Mental health crises in the bush
The dearth of dedicated clinical mental health support and intervention services in remote Australia dissuades many people from seeking help until they are in crisis, according to research from the Royal Flying Doctor Service published by the Medical Journal of Australia.
According to the research, there is little difference in prevalence of mental illness between city and bush, yet poor service access, distance, cost and continued reluctance to seek help, all contribute to higher mental illness acuity and suicide rates.
A total of 2,257 patients were retrieved by the RFDS between July 1, 2014 and June 30, 2017 for treatment of mental or behavioural disorders. Of these, 62 per cent were males (1,394) and 38 per cent were females (863).
Sixty per cent of patients were under 40 years of age, 35 per cent identified as Indigenous Australians. Most retrieval sites were rural and remote communities with low levels of support for mental disorders.
The most frequent mental and behavioural disorders were schizophrenia (227 retrievals, 16.5 per cent), bipolar affective disorder (185 - 13.5 per cent), and depressive episodes (153 - 11.2 per cent).
Psychoactive substance misuse triggered 194 retrievals (14.2 per cent), including misuse of multiple drugs (85 - 6.2 per cent), alcohol (61 - 4.5 per cent), and cannabinoids (25 - 1.8 per cent).
The mean age of patients retrieved for treatment of substance misuse was 29.6 years, which was lower than for retrieved patients overall (37.0 years). Thirty-eight of 194 patients retrieved after psychoactive substance misuse were under 19 years of age.
Dr Fergus Gardiner, Director of Research and Policy with the RFDS, led the study and said the increasing number of retrievals for diagnoses of bipolar affective disorder in children under 14 years was unexpectedly high.
“This may reflect confusion of the symptoms of bipolar affective disorder with the acute behavioural manifestations of attention deficit/hyperactivity disorder, obsessive–compulsive disorder, conduct disorder, learning disorders, pervasive developmental disorders, and unipolar depressive disorders,” Dr Gardiner and colleagues wrote.
“Alternatively, it may reflect the context-specific nature of mental health-related retrievals of children from remote locations: a diagnosis of bipolar affective disorder may be perceived as more acceptable for initiating aeromedical retrieval.
“The high number of bipolar affective disorder diagnoses among retrieved children nevertheless warrants further investigation.”
The study concludes that due to the absence of access to local dedicated mental health support and intervention services, many patients seek clinical assistance only when in crisis. The availability of RFDS and non-RFDS mental health clinical support is lower in most of the retrieval communities than in major cities.
Published: 26 Aug 2019