Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey
1 Centre of Research Excellence in Rural and Remote Primary Health Care and Department of Rural Health, University of Sydney, Broken Hill, NSW, Australia
2 School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
3 Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia
4 Mental Health Services, Hunter New England Local Health District, Newcastle, NSW, Australia
5 Centre for Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
6 Hunter Medical Research Institute, Newcastle, NSW, Australia
7 Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW, Australia
8 Mental Health and Drug & Alcohol Office, NSW Health, Sydney, Australia
9 Department of Health, Northern Territory Government, Darwin, Australia
10 Mental Health and Drug and Alcohol, Western NSW Local Health District, Dubbo, NSW, Australia
11 Mental Health Services, Northern NSW Local Health District, Lismore, NSW, Australia
BMC Health Services Research 2013, 13:157 doi:10.1186/1472-6963-13-157Published: 30 April 2013
The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia.
A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables.
The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose–response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services.
An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.