Treating acute mental illness in rural general hospitals: necessity or choice?
OBJECTIVE
To identify reasons why rural general practitioners (GPs) treat a large proportion of patients with a primary psychiatric diagnosis in general beds of their local hospitals, and the barriers encountered when providing this treatment.


METHODS
A postal questionnaire was developed and distributed to a sample of rural GPs, asking about the treatment of patients with an acute mental illness in their local hospital.


RESULTS
The majority of GPs agreed that they treat the acutely mentally ill in general beds of their local hospital due to lack of availability of, and inability to gain access to, mental health beds in the larger centres; and also to enable ongoing family involvement and continuity of care. Distance factors were identified as least significant. Barriers to providing care to this group of patients included a perceived lack of support by consultant psychiatrists, confidentiality issues, lack of community mental health workers to provide assistance, aggression levels of patients, inappropriate local hospital setting, and lack of confidence of GPs and general hospital nursing staff.


CONCLUSIONS
Addressing these barriers is necessary if rural Australians are to receive a quality of care that is equal to that received by those located in metropolitan Australia. Continuing research in this area is crucial.
Hungerford
Catherine
C
Hunter New England Mental Health Service, Tamworth, New South Wales, Australia. catherine.hungerford@hneheath.nsw.gov.au
D000208:Acute Disease; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D009517:New South Wales; D010343:Patient Admission / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*