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Abstract

The aim of this research was to understand new ways that young rural people with mental health problems could be helped at an early point in their mental health decline. Rural nurses represent skilled mental health helping capital in their local communities, yet this important mental health helping resource, or helping capital, is both under-recognised and under-used in providing early mental health help in rural communities. In recent years international momentum has gathered in support of a paradigm change to reform the delivery of youth mental health services so that they align more closely to the developmental and social needs of young people with mental health problems. A mixed methods case study design was used to explore the early mental health care needs of young rural people. A cross-sectional survey was conducted and data were analysed with descriptive techniques. In-depth interviews were conducted and the transcribed data were analysed using thematic techniques. The results of this study demonstrate that in general rural people are willing to seek mental health care, and that rural nurses are well suited to provide initial care to young people. Non-traditional venues such as community, school and justice settings are ideal places where more convenient first conversations about mental health with young people and their families, and rural nurses should be deployed to these settings. Rural nurses are able to contribute important initial engagement interventions that enhance the early mental health care for young people when it is needed. © 2015 John Wiley & Sons Ltd.

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... A study from an unidentified rural area showed that school nurses were in positions to identify, evaluate, and report physical abuse and sex trafficking of youth (Grace et al., 2012). It was also found that students in rural Pennsylvania and South Carolina were willing to trust school nurses with issues of depression, homelessness, and vulnerability and look to the nurse as a point of contact into the mental health system (Puskar et al., 2011;Villalba, 2011;Wilson & Usher, 2015). Canfield (2014) and Ramos et al. (2014) studied the increase of behavioral issues and mental health among rural and highly mobile, homeless children in rural New Mexico. ...
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A qualitative study was conducted in a rural community in New South Wales, Australia, to understand the barriers to help-seeking among young rural men with emergent mental health problems. In-depth interviews were collected from participants who had real life experiences of these problems within their families. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. However, their helping enclosed the mental health problems within the family setting for long periods of time, and this led to lengthy durations of untreated psychosis in some cases. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached ‘the end of their strings’. This downward spiralling trajectory of mental health and well-being for both the young man and their families has implications for clinical practice. Current models of mental health service delivery do not adequately capture the early help-seeking dynamics of young rural men and their families. The traditional rigid admission-for-treatment process requires a singular client with a medical diagnostic classification. However, a more flexible approach needs to identify the family and the young man as a singular unit, without the pre-requisite for a formal medical diagnosis. Future research should involve health and well-being solution focused service delivery.
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In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process.
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Early intervention into prodromal schizophrenia has shown promise, but controversy continues regarding the ethical acceptability of identifying a group of 'ultra high risk' individuals of whom only 30 to 50% will develop a psychotic disorder. With well developed early intervention services this group faces the possibility of being labelled as 'pre-psychotic', a condition for which the well known stigma associated with the diagnosis of schizophrenia or bipolar disorder is likely to be associated. In addition, the use of potent antipsychotic and other medications (albeit usually at lower doses than those used for those with manifest psychosis) mandates consideration of the risks associated with their use and neurological and metabolic side effects. The potential for iatrogenic morbidity in the 'false positive' group must be weighed against the need of the 'true positives' identified through screening and assessment. Current evidence for the concept of 'at-risk mental state' was reviewed within a neurodevelopmental framework, including emerging data on the effectiveness of early intervention for the purpose of providing recommendations for community mental health services. The review suggests that different treatment strategies may be appropriate depending on the clinical stage of the condition as long as the benefits of intervention outweigh its risk burden. It further suggests that the severity of psychoses and the evidence of its early onset in utero and its acceleration in adolescence positions 'ultra high risk' intervention as a core model for early intervention for young people by teasing apart the symptomatic components of the 'prepsychotic state' and ensuring the population is reaching targeted mental health services for screening. The model is not restricted to the delivery of intervention for 'pre-psychotic' young people but is applicable for targeted programmes for a number of clinical groups considered at 'ultra high risk'. However, only further research in naturalistic populations embedded in clinical practice and ideally conducted in partnership of mental health services with academic research institutions will help clarify potential risks of early identification and intervention and assist in updating and making more explicit the clinical guidelines services will use in approaching those in the 'ultra high risk' group.
Article
To report nationally representative data on the prevalence and correlates (including psychiatric comorbidity and treatment) of DSM-IV alcohol abuse and dependence in Australian adults. The 2007 National Survey of Mental Health and Wellbeing (NSMHWB). Australian nationally representative household survey. 8841 Australian adults (16-85 years). Interview schedule that assessed symptoms of the most prevalent DSM-IV mental disorders in the life-time and the past 12 months. Prevalence of life-time and 12-month disorders was 18.3% and 2.9% for alcohol abuse and 3.9% and 1.4% for alcohol dependence. Current alcohol abuse and dependence was significantly more common in males and younger adults. There were significant associations between current alcohol use and other drug use disorders (OR 18.2) and between anxiety disorders and alcohol use disorders (OR 2.6). Only 22.4% of those with alcohol use disorders were treated for their alcohol disorder. Alcohol use disorders are highly prevalent, especially among young adult males. Comorbidity between anxiety and other drug use disorders is common and remains a significant challenge for the delivery of effective health-care services and treatment. The low rate of effective interventions for alcohol problems is a significant public health concern.
Article
While much has been written about the practice role of remote area nurses in Australia, less is known about the role and function of the rural nurse. The majority of rural nurses practise in rural hospitals, community health settings and nursing homes. In contrast, the remote area nurse's work setting is generally involved with Aboriginal and Torres Strait Islander primary health care services. Rural nurses practice setting is usually located in a larger organisation than that of the remote area nurse. There is usually at least one medical practitioner in the town or on-call close by. Nurses who are employed in the smaller rural hospitals have what has been described as a 'specialist generalist' role. This means that they are required to be multi-skilled and competent in a wide range of nursing and non-nursing practice. In contrast, nurses who work in base/provincial hospitals, may have either a generalist or specialist role. This paper provides a summary of the literature on Australian rural nurses and develops some of the themes contained therein.
Article
The island continent of Australia is the sixth largest country in the world (approximately 8 million square kilometres), larger in size than Western Europe, yet low in population density. 70% of the 20 million people are concentrated in capital cities and major metropolitan areas, mainly in urban coastal regions. This is in contrast to countries with vast rural populations such as India and China. The remaining six million (30%) people are scattered inland in areas referred as rural, the bush, the outback, and in remote areas often difficult to access and provide mental health care. Problems of distance and communication have led to inequities in health provision to rural and remote Australians, many of whom are Aboriginals and Torres Strait Islanders. The majority of health service providers are concentrated in the large cities and it is difficult for remote communities to recruit and retain health practitioners. The Aboriginal and Torres Strait Islander population suffer a morbidity and mortality rate that is far higher than that for other Australians. In addressing these health inequities, rural and remote mental health is emerging as a national priority in Australia with lessons for other countries with considerable remote populations. This editorial focuses on issues relating to remoteness and mental health care in these areas, based on impressions from rural and remote Australia. Why should we consider remote populations as conceptually ‘special’? Remote communities in Australia have small groups of people, vast areas; changing socioeconomic situations; unpredictable ecological issues (fire, drought, flood, salinity); lack of facilities; outmigration (i.e. younger people move to larger towns in
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships. Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed. Data revealed that professional boundaries were frequently breached in regional and rural settings and on occasions these breaches had a significantly negative impact. Factors influencing the impact were: longevity of the clinician's relationship with the community, expectations of the community, exposure to community 'gossip' and size of the community. Participants reported greater stress when the boundary crossing affected their partner and/or children. Clinicians used a range of proactive and reactive strategies, such as private telephone number, avoidance of social community activities, when faced with a potential boundary crossing. The feasibility of reactive strategies depended on the service configuration: availability of an alternative case manager, requirement for either patient or clinician to travel. The greater challenges faced by rural and regional clinicians were validated by metropolitan participants with rural experience and rural participants with metropolitan experience. No single strategy is used or appropriate for managing dual relationships in rural settings. Employers and professional bodies should provide clearer guidance for clinicians both in the management of dual relationships and the distinction between boundary crossings and boundary violation. Clinicians are clearly seeking to represent and protect the patients' interests; consideration should be given by consumer groups to steps that can be taken by patients to reciprocate.
State of the e-mental health field in Australia: where are we now?
  • H Christenson
  • K Petrie
Christenson H & Petrie K (2013b) State of the e-mental health field in Australia: where are we now? Australian and New Zealand Journal of Psychiatry 47, 117-120.
National Mental Health Policy Department of Health and Aging The Acute Phase of Early Psychosis: A Handbook on Management
National Mental Health Strategy (2009). National Mental Health Policy 2008. Department of Health and Aging, Canberra, Australia, 37. ORYGEN Youth Health (2004) The Acute Phase of Early Psychosis: A Handbook on Management. ORYGEN Research Centre, Melbourne.
Information technology as the key to accelerating advances in mental health care
  • H Christenson
  • K Petrie
Christenson H & Petrie K (2013a) Information technology as the key to accelerating advances in mental health care. Australian and New Zealand Journal of Psychiatry 47, 114-116.
The International declaration on youth mental health. Association of Child and Adolescent Mental Health Special Interest Group in Youth Mental Health in Ireland
  • H Coughlan
  • H Cannon
  • D Shiers
  • P Power
  • C Barry
  • T Bates
  • M Birchwood
  • S Buckley
  • D Chambers
  • S Davidson
  • M Duffy
  • B Gavin
  • C Healy
  • H Keeley
  • M Maher
  • C Tanti
  • P D Mcgorry
Coughlan H, Cannon H, Shiers D, Power P, Barry C, Bates T, Birchwood M, Buckley S, Chambers D, Davidson S, Duffy M, Gavin B, Healy C, Keeley H, Maher M, Tanti C & McGorry PD (2011) The International declaration on youth mental health. Association of Child and Adolescent Mental Health Special Interest Group in Youth Mental Health in Ireland. Available at: http://www.iaymh.org/ f.ashx/8909_Int-Declaration-YMH_-print.pdf
Department of Health and Aging
National Mental Health Strategy (2009). National Mental Health Policy 2008. Department of Health and Aging, Canberra, Australia, 37. ORYGEN Youth Health (2004) The Acute Phase of Early Psychosis: A Handbook on Management. ORYGEN Research Centre, Melbourne.
Schall U (2010) Young rural people at risk for schizophrenia: Time for mental health services to translate research evidence into best practice of care
  • T Slade
  • A Johnstone
  • M Teesson
  • H Whiteford
  • P Burgess
  • J Pirkis
  • S Saw
Slade T, Johnstone A, Teesson M, Whiteford H, Burgess P, Pirkis J & Saw S (2009) The Mental Health of Australians 2: Report on the 2007 National Survey of Mental Health and Wellbeing. Department of Health and Aging, Canberra, Australia. Stain HJ, Clark S, O' Donnell, M & Schall U (2010) Young rural people at risk for schizophrenia: Time for mental health services to translate research evidence into best practice of care. Australian and New Zealand Journal of Psychiatry 44, 872-882.
Impact and management of dual relationships in metropolitan, regional and rural mental health practice
  • Endacott