Rural, remote, and very remote mental health

While the prevalence of mental health problems in rural, remote, and very remote (RRvR) settings compared with metropolitan settings is approximately the same, access to services is much poorer. Consequently, the efficient resolution of mental health difficulties is often compromised in nonurban settings. Not only is access to services difficult in more rural locations, the range of health professionals available to residents in RRvR contexts is usually limited. People in RRvR settings, for example, may have access to health professionals who provide psychiatric and case management services but not have access to health professionals who provide alternative psychological and social programs. Thus, the availability of evidence-based programs and services is less than ideal for people living outside metropolitan settings. Furthermore, although people who live in cities have access to specialist mental health services, these services are frequently unavailable to people living in RRvR locations. Moreover, even though the Western biomedical model of (mental) health is dominant in nonmetropolitan Australia, it could be seen to be particularly unhelpful because of the high proportion of Aboriginal and Torres Strait Islander Australians living in RRvR locations who prefer to understand psychological distress from the perspective of social and emotional wellbeing, rather than as a biomedical disorder and illness. In many ways, a social and emotional wellbeing approach would be more closely aligned to a biopsychosocial model than the way in which the current biomedical model is applied in which psychological problems are understood as illnesses analogous to physical illnesses. The social and emotional wellbeing perspective is also compatible with a social determinants of health model which provides another important component of effective service provision for underserved populations. In this chapter, we define the scope of this handbook and outline the current state of RRvR mental health, thereby laying the foundation for the key areas to be explored in detail throughout the book.