The Rural Health Alliance Aotearoa New Zealand
(RHAANZ) was established in March and ''brings together health,
social and political agencies with a rural focus to provide a
unified voice and resource to help find solutions for the
health problems facing rural communities.''
Southern Rural Life invited chairman Dr Jo Scott-Jones to
discuss GPs' roles in mental health in rural communities.
The role of the rural GP has always been one which has had to
provide a wider range of services than in urban centres where
there is easier access to support from other providers.
In many rural towns the general practice team has had to
develop the skills and adapt their service to provide an
extended level of mental health services to their communities
because distance and difficulties of access has meant that
patients have few alternatives to turn to when they are in
Mental health issues have always been an area where patients
have had to build a great deal of trust and a good
relationship to be able to both share their concerns and to
be amenable to treatment.
Where a community has had a long-term GP, or sometimes a
practice nurse with extended skills, the ability for patients
to be able to talk about what they feel is deeply personal is
Unfortunately, there is a problem for many rural towns in
retaining the services of GPs for long periods of time, and
where places rely on short-term locums who come and go every
year or even more frequently, there may be a feeling that the
''family GP'' is no longer there for that community.
Currently, 25% of rural GP practices are looking for
long-term permanent GPs and this lack of workforce resources
adds pressure on the practices that are serving those
It is my experience that rural GPs are able to give as much
time to their patients as they need, sometimes at a sacrifice
to their own health and the welfare of their family, and in
the case of mental health patients often causing other
patients to wait as sensitive consultations will often take a
lot more time.
In some rural towns, the general practice services are in a
''bums up, heads down'' mode dealing with the issues that are
presented to them and their ability to actively seek out
patients or provide ''evening clinics'' in addition to coping
with the presenting patients is limited, and we should
respect them for that and applaud them for what they are
Mental health issues in rural areas have always been
It is fantastic to see an increasing discussion about issues
such as depression and suicide among community-based groups.
It is really important because this helps to decrease any
feeling of stigma, and ''normalises'' the fact that many of
us need help and that this is OK.
The gap between the outcomes for rural and urban communities
in terms of mental health issues is unacceptable and this
''reality'' has to change.
There are things that can be done to improve the level and
scope of services to address this need.
There needs to be an acceptance among rural middle-aged men
in particular that it is OK to ask for help and this will
come from socialising the concepts and developing skills
among rural communities to recognise the warning signs and
improve their knowledge of when to seek help.
The efforts of Federated Farmers, Dairy Women New Zealand and
others to normalise the need for mental health support for
rural communities can be extended and built upon. Public
health education campaigns aimed at and tailored for rural
communities can be developed.
Services to improve access for rural communities can begin
with self-help and community level support, through service
clubs such as Lions and Rotary, local organisations such as
Dairy Women Network and the support of organisations such as
the rural health support trusts.
Mental health consultations often take prolonged periods of
time, and need repeated and regular contacts.
Realistically, patients cannot afford to pay the cost of the
GP's time, and many practices provide these services without
The ability for GPs to subsidise these services through
supported payments would be helpful to some practices in
staffing and providing time for patients.
Practices that can access support from other mental health
professionals, to help them extend their skills and to
provide advice and on-site interventions for some patients
will become more resilient and able to provide more over
DHBs and PHOs could support a visiting psychologist or
psychiatrist to provide regular input to rural practices to
help them to develop their services.