title: Service network analysis for agricultural mental health.
abstract: BACKGROUND
  Farmers represent a subgroup of rural and remote communities at higher risk of suicide attributed to insecure economic futures, self-reliant cultures and poor access to health services. Early intervention models are required that tap into existing farming networks. This study describes service networks in rural shires that relate to the mental health needs of farming families. This serves as a baseline to inform service network improvements.
  
  
  METHODS
  A network survey of mental health related links between agricultural support, health and other human services in four drought declared shires in comparable districts in rural New South Wales, Australia. Mental health links covered information exchange, referral recommendations and program development.
  
  
  RESULTS
  87 agencies from 111 (78%) completed a survey. 79% indicated that two thirds of their clients needed assistance for mental health related problems. The highest mean number of interagency links concerned information exchange and the frequency of these links between sectors was monthly to three monthly. The effectiveness of agricultural support and health sector links were rated as less effective by the agricultural support sector than by the health sector (p < .05). The most highly linked across all areas of activity were Rural Financial Counsellors, the Department of Primary Industry Drought Support Workers and Community Health Centres. Hence for a mental health service network targeting farming families these are three key agencies across the spectrum of case work to program development. The study limitations in describing service networks relate to the accuracy of network bounding, self report bias and missing data from non participants.
  
  
  CONCLUSIONS
  Aligning with agricultural agencies is important to build effective mental health service pathways to address the needs of farming populations. Work is required to ensure that these agricultural support agencies have operational and effective links to primary mental health care services. Network analysis provides a baseline to inform this work. With interventions such as local mental health training and joint service planning to promote network development we would expect to see over time an increase in the mean number of links, the frequency in which these links are used and the rated effectiveness of these links.
authors.affiliation: Department of Rural Health, University of Sydney and Southern Cross University, NSW, Australia. jeffrey.fuller@ncahs.health.nsw.gov.au
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fuller
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.forename: Susan
authors.initials: S
authors.lastname: Law
authors.forename: Georgia
authors.initials: G
authors.lastname: Pollard
authors.forename: Lyn
authors.initials: L
authors.lastname: Fragar
mesh_terms: D000383:Agriculture; D003156:Community Mental Health Services / Q000458:organization & administration*; D055864:Droughts; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D009517:New South Wales; D015397:Program Evaluation; D012017:Referral and Consultation; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D011795:Surveys and Questionnaires