Psychological problems in rural primary care : evaluating a model of mental health service delivery in rural Tasmania

Over the past 10 years in Australia, there has been significant expenditure of resources on mental health. Research has demonstrated that psychological disorders are a frequent and disabling health issue for many in the community. However, there continues to be a singular gap in our knowledge of mental health in rural and remote Australia. Numerous publications have identified the issue and called for more research in rural settings at all levels. Yet a number of reviews have shown that most publications in this area are commentaries, descriptions of services, or policy statements. There is a significant gap in our understanding of the prevalence of mental health problems in rural and remote Australia. Currently we know very little about the risk and protective factors that moderate prevalence and the impact of service delivery on outcome for clients in rural and remote areas. This study included basic research on common mental disorders in a Tasmanian primary care population whilst evaluating the relative clinical effectiveness of a locally developed model of mental health service delivery. The study used a combined survey and naturalistic experimental design to screen participants (N=490) making a routine visit to their GP and subsequently assess them (N=227) using a diagnostic interview and rating scales of psychiatric symptoms and quality of life. Participants were re-assessed on these measures after 12 months. The primary care sample was grouped into those who had received a mental health service (N=22), those who had symptoms but did not receive treatment (Untreated Control, N=100), and those who did not have symptoms and did not receive mental health treatment (Normal Control, N=105). Clients being seen by a Local Mental Health Worker (N=28) were compared to the different groups of primary care participants. The study revealed a high prevalence of common mental disorders in this sample. In addition, a moderate correlation was established between the GP evaluation of psychological well-being and measures used in the survey suggesting that the GPs in this study were good at identifying psychological distress. Finally, it was found that the clients of the Local Mental Health Worker improved to a statistically and clinically significant degree on all the indicators of symptom level, distress, and quality of life compared to the other groups. More research is necessary but this study supports the idea that people do better when treated by mental health professionals in their own community. Such a model should be given serious consideration when developing future services.