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The article presents the highlights of the 13th virtual Rural and Remote Mental Health Symposium (RRMHS) in Australia in November 2021. Topics include the effects of COVID-19 on rural mental health service reform and the benefits of physical health, vaccination and social well-being as components of a holistic approach to mental health and well-being. Presenters include Doctors Ruth Vine and Leanne Beagley and nurse Jo Rasmussen.

The article presents the discussion on rural health in Australia. Topics include rural health being prominent in most state and national health plans and workforce strategies; and widely dispersed rural health workforce in pharmacy, allied health, and general practitioner small businesses supported by the Medical Benefits Schedule (MBS).

Objective: To investigate the impact of COVID‐19 on the mental health and well‐being of rural paramedics, police, community nursing and child protection staff. Method: An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. Setting and Participants: The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. Main outcome measures: The main measures of well‐being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID‐19–related stress. Results: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2–3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. Conclusions: COVID‐19 has increased the workload and stress on rural front‐line community staff. The major sources of stress were related to organisations' responses to COVID‐19 and not COVID‐19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads. [ABSTRACT FROM AUTHOR]

An editorial is presented on the COVID-19, leadership and lessons from physics. Topics include the times of crisis and major disruption bring leadership values into focus, particularly the values of political and public service leaders, the leader needs clarity about their personal and organizational values, and the history of dealing with changing demands, health services have experience in deploying and redeploying staff and resources in response to rapidly changing circumstances.

Objective: This study examines consumer engagement with a social marketing digital media strategy designed to support the implementation of Equally Well--a program to improve the physical health of people living with mental illness. Design: A four-stage strategic analysis and intervention mix were used as the theoretical framework to assess stakeholder needs and to evaluate the effectiveness of the intervention. Setting: Online and digital media. Participants: Mental health consumers, carers, clinicians and service managers. Interventions: A digital media, social marketing intervention to support those seeking to improve the physical health of people living with mental illness. The strategy was developed using a co-design methodology and provided links to self-care resources, access to service providers, clinical tools for health professionals and links to existing successful rural programs. Main outcome measures: The main outcome measures were the number of people from each category accessing the media, making connections and downloading resources. Results: The program has resulted in more than 24 500 website hits per annum, 3500 tweets and 14.5 million Twitter impressions with good bounce and download rates. The analysis suggested the materials were mostly used by clinicians and service managers using desktop computers. Conclusions: Using a co-design approach, the study demonstrated the potential of a social marketing digital media strategy as a health promotion methodology. The paper has provided a framework for implementing and evaluating the effectiveness of digital social media campaigns that can help consumers, carers, clinicians and service planners address the challenges of rural health service delivery and the tyranny of distance. [ABSTRACT FROM AUTHOR]

An available and effective rural mental health workforce is critical to the provision of contemporary mental health care. During the last 5 years new mental health plans and strategies have been released every state and territory of Australia. This policy analysis examines the extent to which workforce, and particularly rural workforce issues are considered in these policies. The analysis revealed that rural workforce issues receive scant attention in state and territory mental health plans. Rural Australians comprise 28% of the total population, yet rural workforce issues are canvased, on average only 6% of the time general workforce issues are addressed. National mental health workforce plans do focus on the rural workforce, but these are not referenced in the state or territory strategies or workforce plans. Given the rural mental health workforce shortages, and consumer challenges in accessing rural mental health services, more planning and consideration to supporting and developing a rural workforce appears warranted. [ABSTRACT FROM AUTHOR]

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery. [ABSTRACT FROM AUTHOR]

The author reflects on the strengths and challenges facing rural health research in Australia. Topics discussed include the importance of addressing the inequities of health research funding in the country, advantages of the Australian rural health teaching and research infrastructure, and implications of the proposed open access revisions by the National Health and Medical Research Council (NHMRC) for rural health outcomes.

An editorial is presented on the public health policy and leadership matters. The article discusses that the extraordinary situation of COVID-19 has mobilized health experts in concert with our political leaders, whose duty it is to convert expert advice to regulation and action; and COVID-19 has been the catalyst for (mostly) rapid and decisive public health action.

People diagnosed with mental illness have relatively poor physical health and die earlier than their counterparts in the general population. People living with mental illness in rural Australia have three times the risk of premature death than the total population. This article reviews recent international, Australian and New Zealand research, identifies the increased risk of early death of people living with mental health issues in rural settings and looks at the need for policy and practice responses. The 'Equally Well' national initiatives are described in Australia and New Zealand, which seek to systematically address this inequity as a matter of priority. Finally, it argues for co‐design and consumer participation in policy development, program implementation and research. Improved understanding of the perspectives and priorities of people with experience of mental illness is vital if change is to be fully realised. [ABSTRACT FROM AUTHOR]

The article focuses on the 11th Australian Rural and Remote Mental Health Symposium that was held between 28 and 30 October 2019 at the Adelaide Convention Centre, South Australia (SA) to discuss mental health. It mentions that the rate of suicide is much higher in rural communities; and also mentions that to be effective, mental health policy development must include stakeholders from rural communities.

The article presents the discussion on Peter Brown, a Commonwealth public servant organising major Australian cultural events such as ballet, orchestral performances, and film showings in China and analysing cultural and social developments in the country.

The article focuses on the goals of the Australian Journal of Rural Health (AJRH) which is to promote scholarly discourse on research, policy and rural health projects and through this promote and improve the health of rural communities. It mentions that the Original research often has a larger sample size and a series of controls that are important to the accurate reporting of reliable, valid and meaningful results.

Objective: To see if a new model of service delivery ensures that individuals with a mental illness in rural and remote settings could be assessed, treated and cared for in a more appropriate way. Design: Community mental health teams (CMHTs), general practitioners (GP) and other agencies were provided with clinical and broader support services by consultant psychiatrists from public and private sectors. The occasions of service were logged, audited and relevant provider groups were interviewed. Ethics approval was provided by Human Research Ethics Community of University of New South Wales. Setting: Far West Area Health Service (FWAHS), remote New South Wales. Participants: An enhanced service was provided for residents, specialist mental health and other healthcare providers. Results: • Regular access to psychiatrists for primary and secondary care was achieved in remote communities in FWAHS. • 3908 new patients were seen by CMHTs between July 2002 and December 2003 and 380 by visiting psychiatrists between January 2002 and July 2003. • Secondary consultation, mentoring and education opportunities were made available by tele-conference and face-to-face for CMHTs and others in FWAHS. • GPs and CMHTs in remote settings were satisfied with improved access to psychiatrist care. Conclusions: This model appears to be sustainable with reasonable levels of funding in FWAHS and may be applicable to other remote contexts. [ABSTRACT FROM AUTHOR]

An editorial is presented on an editorial is presented on researching for better health for regional and rural Australians. Topic include effective use of the personnel, infrastructure and clinical expertise; and developing new medicines and innovative treatments, the health of communities is about control.

The article offers information on 10th Australian Rural and Remote Mental Health Symposium held in Hobart, Tasmania on October 15-17, 2018. Topics discussed include need to address mental health literacy, importance of good physical health to mental health and well-being and ways to effectively incorporate and integrate the volunteer and career support. It also mentions need to provide reliable professional support to mental health workers to delivery to rural and remote communities.

The article discusses the impact of Medicare on rural Australia since established in 1983. Topics include the tendency for health disparities such as access to health services, disease burden and life expectancy to be worse for rural Australians than for those in more urban areas, the need for collaborative service planning within the Medicare system, and the Medicare system's failure to encourage health promotion or illness prevention.

The article offers information on the Rural Health Conference in Hobart held in March 2019 which showcased how people have made a difference in rural health. Topics include that the conference showcased research studies demonstrating how innovative services improved health; an discusses that many of the presentations reported the result of short‐term projects, and described years, and often decades of engagement, planning and implementation and evaluation.

An editorial is presented that discussed the impact of extreme temperatures on rural Australia as in result with the drought, drying rivers, algal blooms and fish kills. It discussed the re-emergence on social media of the Australian Broadcasting Corporation (ABC) program that shows the levels of collusion, non-compliance and also presents the development of a national rural and remote mental health strategy.

An introduction is presented in which the editor discusses various reports within the issue on topics including a community development continuum model that can be used in rural health and rural health advocacy.

The author discusses information about the Stronger Rural Health Strategy and associated budget released in Australia in May 2018. Topics mentioned include the strategy's lack in actions to improve the availability of medical specialists in rural communities, priority for training students close to their place of residence, and the importance of supporting rural health workers to maintain and develop their skills.

In this editorial, the author talks about importance of authorship. Topics discussed include its impact on conception, design, analysis and writing of the study; describing contribution and intellectual input of persons involved in research; and criteria drafted by the International Committee of Medical Journal Editors for evaluating the same.

An editorial is presented on the Australian Bureau of Statistics (ABS) report entitled "Mortality of people using mental health services and prescription medications" which was released on September 2017. It states that ABS it reports on the mortality of people who are gaining access to the Medical Benefits Scheme (MBS) or the Pharmaceutical Benefits Scheme (PBS) subsidised mental health-related treatments.

The author reflects on the growing number of people 85 years and older in Australia, and its impact of the said increase in longevity. The author says that the rapid increase of older people in the country will result to high demand for health services; thus, leads to health care crisis. He also discusses the factors to influence the rise of longevity, the community participation and voluntary labour by older Australian, and the high rate of depression in residential aged-care facilities.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment. [ABSTRACT FROM AUTHOR]

The article focuses on the 14th National Rural Health Conference in Cairns. It is stated that increasing the investment in research and evidence-based practice and increasing the number of collaborative rural health research projects were recommended at the conference. It is noted that some initial directions for developing agreed collaborative research priorities were provided by these recommendations.

The author comments on the proposed introduction of a Rural Health Commissioner in Australia to enhance the health care of rural Australians. The author stresses the importance of independence, rural credibility, political support and longevity of the Rural Health Commission in order to succeed. The author warns about health workers' lack of living and working in rural areas and points out the need of the commission to remain above politics.

The author emphasizes the importance of an integrated approach to providing health care for Australians in rural areas. Topics covered include data linking physical illness and mental health conditions, chronic disease co-morbidity, and important role of rural health workers in connecting clients to other health professionals and services. It also cites issues of distance and scarce health resources, workforce development, life expectancy gap, and insights from various types of research.

The author discusses whether the National Mental Health Commission's first report: `A Contributing Life: the National Report Card' will make any meaningful contribution to mental health reform. He mentions that the report draws attention to a few key research findings and gives high visibility to consumer stories. He states that the report provides 10 recommendations none of which are new and the most disappointing thing is that it does not say anything about regional and remote mental health.

The author discusses the media release "Delivering National Mental Health Reform" about the 2.2 billion Australian dollars mental health services under a five-year reform package. The media release contains funds committed at the 2010 election in Australia as well as the amount reduced from existing mental health programs. Some of the laudable features of the mental health budget package are funding for personal helpers and mentors to support daily living, housing, employment and transport.

Aim: We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. Context: This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details. Approach: An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is 'nothing about Indigenous people, without Indigenous people' in rural health research publications. Conclusion: Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals "Editing with IndigenUs and for IndigenUs". [ABSTRACT FROM AUTHOR]

The authors present a position statement regarding the publication of articles about Indigenous people or communities in rural health journals, particularly "Australian Journal of Rural Health," "Canadian Journal of Rural Health" and "Rural and Remote Health." The move is aimed at showing respect to Indigenous cultural identity and to enhance all aspects of academic publishing. Also cited is the effort to promote and support Indigenous authors and rural research.