Addressing mental health issues in rural and remote NSW

Impact summary

Research partners
University of Newcastle - Professor David Perkins, Dr Hazel Dalton, Dr Tonelle Handley, Dr Scott Fitzpatrick, Nic Powell.
NSW Health - David Pearce, Amy Wyndham, Becky Walker

The Challenge
People living in rural and remote communities experience consistently poorer mental health outcomes than those who live in cities. Rural mental health services are not working, despite increases in government funding.
Rural people face a series of challenges not being addressed by the current service mix, as well as unique stresses such as droughts, floods and bushfires, which can lead to a lack of control over their own economic security.
Those who do reach out for professional help often find it isn’t easy to come by, with waiting lists for many services.
Communities outside large regional centres often face a shortage of resident medical and allied health specialists such as psychiatrists, psychologists and mental health nurses.
Suicide rates outside of capital cities are consistently higher – by 67 per cent in 2019, according to ABS data – and remote communities have higher suicide rates on aggregate. Suicide among young Australian men in rural and remote areas is estimated to occur at almost twice the rate as metropolitan areas.
For young Indigenous males and females in remote communities, suicide rates may be up to six times higher compared to other Australians.

The Project
The Centre for Rural and Remote Mental Health (CRRMH) was established to create healthy rural communities.
The CRRMH has many key objectives, one of which is to coordinate and manage the Rural Adversity Mental Health Program (RAMHP), which it developed and runs in partnership with nine local health districts in regional NSW and the NSW Ministry of Health. RAMHP aims to promote the mental wellbeing of people in rural and remote NSW and connect those who experience mental health concerns with appropriate services and resources. These were delivered through training, community events, tailored mental health support conversations and extensive material available on the CRRMH website (crrmh.com.au), including The Glove Box Guide to Mental Health and the online magazine Take Time.

The Outcome
The RAMHP was successful in achieving four of its five key objectives (1):
• Communities and organisations had increased awareness of mental health services and resources.
• RAMHP training participants increased their knowledge on mental health.
• Communities and organisations (e.g. NSW Farmers, CWA) had better ability and capacity to recognise instances of mental ill health and could effectively link people to services and resources.
• Key agencies coordinated and collaborated to develop networks and resources that built an integrated and proactive response to community mental health needs.
(Maddox, 2021)

The Impact
CRRMH promoted mental health literacy, links rural people to services and responds to drought, fire and floods. In the five years (2016-2020) it linked 11,499 NSW people to mental health support and services, trained 41,991 participants through 1,967 courses and took part in 2,200 community events attended by over 33,000 people.

Research and engagement activities leading to impact

The RAMHP program was coordinated across nine local health districts in Regional NSW. The health districts cover a large scope of regional NSW. RAMHP Coordinators were based in Lismore, Grafton, Moree, Armidale, Tamworth, Port Macquarie, Forster, Tamworth, Maitland, Dubbo, Mudgee, Orange, Lithgow, Canowindra, Cootamundra, Nowra, Yass, Wagga Wagga, Ivanhoe and Broken Hill. (Maddox, 2021)

Research outputs associated with the impact

The Centre produced a number of research outputs, notably three publications between 2019 and 2021 which had a particular focus on developing an evidence base to inform rural mental health programs.
These papers describe the in-depth development, implementation and results of the RAMHP program for 2016-2020, and its evaluation model. The complete outcomes evaluation was completed in 2021 (Maddox, 2021).

The program also developed outputs for the community including The Glove Box Guide to Mental Health (TheMHS award 2018), an online magazine titled Take Time, the 'Let's Talk' podcast series (TheMHS award 2019), the 'Let's Talk' resources to support mental health literacy and service access, and a website focused on helping rural men - You Got This Mate.

Researcher involvement

From 2016-2022, I was the Research Leader at the Centre for Rural and Remote Mental Health (CRRMH), University of Newcastle in Orange NSW. I led the research team and facilitated their research support of the Rural Adversity Mental Health Program. This included the published research listed here, but also the active provision of evidence and participation in the generation of resources to support RAMHP activities.

Outcomes of research leading to impact

In 2015, the CRRMH was awarded a five-year contract from NSW Health Mental Health Branch, to continue the delivery of the RAMHP program (then running for 8 years on short term contracts). This enabled us to employ a dedicated RAMHP Evaluation Manager (Ms Sarah Maddox), reconceive the program logic and devise an evaluation framework and data collection system (app-based tool) to capture the work done by RAMHP Coordinators in the field, without compromising their ability to act flexibly in their rural community contexts.
The evaluation captured the breadth of the work conducted by the RAMHP program whilst it was managed within a translational research approach by the Centre for Rural and Remote Mental Health. It promoted mental health literacy, links rural people to services and responds to drought, fire and floods.

Beneficiaries of the impact

In the five years (2016-2020), RAMHP linked 11,499 NSW people to mental health support and services, trained 41,991 participants through 1,967 courses and taken part in 2,200 community events attended by over 33,000 people. (Maddox, 2021)

Details of the impact achieved

The five-year outcome evaluation contributed to converting a contracted program to a contract-managed but ongoing program of NSW Health. Thus, capacity has increased to support the mental health of rural and remote residents in NSW. There are now 20 coordinators in ongoing NSW Health positions across rural and remote NSW who deliver mental health promotion, health literacy training, community engagement activities and linking people to the help they need.

Program management was awarded to Grand Pacific Health in late 2021 as such, RAMHP continues to deliver its valuable services and support (www.ramhp.com.au).

Impact date	2016 → 2020
Category of impact	Quality of life Impact
Impact level	State