Where does youth friendly mental health access fit in rural Australia? Rural young people at risk of drug and alcohol and mental health problems reported in far West NSW, Australia

ABC Broken Hill journalist John Casey yesterday reported that drug use in the Far West of NSW is adversely impacting the rural community in that region, and in particular that methamphetamine use is a prominent concern.

The effects of drug use in rural communities compromises the well-being of entire communities. Mental health at individual and community levels decline, and as these reports indicate, people die of preventable causes (suicide, violence, risk-taking behaviours). Yet rural communities continue to have too few mental health and drug and alcohol services for rural young people. Every community needs to have convenient access to mental health services for young people.

On the 17th Sept, 2013, Casey from ABC Broken Hill interviewed a mother of a 15 year old boy who relayed her experiences of help-seeking in regard to appropriate mental health care for young rural people and families.  In the interview the mother indicated that it was not possible to gain sufficient access to appropriate skilled and expert help in her community.

This mother and son  situation is unfortunately all to common in Australia, and in rural Australia. We know that there is a high prevalence of mental health problems for young people in Australia: 1:4 16-24 year olds will have a mental health problem, and we know that families are especially vulnerable to violence emanating from young people with a mental health problem…

headspace represents the cornerstone of the national youth mental health initiative… it is a huge (and maybe unrealistic) national responsibility because despite commencing in 2006, too few centres are in too few locations nationally. Perhaps this will improve gradually overtime, but time is not available to young people and their families in current crisis. All-eggs-in-one-basket approaches to rural youth mental health is not yet meeting the day-to-day needs of young people in rural communities, as demonstrated by the recent candid media which presumably reports the real life pain of rural people at the present time.

The Headspace model has been shown to demonstrate effective mental health care for young people where it is available, however more immediate help and support is required in communities where it doesn’t exist. Practical measures could be taken to enhance the mental health provision capital that does exist in all rural communities. This could be achieved by enhancing the capacity nurses in rural communities have to help young rural people in the communities where they already work and live. Nurses dedicated to working with young people in health settings, school and police stations could improve the outcomes for mental health help seekers, and better utilise the referral and visiting services structures that do exist.

Why should Australia modify the youth national mental health plan and include local rural nurses as part of the solution? …because we will be waiting for some time for a headspace to be commissioned in every rural town and place in Australia.

There is hope though... we could use what we have better… to do this, the medicare funded Mental Health Nurse Incentive Program could be expanded to accommodate supporting early help-seeking youth, and this would see nurses using their expertise as health promotion specialists more effectively. In addition, state based community health services could collaborate with MHNIP nurses to facilitate a smoother transition to young people mental health services…. it would require some partnership between state and national governments, which might be a big ask, but is not impossible.

At the moment it is clearly too hard for some rural young people and their families and communities to find access to appropriate mental health services. Nationally, we have some way to go in addressing the shortfall  of mental health help available to young rural people. Globally, the spot light is on youth mental health  with an International Declaration of Youth Mental Health which urges us to:

 Engage young people & their families meaningfully in service development
 Improve understanding of youth mental health within communities
 Ensure access to youth friendly services and support
 Embrace a youth-focused, strengths based ethos of care
 Focus on resilience, hope and recovery

Ways forward for improving the mental health of rural young people:

  • Include rural local nurses in the immediate and future responses so that community and service sustainability is developed for the long term – Nurses are great at listening and piecing together helpful strategies to improve health and well-being outcomes of people and communities. Society needs to rely more on the in put and intervention of rural nurses for health rural outcomes.
  • Place nurses in locations where young people can find them easily and without stigma (eg health settings, GP clinics, schools, police stations, youth services, employment agencies, centrelink…….surely not too radical an idea!)
  • Continue to build the headspace service strategy – establishing one in every rural town.
  • Advocate for youth friendly approaches to engaging with young people – make it easy for them to seek help.
  • Be mindful of the International Declaration of Youth Mental Health – building resilience, hope and recovery options for rural young people. Advocating for implementation of the declarations ten year targets to be met in rural Australia.

Some further interesting reading:

Wilson, R. L., Cruickshank, M., & Lea, J. (2012). Experiences of families who help young rural men with emergent mental health problems in a rural community in New South Wales, Australia. Contemporary Nurse, 42(2), 167-177.

http://www.inspireireland.ie/wp-content/uploads/2011/10/international-declaration-on-youth-mental-health_new-leaflet_sept2011_final-final-version.pdf

Patulny, R., Muir, K., Powell, A., Flaxman, S., & Oprea, I. (2013). Are we reaching them yet? Service access patterns among attendees at the headspace youth mental health initiative. Child and Adolscent Mental Health, 18(2), 95 -102.

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