Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande)

Abstract

Objective: Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. Methods: We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. Results: All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. Conclusion: We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

“…It can be challenging to provide good health services in rural and remote areas ( 1 – 11 ), because of long travel distances ( 2 , 12 – 15 ) and low population densities ( 12 , 16 ). Flexible Assertive Community Treatment (FACT) is a multidisciplinary recovery- oriented model used to provide long-term outreach care and integrated treatment to people with severe mental illness ( 17 ).…”

“…Long travel distances can create transport challenges ( 2 , 8 , 47 ), and make it more difficult to handle crises ( 48 ) and perform outreach work ( 13 , 15 , 49 – 51 ). This can be further complicated by challenging driving conditions ( 11 , 15 ) because heavy snowfall is common in Norway. Long travel distances can lead to time wastage ( 14 ), and increased costs ( 1 , 14 ).…”

Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT

“…To the best of our knowledge this is the first international comparison of patterns of urban mental health service provision using a bottom-up approach, and standardised methods and tools. It follows the analysis of rural care patterns in Australia as part of the GLOCAL (Global-Local) Atlas project [ 38 , 45 ], which identified significant interstate variation [ 46 ]. Previous bottom-up studies have been limited to Europe [ 30 , 34 ].…”

“…tools. It follows the analysis of rural care patterns in Australia as part of the GLOCAL (Global-Local) Atlas project [38,45], which identified significant interstate variation [46]. Previous bottom-up studies have been limited to Europe [30,34].…”

Cohort study comparison of Mental Health and Wellbeing Services delivered by The Royal Flying Doctor Service, across Far North and Central West Queensland

“…Australian remote areas often lack stable mental health services, even though these services are considered a key component of community mental health care. 36 Furthermore, many of these areas lack residential subacute or long-term bed-based mental healthcare provision, 10 resulting in clients, who are unable to be discharged to community remaining in hospital and removed from traditional lands and their community. 36 Small subacute units and adequately trained staff are urgently needed in many regional hospitals to provide community based care.…”