Out back and out-of-whack: issues related to the experience of early psychosis in the New England region, New South Wales, Australia.

Abstract

CONTEXT: The slow slide into a first episode of psychosis is often difficult to detect and is often described in retrospect as the point at which things were not quite right. A rural setting can add an layer of complexity to detecting early psychosis, with local structural issues and other disadvantages potentially complicating both identification and early treatment. Fewer specialist workers are available in rural communities compared with urban communities, and drug and alcohol usage can mask the early signs of prodrome (early psychosis symptoms). Along with these more predictable contextual issues, family and drought conditions can impact significantly the mental health of vulnerability rural populations. The use of a vignette provides a window to the lived experience of early psychosis in rural communities. This article explores these issues in the context of northern New South Wales, Australia. ISSUES: Embedded rural health workers are uniquely positioned to work with local people. One way to address access issues and the lack of diversity among available healthcare practitioners is by recognising and nurturing generalist health workers in all disciplines in their specialist role as generalist. It is also important to recognise the natural processes of a rural community with regard to a sense of community, structures and networks, and to accommodate these when planning mental health services. LESSONS LEARNED: The development of generalist health workers to undertake supported early identification of psychosis in rural communities is a useful strategy. In practice, a key feature is the availability of a specialist project worker. In addition, it is important to continue to advocate for services to rural communities that aim at preventing psychiatric illness, as well as optimising continuity of care for rural residents.