Rural and remote communities
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Lack of available services for people with intellectual disability
Despite rural and remote areas having a higher prevalence of intellectual disability than metropolitan areas, the range of services is small. Many people with intellectual disability living in rural and remote areas rely on outreach services. This is a significant barrier to service use and access.
There is also a higher proportion of First Nations peoples with intellectual disability living in rural and remote areas, who may experience additional barriers to access. Read more about how to meet the mental health challenges of First Nations peoples.
Inadequate training in intellectual disability mental health
Mental health professionals in rural and remote areas report feeling inadequately trained to provide support to people with intellectual disability and mental health problems.  This means that people with intellectual disability may not receive services that accommodate their needs, as professionals may not know how mental health problems manifest in people with intellectual disability or how to adjust practice to meet their needs. However, living and working in rural and remote communities can limit the professional development and training opportunities for professionals. The additional costs associated with attending workshops and conferences when living in rural areas, such as transport and accommodation costs, are a significant barrier.  Furthermore, there is often a lack of clinical supervision for mental health professionals working in rural and remote communities.
Key challenges in meeting the mental health needs of people with intellectual disability living in rural and remote communities
Rural and remote communities do not have the same range of community and health services, including mental health services, as metropolitan areas for people with intellectual disability. [3, 4] Because of the lack of services available, mainstream mental health services are often used but even mainstream services can be difficult to access. As a result, access to timely and effective services is diminished for people with intellectual disability, who often have complex health needs, living in rural and remote communities. The launch of Western NSW Local Health District’s Specialist Intellectual Disability Health Team in 2021 has improved access to services in rural and remote areas. However, services are often reactionary and do not have a focus on mental health promotion. More information about the Specialist Intellectual Disability Health Teams is below.
Mainstream mental health services also may not be appropriate for people with intellectual disability. However, appropriate specialist intellectual disability services and behaviour supports are difficult to access as it is not viable to have specialist services in every town due to the small population base in rural and remote communities. People with intellectual disability often need to attend a specialist intellectual disability service in a metropolitan area or wait for a metropolitan-based specialist to visit the local area. This results in very long waiting times to access appropriate services.
Access to specialist services has improved since the establishment of the Western NSW Local Health District Specialist Intellectual Disability Health Team in 2021, which also offers a virtual care service to the Murrumbidgee and Far West Local Health Districts. Other regional Local Health Districts are covered by a metropolitan Specialist Intellectual Disability Health Team that may provide fly-in fly-out clinics or virtual clinics. However, access to specialist services is still difficult for diagnostic services.
Because of the lack of available appropriate services, there may be an overuse of doctors and mental health professionals that people deem to be “good”, leading to burnout in these professionals and their sudden refusal to take on people with intellectual disability as consumers. This can further limit access to mental health services for people with intellectual disability. Additionally, to meet the mental health needs of people with intellectual disability, there is a strong reliance on support networks to facilitate communication and provide information about the person, but there is often a high turnover of disability staff.
People living in rural and remote communities may have to travel long distances to their local regional centre for services. This may limit the services that a person with intellectual disability can access. Public transport may also be a barrier to accessing mental health services, as it may not be readily accessible in many areas. The distance that a person with intellectual disability can travel with support workers covered by the NDIS may also be limited.
How I can meet the mental health needs of people with intellectual disability living in rural and remote communities
Mental health professionals can engage in ongoing training and education in the area of intellectual disability mental health, especially through online learning and webinars that do not require travel. For example, professionals could engage with 3DN’s Intellectual Disability Health Education e-learning courses. The Specialist Intellectual Disability Health Teams are also funded to provide education in online or face-to-face formats.
Professionals could also engage in internet-based clinical supervision or mentoring, and establish or join professional networks that facilitate communication between professionals working across metropolitan, rural and remote areas. Mental health professionals who feel adequately trained and confident to provide services to people with intellectual disability could actively provide outreach services to remote communities to ensure that mental health needs are met in a timely manner.
Professionals could provide telehealth services to people with intellectual disability who are able to engage with services in this way. For example, telehealth services could be used to provide Positive Behaviour Support – a clinical trial is currently underway with autistic children and young people in rural and remote communities.  Research shows that people with intellectual disability and their support networks generally feel positive about telehealth services. 
Telehealth methods can also be used to teach carers and support staff techniques that can be used to help with the person with intellectual disability’s mental health problems. For example, telehealth was used to teach carers a mindfulness technique that was adapted specifically for people with intellectual disability. 
For professionals working in rural and remote communities, videoconferencing and other technology can also be used for case conferencing purposes or to consult with specialists in other regions. For example, the Statewide Intellectual Disability Mental Health Outreach Service runs joint assessments, primarily using telehealth, to facilitate access for those in rural and remote communities.
While the success of solutions that rely on technology depend on the communication network capacity in the area, the rise of telehealth in the last two years means that there are new options available to those in rural and remote communities.
Providing psychoeducation or basic mental health training to carers and support staff can help to meet the mental health needs of people with intellectual disability. Professionals could provide psychoeducation themselves or refer support networks to programs like the Rural Minds workshop program.
It is also important to provide psychoeducation to people with intellectual disability. Providing psychoeducation can empower the person through increased knowledge about mental health. It also means that mental health problems can be detected and addressed at an earlier stage.
It is important to take into account the mental health needs of family members and carers to ensure that they can provide adequate support. Link carers in with support groups online or in their area. The government’s Carer Gateway has resources and support for rural and remote carers.
It is also important to take care of your own mental health needs. Practise self-care to mitigate the effects of stress and burnout when working in this area, to ensure that you can provide high quality care. If you need support for your mental health, you can contact the Bush Support Line, which provides support for the current and emerging remote health workforce and their families. Also see the Support and self-care for professionals section.
- Intellectual Disability Mental Health Hubs offer direct support to consumers and training to health professionals. There are currently two Hubs that provide services statewide:
- NSW Intellectual Disability Health Service Network (made up of Specialist Intellectual Disability Health Teams run by metropolitan Local Health Districts) provides outreach services (fly-in fly-out and virtual) to regional Local Health Districts.
- Rural Minds program by Rural & Remote Mental Health is a workshop program for anyone living in rural communities to learn more about mental illness. It is targeted towards carers and family members and provides basic mental health training.
- 3DN’s Intellectual Disability Health Education provides online learning courses to health and mental health professionals, disability professionals and carers on intellectual disability mental health.
- Bush Support Line provides free counselling support to members of the current and emerging remote health workforce and their families. It operates 24/7 and you can contact the support line at 1800 805 391.
- Better Access Initiative allows all people with a Mental Health Treatment Plan from their GP to access Medicare rebates for telehealth sessions.
Additional background information
People living in rural and remote areas of Australia have poorer health outcomes, shorter lives and higher levels of risk factors for disease.  They experience reduced access to primary health care and multidisciplinary services, with health disparities being greater for young people living in rural and remote communities.  There is also further disadvantage for First Nations peoples, many of whom live in remote communities. This disadvantage is exacerbated by the lack of reliable demographic information about the First Nations populations living in remote NSW communities, impeding effective service development to meet their needs.
More people with disability live in rural and remote areas compared to metropolitan areas, including people with intellectual disability. The proportion of public mental health service users with intellectual disability is higher in rural and regional Local Health Districts than metropolitan Local Health Districts.  Despite this, there is a lack of appropriate services for people with intellectual disability in rural and remote communities.
The Intellectual Disability Health Data Portal provides information and data on people with intellectual disability and mental health service use in each Local Health District and Specialty Health Network in NSW, including those that service rural and remote communities. The Intellectual Disability Health Data Portal can be accessed by NSW Health staff who work in a role that is relevant to intellectual disability. Access to the Portal requires a letter of nomination from the Chief Executive of your Local Health District or Specialty Health Network.
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- Dew A, Bulkeley K, Veitch C, Bundy A, Lincoln M, Brentnall J, et al. Carer and service providers' experiences of individual funding models for children with a disability in rural and remote areas. Health Soc Care Community. 2013;21(4):432-41.
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- Australian Institute of Health and Welfare. Rural & remote health. Canberra: Australian Institute of Health and Welfare; 2019 [Available from: https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health.
- Odiyoor MM, Jaydeokar S. Intellectual disability in rural backgrounds: challenges and solutions. Mental Health & Illness in the Rural World. 2020:97-117.
- Srasuebkul P, Cvejic R, Heintze T, Reppermund S, Trollor JN. Public mental health service use by people with intellectual disability in New South Wales and its costs. Med J Aust. 2021;215(7):325-31.