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Aust. J. Rural Health (2014) 22, 271–272
Special Issue – Psychology in the Bush Editorial The health challenges facing rural people and communities in Australia: What can psychology offer? Much has been written about the challenges confronting rural and remote Australia. These challenges can operate at the individual level such as unhelpful health behaviours and high levels of physical and mental health problems, but also at the community level where a range of external pressures including climate change, changing economic conditions and natural disasters impinge on whole of community well-being. Health outcomes for rural and remote communities are reported to be poorer outside of metropolitan areas.1 Risk factors for many chronic diseases are also higher outside major cities with people living in rural and remote regions reporting high rates of cigarette smoking, risky levels of alcohol consumption and obesity.2 People living outside of major cities are also more at risk of motor vehicle accidents. Not only do people who live outside major cities have poorer health outcomes than city dwellers, but rural communities themselves have been described as dying, with a dwindling sense of autonomy and social cohesion.3 The difficulty in providing communities outside major cities with access to adequate services has been frequently cited as one of the reasons for the disparity in health outcomes between city and rural dwellers. For instance, on average, rural communities might not have equitable access to goods and services (including health services), educational and employment opportunities. Accordingly, significant research, policy and funding efforts have been devoted to rural health service delivery and particularly growing a rural health workforce. These efforts, however, have generally been directed at enhancing a health workforce that can provide treatment rather than one that can operate on the multiple upstream determinants of rural health status. Although there is no doubt that health services need to provide effective treatment, the data points to a central role for lifestyle factors and external events in the health outcomes of rural individuals and communities. Behavioural and lifestyle factors as well as the capacity to cope with external stressors over which one often has little control are issues that are not easily addressed by a treatment-focused health system. One of the health professions best equipped to understand and assist with behaviour change and coping, at both the individual and community level, is psychology. In Australia, psychologists are generally thought of as being a profession that is mainly involved in managing © 2014 National Rural Health Alliance Inc.
mental illness. The evidence certainly indicates that psychologists provide most of the evidence-based psychological interventions delivered to individuals under the Medical Benefits Schedule.4 However, current policy and funding options in Australia provide very few opportunities for people, particularly those in rural regions, to access a psychologist to assist them to change the unhealthy behaviours that are associated with chronic illness. Not only can psychologists play a role in preventing and helping rural people to live with and manage chronic illness, but psychological knowledge needs to play an increasing role in rural issues. For example, rates of smoking in outer regional and remote areas have stayed high despite a fall in smoking rates in major cities over the last 15 years.5 The reasons for this are unclear but are likely to include environmental and social factors associated with rural life. Clearly, applying the learnings from urban experiences to health promotion activities in rural contexts is not working. Research that seeks to understand the psychosocial and cultural aspects of rural life in order to construct targeted health promotion campaigns will be needed to tackle the high rates of smoking outside major cities. There is a growing evidence base that suggests that community interventions that draw on psychological knowledge can enhance community resilience, with highquality resources developed within Australia now available to support communities to become more resilient.6 Psychologists have also been involved in research on developing resilience after disasters. The Australian Psychological Society, the peak professional organisation for psychologists in Australia, has developed a national network of psychologists who have a special interest and expertise in working with individuals and communities affected by disasters and emergencies in Australia. Psychologists have been involved in collaborative, multidisciplinary work on environmental issues in Australia and internationally for decades. There is strong consensus among psychologists and other scientists that human motivations and behaviours constitute core causal factors with respect to environmental problems.7 Psychologists can contribute to rural communities by providing answers to questions about how people and organisations can change their behaviour to reduce the threats of climate change and helping individuals and communities adapt to the psychosocial impacts of climate change and threats. doi: 10.1111/ajr.12155
272
As indicated, psychologists play a key role in the prevention and management of mental illness and are the largest mental health profession in Australia. Like all the mental health professions, the majority of psychologists are employed in major cities, but there is evidence that the number of psychologists in rural and remote regions is increasing.8 Psychologists deliver evidencebased, cost-effective psychological treatments, especially for people with high-prevalence mental health disorders, but access to such services in rural and remote locations needs to be significantly improved. Australian government-funded programs such as Access to Psychological Services and Mental Health Services in Rural and Remote Australia have improved access, but Australia is yet to adequately embrace the use of technology to deliver such services. Despite the evidence for the efficacy of the delivery of psychological services via means other than face-to-face, there is no Medicare rebate available for people in rural and remote regions to see a psychologist via telehealth. Given that the skills of psychologists in working with behavioural and mental health issues, improving coping strategies and building community resilience are particularly applicable to the issues confronting rural Australia, it would seem prudent to make better use of psychologists and psychological knowledge in the bush. Unfortunately, psychologists have not benefitted from the government incentives to work and stay in rural regions that have been available for some time for medical practitioners and nurses. Despite the evidence for the use of grow-your-own strategies to develop the rural medical workforce, strategies such as quarantined places for rural students, supported entry for rural students, financial support and funding for rural training including rural placements have been limited for rural psychology students or those wishing to work in rural settings.
EDITORIAL
Implementing strategies to grow the rural and remote psychology workforce combined with effective and efficient use of the skills and knowledge of psychologists could help to address the health and well-being challenges confronting individuals and communities that are located outside the major cities in Australia. Louise Roufeil,1,2 Judith Gullifer,2 and Darryl Maybery3 1 Australian Psychological Society, 2 Charles Sturt University and 3Monash University
References 1 Australian Institute of Health and Welfare. Rural health. 2013. [Cited 3 Nov 2014]. Available from URL: http://www.aihw.gov.au/rural-health-impact-of-rurality/ 2 Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health status and determinants of health. 2008; AIHW cat. no. PHE 97. 3 Holden T, Bourke L. Rural community wellbeing. Rural Society 2014; 23: 208–215. 4 Australian Institute of Health and Welfare. Mental health services – in brief 2013. 2013; Cat. No. HSE 141. 5 Fact Sheet Smoking and Rural Health. Canberra: National Rural Health Alliance, 2014. [Cited 3 Nov 2014]. Available from URL: http://ruralhealth.org.au/content/fact-sheetsmoking 6 Hegney D, Ross H, Baker P et al. Building Resilience in Rural Communities Toolkit. Toowoomba, Qld: University of Qld/University of Southern Qld, 2008. 7 Australian Psychological Society. Position Paper: Psychology and Climate Change. Melbourne: Australian Psychological Society, 2010. 8 Health Workforce Australia. Australia’s Health Workforce Series: Psychologists in Focus. Adelaide, SA: Health Workforce Australia, 2014.
© 2014 National Rural Health Alliance Inc.
Copyright of Australian Journal of Rural Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Aust. J. Rural Health (2014) 22, 271–272
Special Issue – Psychology in the Bush Editorial The health challenges facing rural people and communities in Australia: What can psychology offer? Much has been written about the challenges confronting rural and remote Australia. These challenges can operate at the individual level such as unhelpful health behaviours and high levels of physical and mental health problems, but also at the community level where a range of external pressures including climate change, changing economic conditions and natural disasters impinge on whole of community well-being. Health outcomes for rural and remote communities are reported to be poorer outside of metropolitan areas.1 Risk factors for many chronic diseases are also higher outside major cities with people living in rural and remote regions reporting high rates of cigarette smoking, risky levels of alcohol consumption and obesity.2 People living outside of major cities are also more at risk of motor vehicle accidents. Not only do people who live outside major cities have poorer health outcomes than city dwellers, but rural communities themselves have been described as dying, with a dwindling sense of autonomy and social cohesion.3 The difficulty in providing communities outside major cities with access to adequate services has been frequently cited as one of the reasons for the disparity in health outcomes between city and rural dwellers. For instance, on average, rural communities might not have equitable access to goods and services (including health services), educational and employment opportunities. Accordingly, significant research, policy and funding efforts have been devoted to rural health service delivery and particularly growing a rural health workforce. These efforts, however, have generally been directed at enhancing a health workforce that can provide treatment rather than one that can operate on the multiple upstream determinants of rural health status. Although there is no doubt that health services need to provide effective treatment, the data points to a central role for lifestyle factors and external events in the health outcomes of rural individuals and communities. Behavioural and lifestyle factors as well as the capacity to cope with external stressors over which one often has little control are issues that are not easily addressed by a treatment-focused health system. One of the health professions best equipped to understand and assist with behaviour change and coping, at both the individual and community level, is psychology. In Australia, psychologists are generally thought of as being a profession that is mainly involved in managing © 2014 National Rural Health Alliance Inc.
mental illness. The evidence certainly indicates that psychologists provide most of the evidence-based psychological interventions delivered to individuals under the Medical Benefits Schedule.4 However, current policy and funding options in Australia provide very few opportunities for people, particularly those in rural regions, to access a psychologist to assist them to change the unhealthy behaviours that are associated with chronic illness. Not only can psychologists play a role in preventing and helping rural people to live with and manage chronic illness, but psychological knowledge needs to play an increasing role in rural issues. For example, rates of smoking in outer regional and remote areas have stayed high despite a fall in smoking rates in major cities over the last 15 years.5 The reasons for this are unclear but are likely to include environmental and social factors associated with rural life. Clearly, applying the learnings from urban experiences to health promotion activities in rural contexts is not working. Research that seeks to understand the psychosocial and cultural aspects of rural life in order to construct targeted health promotion campaigns will be needed to tackle the high rates of smoking outside major cities. There is a growing evidence base that suggests that community interventions that draw on psychological knowledge can enhance community resilience, with highquality resources developed within Australia now available to support communities to become more resilient.6 Psychologists have also been involved in research on developing resilience after disasters. The Australian Psychological Society, the peak professional organisation for psychologists in Australia, has developed a national network of psychologists who have a special interest and expertise in working with individuals and communities affected by disasters and emergencies in Australia. Psychologists have been involved in collaborative, multidisciplinary work on environmental issues in Australia and internationally for decades. There is strong consensus among psychologists and other scientists that human motivations and behaviours constitute core causal factors with respect to environmental problems.7 Psychologists can contribute to rural communities by providing answers to questions about how people and organisations can change their behaviour to reduce the threats of climate change and helping individuals and communities adapt to the psychosocial impacts of climate change and threats. doi: 10.1111/ajr.12155
272
As indicated, psychologists play a key role in the prevention and management of mental illness and are the largest mental health profession in Australia. Like all the mental health professions, the majority of psychologists are employed in major cities, but there is evidence that the number of psychologists in rural and remote regions is increasing.8 Psychologists deliver evidencebased, cost-effective psychological treatments, especially for people with high-prevalence mental health disorders, but access to such services in rural and remote locations needs to be significantly improved. Australian government-funded programs such as Access to Psychological Services and Mental Health Services in Rural and Remote Australia have improved access, but Australia is yet to adequately embrace the use of technology to deliver such services. Despite the evidence for the efficacy of the delivery of psychological services via means other than face-to-face, there is no Medicare rebate available for people in rural and remote regions to see a psychologist via telehealth. Given that the skills of psychologists in working with behavioural and mental health issues, improving coping strategies and building community resilience are particularly applicable to the issues confronting rural Australia, it would seem prudent to make better use of psychologists and psychological knowledge in the bush. Unfortunately, psychologists have not benefitted from the government incentives to work and stay in rural regions that have been available for some time for medical practitioners and nurses. Despite the evidence for the use of grow-your-own strategies to develop the rural medical workforce, strategies such as quarantined places for rural students, supported entry for rural students, financial support and funding for rural training including rural placements have been limited for rural psychology students or those wishing to work in rural settings.
EDITORIAL
Implementing strategies to grow the rural and remote psychology workforce combined with effective and efficient use of the skills and knowledge of psychologists could help to address the health and well-being challenges confronting individuals and communities that are located outside the major cities in Australia. Louise Roufeil,1,2 Judith Gullifer,2 and Darryl Maybery3 1 Australian Psychological Society, 2 Charles Sturt University and 3Monash University
References 1 Australian Institute of Health and Welfare. Rural health. 2013. [Cited 3 Nov 2014]. Available from URL: http://www.aihw.gov.au/rural-health-impact-of-rurality/ 2 Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health status and determinants of health. 2008; AIHW cat. no. PHE 97. 3 Holden T, Bourke L. Rural community wellbeing. Rural Society 2014; 23: 208–215. 4 Australian Institute of Health and Welfare. Mental health services – in brief 2013. 2013; Cat. No. HSE 141. 5 Fact Sheet Smoking and Rural Health. Canberra: National Rural Health Alliance, 2014. [Cited 3 Nov 2014]. Available from URL: http://ruralhealth.org.au/content/fact-sheetsmoking 6 Hegney D, Ross H, Baker P et al. Building Resilience in Rural Communities Toolkit. Toowoomba, Qld: University of Qld/University of Southern Qld, 2008. 7 Australian Psychological Society. Position Paper: Psychology and Climate Change. Melbourne: Australian Psychological Society, 2010. 8 Health Workforce Australia. Australia’s Health Workforce Series: Psychologists in Focus. Adelaide, SA: Health Workforce Australia, 2014.
© 2014 National Rural Health Alliance Inc.
Copyright of Australian Journal of Rural Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
