding to the Health Needs 2028 #Remote population stable, but chronic illness and #rural workforce shortage to jump over decade

“Chronic illness growth and rural workforce shortage is but a forecast.

Investing in country health services and rural health professionals can halt these forecasts from ever being realised.

Investing now will save lives and dollars in the long run.”

RFDS CEO Dr Martin Laverty called the report a call to arms.

Download the Report HERE

RFDS NACCHO_Looking_Ahead_Report_D3

  ” Indigenous Australians comprise approximately 2.8% of the total Australian population, although they comprise almost half the population in remote areas.

The RFDS notes the National Aboriginal Community Controlled Health Organisation (NACCHO) and its state-based organisations provide a pivotal service to rural and remote communities. NACCHO supports the Aboriginal Medical Service (AMS) which is a primary healthcare service operated by local Aboriginal communities.

The RFDS works in close partnership with many remote branches of the AMS, and respects and promotes the principle of community control “

 “The RFDS respects and acknowledges Aboriginal and Torres Strait Islander peoples as the first Australians and our vision for reconciliation is a culture that strives for unity, equity and respect between Aboriginal and Torres Strait Islander peoples and other Australians.

The RFDS is committed to improved health outcomes and access to health services for all Aboriginal and Torres Strait Islander Australians, and our Reconciliation Action Plan (RAP) outlines our intentions to use research and policy to drive this improvement.

RFDS research and policy reports, such as this one, include data on Aboriginal and Torres Strait Islander peoples as part of a broader effort to improve health outcomes and access to health services a contribution to the ‘Close the Gap’ campaign.”

RFDS Press Release

Australia’s remote population is forecast to grow only marginally in a decade. Yet chronic illness will rise dramatically, with the burden of mental illness forecast to increase by a fifth, if action is not taken to halt current trends.

Health service access in rural regions is also forecast to lag behind metropolitan areas, according to Royal Flying Doctor Service (RFDS) research: From 90 to 100: Planning for the health needs of country Australia in 2028. The report provides health service forecasts form 2018, the RFDS 90th year of operation until 2028, the centenary year of the RFDS.

The forecast shows while the Australian population will grow from 25 million to 29 million in a decade, remote and very remote Australia’s population will grow by an average of only 0.2% each year, from 493,752 to only 504,724 in 2028.

11.8 million Australians currently live with at least one chronic illness, with 2028 forecasts equalling 13.8 million, a national increase of 15.6%. Yet chronic illness prevalence forecast to remain higher in remote Australia than metropolitan areas.

Disability-adjusted life years (DALY), or the number of years lost to ill-health, disability or early death, are forecast to increase in remote areas over the decade to 2028 with:

  • cancer up by 15.6%, from 37.6 to 44 DALYs;
  • mental illness up by 21.6%, from 21.8 to 27.1 DALYs;
  • neurological conditions such as Alzheimers, up by 47.8%, from 13.2 to 21.5 DALYs.

A welcome fall of 22.8% in the burden of cardiovascular disease in remote Australia is forecast, from 37.6 DALYs down to 29.9 in 2028, reflecting improvement in heart attack prevention and treatment in parts of country Australia.

The report forecasts by 2028 remote Australia will have only:

  • a fifth the number of General Practitioners compared to metropolitan areas (43 compared to 255 per 100,000 population);
  • a twelfth of the number of physiotherapists (23 compared to 276 per 100,000 population);
  • half the number of pharmacists (52 as compared to 113 per 100,000 population);
  • and a third the number of psychologists (34 as compared to 104 per 100,000 population).

Nurse and midwifery levels in metropolitan and remote areas by 2028 are forecast to be almost even, with 1,361 per 100,000 population in city areas and 1,259 in remote areas.

A survey of rural clinicians published in the report finds health literacy, mental health services, and improved access to primary care services are priorities for the next decade. The report also forecasts growth in demand for RFDS services by its centenary year in 2028.

Looking Ahead: Responding to the Health Needs of Country Australia in 2028 is available here

NACCHO Aboriginal #MentalHealth and #Suicide : @RoyalFlyingDoc says mental health services in rural and remote Australia are in a state of “crisis”.

 “We see [more remote] people only accessing mental health services at … 20 per cent the rate of those who access services in the city.

If that’s not a crisis, I don’t know what a crisis is.

We provide 24-hour medical care to people in rural and remote Australia, but our doctors are finding themselves overwhelmed by the amount of psychological support they need to provide to their patients.

Last year the Flying Doctors saw 24,500 people to provide mental health counselling, but we could double or triple that service tomorrow and still not touch the surface,” .

The RFDS chief executive Martin Laverty said major disparities between country and city services still existed, despite numerous government reviews designed to address the problem

WATCH TV COVERAGE HERE

Read over 169 NACCHO Mental Health Articles published over past 6 years

Read over 119 NACCHO Suicide Prevention articles published over past 6 years

Fact 1   

“Roughly half the people the Flying Doctor cares for in our health or dental clinics or transports by air or ground are Indigenous.

“The Flying Doctor RAP, agreed with Reconciliation Australia, contains tailored actions for tangible improvements in the health of Aboriginal and Torres Strait Islander people.”

RFDS Website

Fact 2

Each year, around one in five, or 960,000, remote and rural Australians experience a mental disorder. The prevalence of mental disorders in remote and rural Australia is the same as that in major cities, making mental disorders one of the few illnesses that does not have higher prevalence rates in country Australia compared to city areas.

The Royal Flying Doctor Service says mental health services in rural and remote Australia are in a state of “crisis”.

Originally published ABC TV NEWS

Key points:

  • There are no registered psychologists in 15 of Australia’s rural and remote areas
  • “There should be no excuse in a country of universal access to healthcare,” RFDS CEO says
  • Mental health advocates are calling for a bigger financial commitment from the Government in this year’s budget

Data from the Department of Health showed the number of registered psychologists across the country increased in 2015/16. But there were no registered psychologists in 15 rural and remote areas.

Mr Laverty said areas like west coast Tasmania, central Australia, western Queensland and the Kimberley in Western Australia missed out.

“Areas where perhaps you’re not surprised to see that there aren’t health professionals in abundance,” he said.

“That should be no excuse in a country of universal access to healthcare.”

Mental Health Australia chief executive Frank Quinlan said doctors were not always the best people to provide mental health support.

“It is not necessarily the best way for us to be spending our resources — to have GPs with 10 years or more of training — delivering basic brief interventions and counselling interventions that could be delivered by other professionals and trained peer workers,” he said.

Suicide rates in rural areas are 40 per cent higher than in major cities, and in remote areas, the rate is almost double.

Mental health advocates call for greater commitment

The Coalition allocated $80 million for psychosocial support services in last year’s federal budget.

The program would help people suffering from severe mental illness — who are not eligible for the National Disability Insurance Scheme (NDIS) — find housing, education and better care.

But the Government will not release the money unless states and territories stump up funds too, and Mr Quinlan said that was yet to happen.

“That’s in spite of the fact that we know that with the roll-out of the NDIS and the roll-back of previous Commonwealth programs, people are already starting to fall into the gaps,” he said.

Health Minister Greg Hunt has acknowledged more assistance is needed for people in the bush.

“I do believe there is a very significant challenge and this is because there are four million Australians every year who have some form of mental health challenge and in the rural areas this is a significant challenge which is precisely why we are looking at additional services,” he said.

The Federal Government recently announced more than $100 million for the youth mental health service Headspace.

It is also spending $9 million improving tele-health services in rural areas.

But mental health advocates are calling for a bigger commitment to such initiatives in this year’s federal budget.

“The Minister — Greg Hunt — was relatively new to the ministry when the 2017 budget was released,” Mr Quinlan said.

“So I think the sector quite broadly and quite rightly, now, 12 months on, will be looking to the 2018 budget to see whether the Government is actually able to prioritise a lot of the concerns and issues that have been addressed.”

Federal Labor response ( added comment )

The Turnbull Government must break its silence over growing concerns about the quality of mental health services being delivered across Australia.

The Royal Flying Doctors Service is the latest organisation to raise the alarm about mental health service issues in rural and remote Australia. These comments today should be a wake-up call for Malcolm Turnbull.

It is vitally important the Turnbull Government gets this right. The mental health gap between the city and country is already too wide.

Today’s comments follow the Australian Medical Association’s position statement on mental health last week on the ‘gross’ underfunding of mental health services.

The Turnbull Government must prioritise greater funding for mental health services in the lead-up to the Budget.

Labor knows there is more work to be done to improve the mental health of all Australians and find ways to further reduce the thousands of lives lost to suicide each year.

It is only by working together that we will be able to finally reduce the impact of mental health issues in our society .

Mental health services need more than lip-service from Malcolm Turnbull and his Government.

For Help Contact your Nearest ACCHO

 

NACCHO Aboriginal Rural and Remote Health Research Alert : @RoyalFlyingDoc Health Care Access in the bush Survey

 

” The RFDS survey of country health consumer priorities was released 100 years to the day since the first patient was treated by a pioneering doctor in Western Australia, leading to the founding of the RFDS which is now recognised as Australia’s most reputable charity.

The survey of 450 country people drawn from every state and territory saw one-third of responses (32.5%) name doctor and medical specialist access as their key priority. Addressing mental health (12.2%) and drug and alcohol problems (4.1%) were second and third priorities

Around seven million Australians who reside in remote and rural areas.

Of these, more than half a million live in either remote, or very remote, areas of Australia. Aboriginal and Torres Strait Islander (Indigenous) Australians are overrepresented in remote and very remote areas—almost half (45%) of all people in very remote areas and 16% in remote areas are Indigenous Australians, compared with a 3% Indigenous representation in the total population

The research paper “Health Care Access, Mental Health, and Preventative Health; Health Priority Survey Findings for People in the Bush

DOWNLOAD COPY HERE

RN032_Healths_Needs_Survey_Result_P1_U0FsohZ

Extract : 4.2.4 Indigenous health issues

Few respondents identified Indigenous health issues as important.

This was disappointing since across all remoteness areas, Indigenous Australians generally experience poorer health than non-Indigenous Australians (Australian Institute of Health and Welfare, 2014) in relation to chronic and communicable diseases, mental health, infant health, and life expectancy (Aboriginal and Torres Strait Islander Social Justice Commissioner, 2005).

However, this result is unsurprising considering the very low proportion of respondents who were Indigenous.

Indigenous Australians are five times as likely as non-Indigenous Australians to die from endocrine, nutritional and metabolic conditions such as diabetes, and three times as likely to die from digestive conditions (Australian Institute of Health and Welfare, 2015b).

Age-adjusted data demonstrated that in 2014–2015 Indigenous Australians were more than twice as likely as non-Indigenous Australians to be hospitalised for any reason (Australian Institute of Health andWelfare, 2016b).

Indigenous Australians are twice as likely as non-Indigenous Australians to be hospitalised for an injury (Australian Institute of Health and Welfare, 2015a), and 1.8 times as likely to die from an injury than non-Indigenous Australians (Henley & Harrison, 2015).

Indigenous Australians are three times as likely to die from chronic lower respiratory diseases and twice as likely to die as a result of self-harm (suicide) than non-Indigenous Australians (Australian Bureau of Statistics, 2016).

Compared to non-Indigenous Australians, Indigenous Australians demonstrate higher age standardised death rates for a number of illnesses and injuries (Australian Institute of Healthand Welfare, 2015c).

Indigenous Australians also experience higher prevalence rates of communicable diseases compared with non-Indigenous Australians, including shigellosis (2.6 times greater), pertussis (whooping cough) (54.3 times greater), and tuberculosis (6 times greater) (Abdolhosseini, Bonner, Montano, Young, Wadsworth, Williams, & Stoner, 2015).

Similarly, life expectancy is lower and mortality rates are higher among Indigenous Australians compared to non-Indigenous Australians.

In 2010–2012, the estimated life expectancy at birth was 10.6 years lower for Indigenous males (69.1 years) compared to non-Indigenous males (79.7 years) and 9.5 years lower for Indigenous females (73.7 years) compared to non- Indigenous females (83.1 years) (Australian Institute of Health and Welfare, 2015c).

Fatal burden of disease studies have also demonstrated the existence of health inequalities— the fatal burden of disease and injury in the Indigenous population is estimated to be 2.6 times that experienced by non-Indigenous Australians, with injuries (22%) and cardiovascular disease (21%) contributing the most to the fatal  burden of disease for Indigenous Australians (Australian Institute of Health and Welfare, 2015b).

Press Coverage : Rural and remote Australians remain deeply concerned about poor access to healthcare, and want the Federal Government to spend more to fix the problem.

That is the key finding from the latest Royal Flying Doctor Service (RFDS) research, released last week as reported ABC

The RFDS surveyed more than 450 country Australians, and one-third nominated access to doctors and specialists as their single biggest healthcare concern.

A third of respondents called for more government funding of services, particularly for mental health and preventative care.

RFDS chief executive Martin Laverty said it raised a question for governments as to whether policies aimed at bridging that gap had failed.

“We have an oversupply of doctors in this country; the problem is, the doctors are simply not all working in areas where they’re most needed,” he said.

“It brings into question the success of repeated programs of Commonwealth governments to encourage doctors to work in remote and country Australia.

“The question for government is, are our incentives for doctors sending them to where they’re most needed?”

Access to doctors in remote areas a challenge

The survey found encouraging news in other areas.

Two-thirds of respondents said they needed to travel for one hour or less to see their GP or another non-emergency medical professional.

But for Australians living in more remote places, a visit to the doctor could mean a 10-hour round trip or more.

RFDS chief medical officer in Queensland Abby Harwood said governments could do other things to improve their access to care beyond putting more bodies on the ground.

“There is a lot of telephone and email consultation going on between people out bush and their GPs, but that requires actually having a pre-existing relationship with a healthcare provider who knows you,” she said.

“Technology such as video-conferencing is a fantastic opportunity, [but] currently the telecommunications infrastructure out in these areas is not quite sufficient to be able to do that reliably.”

GPs not paid by Medicare for teleconference consultations

Unlike specialists, who can bill Medicare for video-conferencing consultations with patients, GPs currently are not paid unless their patient attends a consultation in person.

Dr Harwood said that meant GPs who assisted remote patients over the phone or by teleconference were doing so on their own time and usually out of their own pocket.

“From my experience, most of us would just do it [for free] out of the service that we provide,” she said.

“At the moment it’s either the healthcare provider doing it for free, or the person accessing the GP is paying for it out of their pocket with no subsidy.

“When you consider the petrol bills, how much it costs in fuel to drive a 1,000km round trip, a lot of them would rather pay out of their own pocket to do that [if the doctor is not already doing it for free].”

Dealing with issues before crisis point

Dr Harwood seconded the call for a greater focus on preventative care for rural and remote patients, who were too often only dealing with medical issues once they had reached crisis point.

She said changing that made medical and economic sense.

“[When there’s a crisis] a patient then has to travel in and out of their regional centre or capital city, which obviously causes a lot of disruption and it’s expensive,” she said.

“I don’t think anyone has actually measured the full cost to Australia as a country, taking into account that social dislocation and the economic disruption when people need to leave their properties, leave their workplace.

“It’s been proven over and over again that good primary health care, delivered to people out there on the ground, can often prevent those crises from happening.”

 

Significant boost in GP numbers ‘in all areas’

Assistant Minister for Health David Gillespie, who has responsibility for regional health issues, is on leave.

But in a statement, a federal Department of Health spokeswoman said there had been a significant boost in GP numbers “in all areas of Australia” over the past decade.

“A 2017 budget announcement included funding of $9.1 million over four years from 2017-18 to improve access to mental health treatment services for people in rural and regional communities,” the statement read.

“Currently, Medicare provides rebates for up to 10 face-to-face consultations with registered psychologists, occupational therapists and social workers for eligible patients under the Better Access initiative.

“From 1 November 2017, changes to Medicare will take effect so that seven of the 10 mental health consultations can be delivered through online channels [telehealth] for eligible patients, that is, those with clinically diagnosed mental disorders who are living in rural and remote locations.

“Relevant services can be delivered by clinical psychologists, registered psychologists, occupational therapists and social workers that meet the relevant registration requirements under Medicare.”

NACCHO Aboriginal Mental Health : Download report “Mental health in remote and rural communities “

 ” The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

The relationship of remoteness to health is particularly important for Indigenous Australians, who are overrepresented in remote and rural Australia (Australian Institute of Health and Welfare, 2014a).

The National Mental Health Commission (2014a, p. 19) identified that “the mental health needs of Aboriginal and Torres Strait Islander people are significantly higher than those of other Australians.”

Photo above

“ The women of Inkawenyerre, a small settlement in the Utopia community four hours by road north of Alice Springs, regularly take part in a different kind of mental health therapy, known as ‘narrative therapy.’

Narrative therapy taps into the centuries-old tradition among Aboriginal people of story-telling and expression through art. At the family Urapuntja Clinic, both women and children take part in narrative therapy.

They recreate what is commonly seen on any given evening in an Aboriginal community—people sitting around the fire, relating to one another and telling stories.

The activity is enjoyable for participants with group members often laughing and supporting one another as they tell stories and work on their painting—all while promoting good mental health living practice,”

Lynne Henderson, former RFDS Central Operations mental health clinician.

“People who live in the country get less access to care. And they become sicker,”

To increase the access to care, the RFDS said it needed a massive increase in funding. Country Australians see mental health professionals at only a fifth the rate of those who live in the city,

So there should be a five-fold increase in access to mental health care for country Australians.”

RFDS CEO Martin Laverty see story Part 2 below

Mental health in remote and rural communities

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the Royal Flying Doctor Service (RFDS), but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

Download the report HERE

RN031_Mental_Health_D5

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

AHCRA believes that’s something that everyone should be concerned about, with access to care regardless of location.

 

Part 1  Indigenous mental health and suicide

Data from the 2011 Australian Census demonstrated that 669,881 Australians, or 3% of the population, identified as Indigenous (Australian Bureau of Statistics, 2013b), and that 142,900 Indigenous Australians, or 21% of the Indigenous population, lived in remote and very remote areas (Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

Around 45% of people in very remote Australia (91,600 people), and 16% of people in remote Australia (51,300 people) were Indigenous (Australian Bureau of Statistics, 2013b; Australian Institute of Aboriginal and Torres Strait Islander Studies, 2014).

In 2011–2012 around one-third (30%) of Indigenous adults reported high or very high levels of psychological distress—almost three times the rate for non-Indigenous Australians (Australian Bureau of Statistics, 2014).

In 2008–2012, in NSW, Queensland (Qld), WA, SA and the NT, there were 347 Indigenous deaths11 from mental health-related conditions (Australian Institute of Health and Welfare,

2015a). Specifically, age-standardised death data demonstrated that Indigenous Australians (49 per 100,000 population) were 1.2 times as likely as non-Indigenous Australians (40 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised deaths from mental and behavioural disorders increased with increasing age in both Indigenous and non-Indigenous Australians in 2008–2012.

Very few Indigenous and non-Indigenous Australians under the age of 35 years died as result of mental and behavioural disorders in 2008–2012. However, Indigenous Australians aged 35 years or older were more likely to die from mental and behavioural disorders than non-Indigenous

Australians in 2008–2012. Specifically, Indigenous Australians (7.2 per 100,000 population) aged 35–44 years were 5.7 times as likely as non-Indigenous Australians (1.3 per 1200,000 population) to die from mental and behavioural disorders (Australian Institute of Health and

Welfare, 2015a). In 2008–2012, Indigenous Australians (14.7 per 100,000 population) aged 45–54 years were 4.9 times as likely as non-Indigenous Australians (3.0 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

In 2008–2012, Indigenous Australians (18.3 per 100,000 population) aged 55–64 years were 2.7 times as likely as non-Indigenous Australians (6.9 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). In 2008–2012,

Indigenous Australians (91.2 per 100,000 population) aged 65–74 years were 2.9 times as likely

as non-Indigenous Australians (31.3 per 100,000 population) to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a).

Further exploration of death data from mental and behavioural disorders illustrates the significant impact of psychoactive substance use (ICD-10-AM codes F10–F19) on Indigenous mortality (Australian Institute of Health and Welfare, 2015a). In 2008–2012, 29.1% of Indigenous deaths due to mental and behavioural disorders were the result of psychoactive substance use, such as alcohol, opioids, cannabinoids, sedative hypnotics, cocaine, other stimulants such as caffeine, hallucinogens, tobacco, volatile solvents, or multiple drug use. During this period, Indigenous Australians (7.3 per 100,000 populations) were 4.8 times as likely as non-Indigenous Australians to die as a result of psychoactive substance use (Australian Institute of Health and Welfare, 2015a).

Similarly, in 2006–2010, there were 312 Indigenous deaths from mental health-related conditions (Australian Institute of Health and Welfare, 2013a). Indigenous Australians living in NSW, Qld, WA, SA and the NT were 1.5 times as likely as non-Indigenous Australians to die from mental and behavioural disorders in 2006–2010 (Australian Institute of Health and Welfare, 2013a).

11 Deaths from mental and behavioural disorders do not include deaths from intentional self-harm (suicide). Intentional self-harm is coded under ICD-10-AM Chapter 19—Injury, poisoning and certain other consequences of external causes.

Age-standardised death data demonstrated that Indigenous males (49 per 100,000 population) were 1.7 times as likely as non-Indigenous males to die from mental and behavioural disorders. Indigenous females were 1.3 times as likely as non-Indigenous females to die from mental and behavioural disorders (Australian Institute of Health and Welfare, 2013a).

The greater number of deaths from mental and behavioural disorders with age may also represent the impact of conditions associated with ageing, such as dementia. For example, in 2014, Indigenous Australians (50.7 per 100,000 population) in NSW, Qld, SA, WA and the NT were 1.1 times as likely as non-Indigenous Australians (45.3 per 100,000 population) to die from dementia (including Alzheimer disease) (Australian Bureau of Statistics, 2016a).

In 2014–2015, Indigenous Australians (28.3 per 1,000 population) were 1.7 times as likely as non-Indigenous Australians (16.3 per 1,000 population) to be hospitalised for mental and behavioural disorders (Australian Institute of Health and Welfare, 2016a).

In 2011–2013, 4.2% of Indigenous hospitalisations were for mental and behavioural disorders (Australian Institute of Health and Welfare, 2015a). Age-standardised data demonstrated that Indigenous Australians (27.7 per 1,000 population) were twice as likely as non-Indigenous Australians (14.2 per 1,000 population) to be hospitalised for mental and behavioural disorders in 2011–2013 (Australian Institute of Health and Welfare, 2015a).

In 2008–2009, Indigenous young people aged 12–24 years (2,535 per 100,000 population) were three times as likely to be hospitalised for mental and behavioural disorders than non-Indigenous young people (Australian Institute of Health and Welfare, 2011).

 

The leading causes of hospitalisation for mental and behavioural disorders amongst Indigenous young people were schizophrenia (306 per 100,000 population), alcohol misuse (348 per 100,000 population) and reactions to severe stress (266 per 100,000 population) (Australian Institute of Health and Welfare, 2011).

A preliminary clinical survey of 170 Aboriginal and Torres Strait Islander Australians in Cape York and the Torres Strait, aged 17–65 years, with a diagnosis of a psychotic disorder, was undertaken to describe the prevalence and characteristics of psychotic disorders in this population (Hunter, Gynther, Anderson, Onnis, Groves, & Nelson, 2011).

Researchers found that: 62% of the sample had a diagnosis of schizophrenia, 24% had substance-related psychoses, 8% had affective psychoses, 3% had organic psychoses and 3% had brief reactive psychoses; Indigenous Australians aged 30–39 years were overrepresented in the psychosis sample compared to their representation in the population (37% of sample versus 29% of population) with slightly lower proportions in the 15–29 years and 40 years and older age groups; almost three-quarters (73%) of the sample were male (versus 51% for the Indigenous population as a whole); Aboriginal males (63% in the sample compared to 46% for the region as a whole) were overrepresented; a higher proportion of males (42%) than females (5%), and Aboriginal (44%) than Torres Strait Islander patients (10%) had a lifetime history of incarceration; comorbid intellectual disability was identified for 27% of patients, with a higher proportion for males compared to females (29% versus 20%) and Aboriginal compared to Torres Strait Islander patients (38% versus 7%); and alcohol misuse (47%) and cannabis use (52%) were believed to have had a major role in the onset of psychosis (Hunter et al., 2011).

In 2015, Indigenous Australians (25.5 deaths per 100,000 population) in Qld, SA, NT, NSW and WA were twice as likely as non-Indigenous Australians (12.5 deaths per 100,000 population) to die from suicide (Australian Bureau of Statistics, 2016b). In their spatial analysis of suicide, Cheung et al. (2012) concluded that higher rates of suicide in the NT and in some remote areas could be explained by the large numbers of Indigenous Australians living in these areas, who demonstrate higher levels of suicide compared with the general population.

The poorer mental health of remote and rural Indigenous Australians is also impacted by the social determinants of Indigenous health, which are well recognised nationally and internationally.

These relate to the loss of language and connection to the land, environmental deprivation, spiritual, emotional and mental disconnectedness, a lack of cultural respect, lack of opportunities for self-determination, poor educational attainment, reduced opportunities for employment, poor housing, and negative interactions with government systems

Part 2 Flying Doctors fight barriers to treat mental illness in rural Australia

Source ABC

Like so many in the bush, Brendan Cullen has a lot on his plate.

He manages a 40,000-hectare property south of Broken Hill. There are 8,000 sheep to keep track of. And that’s just a fraction of the number he looked after previously at another station.

A few years ago, the mustering, the maintenance, juggling bills and family — it all caught up to him.

“You just bottle stuff up. And sometimes you can’t find an out,” he said.

“In the bush you have a lot of time by yourself.”

He spent a lot of that time thinking about his problems. But Mr Cullen was lucky.

He heard about a mental health clinic being run by the Royal Flying Doctor Service (RFDS) in a nearby community and decided to go along.

“Catching up with one of the mental health nurses gave me the tools to be able to work out how I go about living a day-to-day life,” he said.

“My life’s a hell of a lot easier now than what it used to be.”

Mental health disorders are not more common in rural and regional Australia than they are in Australia’s cities, according to a new report from the RFDS, but they are a lot harder to treat.

The report, Mental Health in Remote and Rural Communities, found about one in five remote and rural Australians — 960,000 people — experience mental illness.

But a combination of lack of access to facilities, social stigma, and cultural barriers present challenges to getting people the help they need.

“People who live in the country get less access to care. And they become sicker,” RFDS CEO Martin Laverty said.

To increase the access to care, the RFDS said it needed a massive increase in funding.

“Country Australians see mental health professionals at only a fifth the rate of those who live in the city,” Mr Laverty said.

“So there should be a five-fold increase in access to mental health care for country Australians.”

The impact of distance and isolation when it comes to treating mental disorders can be seen in suicide rates. In remote Australia, the rate is nearly twice what it is in major metropolitan areas — 19.6 deaths per 100,000 people.

The suicide rate is even greater in very remote communities.

If you or anyone you know needs help:

The RFDS has responded by increasing its mental health outreach. In communities like Menindee, about an hour’s drive from Broken Hill in the far west of New South Wales, a mental health nurse is on call once a fortnight.

“I have needed them in the past. I got down to rock bottom at one stage. Even now I appreciate that support,” Menindee resident Margot Muscat said.

Ms Muscat plays an active role in the remote community. But she has also felt pressure in the past to manage that role, her work, and family commitments.

Mental health counselling has given her a valuable outlet.

“Just to know that I wasn’t alone. And that you don’t have to take the drastic step of suiciding, so to speak,” Ms Muscat said.

Some the RFDS’s mental health counselling is done over the airwaves. From its regional base in Broken Hill, mental health nurse Glynis Thorp counsels patients over the phone. Often calls are simply people checking in.

“It’s critically important…often there might only be two people on the property. So no one to talk to maybe,” she said.

“We might get out to a clinic every fortnight, but we might have follow up phone calls to check how people are going. For myself it’s probably a ratio of four to one.”

The RFDS report reveals every year hundreds of serious mental illness incidents require airplanes to be dispatched to remote areas to fly patients out for treatment.

Over three years from July 2013 the RFDS conducted 2,567 ‘aeromedical retrievals’.

The leading causes for evacuation flights due to mental disorder are

The RFDS also uses airplanes to carry its mental health nurses to very remote areas. On a typical day in Broken Hill, the medical team takes off just after dawn to head to three communities hundreds of kilometres away: Wilcania, White Cliffs and Tilpa.

In the opal mining town of White Cliffs, the mental health nurse sees patients at the local clinic. One is “Jane”, who doesn’t want her full name used.

“Without them, we would really be lost here,” she said.

Jane has been counselled by the RFDS and was recently directed to mental health treatment in Broken Hill. But she’s still reluctant to talk openly in town about the help she’s getting.

“In a small community it’s not wise to talk to other people in town,” she said. “And mental health, it does carry a stigma.”

Back on his station south of Broken Hill, Mr Cullen believes that stigma over mental health is slowly changing in the bush.

“People get wind that someone’s had a mental health problem, people talk now. As opposed to, let’s go back five years even, 10 years. It was a closed book,” he said.

“With these clinics, once upon a time you might have had a dental nurse, a doctor, and the like.

“But now you have a mental health nurse…And these clinics are close by. So you’re able to go to them. They come to you.”

NACCHO Aboriginal Health Workforce #NRW2017 : @RoyalFlyingDoc Strengthening Indigenous health workforce will help #ClosetheGap

“Cultural safety and removal of racism in health care can be achieved by supporting Indigenous health care students and graduates to become the health system leaders of tomorrow.”

Royal Flying Doctor Service of Australia (RFDS) CEO Martin Laverty

Minister for Indigenous Health, the Hon Ken Wyatt, yesterday  launched a new partnership of the RFDS with

  • The Australian Indigenous Doctors Association (AIDA),
  • The Congress of Aboriginal and Torres Strait Islander Nurses  and Midwives (CATSINaM),
  • Indigenous Allied Health Australia (IAHA)

to deliver the RFDS Indigenous Health Scholarship Scheme.
RFDS scholarships will support Indigenous students undertaking remote or rural clinical placements in medicine, nursing, midwifery and allied health.

Minister Wyatt announced  the first recipients as:

• Ms Amanda Robinson, for medicine;
• Mr Tim Haynes, for medicine;
• Amanda Bailey, for allied health;
• Amy Thompson, for nursing/midwifery;
• Jennifer Mairu, for allied health.

Tim, member of AIDA receiving his scholarship. Tim is heading to Cairns, Alice and Broken Hill.

AIDA CEO Craig Dukes said “The RFDS Indigenous health scholarship provides great opportunities for AIDA members to undertake placement in rural and remote areas.

On behalf of AIDA I congratulate recipients, Ms Amanda Robinson and Mr Tim Haynes and thank the RFDS for their continued support towards career opportunities for Aboriginal and Torres Strait Islander doctors. This experience for Ms Robinson and Mr Haynes contributes not only towards their own professional development, and to the broader goal we all share to create a culturally safe health care system.”

CATSINaM CEO Janine Mohamed said “We would like to thank the RFDS for the funding to not only assist with the implementation of their Reconciliation Action Plan, but also to help us grow the Aboriginal and Torres Strait Islander nursing and midwifery professions. The clinical placement experience will afford the students with insight into what it means to live and work in rural and remote Australia, which we hope is a direction they pursue once they graduate.”

Amanda, member of IAHA receiving her scholarship. Amanda moves from nursing into OT, congratulations

IAHA CEO Donna Murray said “The RFDS scholarships will provide much needed support for allied health students to undertake a rural or remote clinical placement which is critical for developing the Aboriginal and Torres Strait Islander allied health workforce. This is also an important step in further supporting locally driven workforce development models that provide culturally safe and responsive allied health services with Aboriginal and Torres Strait Islander people.”