How can we improve the wellbeing of people in disadvantaged communities?
Disadvantaged communities experience marked social and health inequalities compared with the general population.
These can include reduced educational and employment opportunities; lower income; poorer access to and use of health services; higher levels of disease risk factors and illness; and higher rates of suicide.
In Australia, people living in regional, rural and remote areas as well as Aboriginal and Torres Strait Islander peoples have been identified as groups that are likely to experience persistent disadvantage.
While no marked difference has been found in the overall prevalence of mental illness between people living in metropolitan areas and those living in regional, rural and remote areas, dramatic differences have been found in the acuity of mental illness for people living in regional, rural and remote areas.
This is due to poor access to primary and acute care; limited numbers of mental health services and mental health professionals; distance from and cost of mental health services; concerns about stigma; cultural barriers relating to service access; and reluctance to seek help.
Rates of suicide and self- harm have also been found to increase with remoteness (compared with cities, rates are 40% higher in rural areas and almost double in remote areas). It is estimated that people living in remote areas are only able to access mental health services at a fifth of the rate of their metropolitan counterparts.
Disparity also exists in the quality and outcomes of mental health care for those who access services. For Aboriginal and Torres Strait Islander peoples, rates of serious mental illness and of mental health problems associated with social disadvantage are higher than for non-Indigenous Australians. Furthermore, the disadvantage is even greater for those living in regional, rural and remote areas.
Suicide also accounts for a greater proportion of all deaths of Aboriginal and Torres Strait Islander peoples compared with deaths of non-Indigenous Australians (6% v 2%, respectively). In relation to the mental health and wellbeing of all young people living in regional, rural and remote areas, the suicide rate for young men aged 15–29 years is almost twice as high as it is in major cities.
For Aboriginal and Torres Strait Islander peoples aged 15–34 years, intentional self-harm was the leading cause of death between 2013 and 2017. A sense of pessimism about future prospects, unemployment, loneliness and pressure to conform to locally accepted patterns of behaviour may exacerbate the risk of mental health problems for young people living in these areas.
For lesbian, gay and bisexual (LGB) individuals, minority stress and less LGB community connectedness are additional risk factors for psychiatric morbidity. The use of health information technologies, however, holds promise in terms of augmenting health service delivery and reducing marginalisation for all disadvantaged communities across Australia, and for young people in particular.
Research findings suggest that internet use among children and young people does not differ significantly between metropolitan and remote areas of Australia. Furthermore, it has been highlighted that youth in rural areas may stand to benefit the most from technology-supported services.
This is, at least partially, because these young people experience structural barriers to help seeking, such as a lack of specialist services, out-of-hours support and reliable transport. Young people in rural areas also experience contextual barriers, such as reduced anonymity associated with rural communities, which may exacerbate fear of gossip, stigma and social exclusion.
The primary objective of this study was to evaluate the engagement of young people living in disadvantaged communities in three areas of New South Wales with a prototypic online platform and observe any changes in health and wellbeing in this group when using the prototype.
A secondary objective was to further inform the co-design and development of the prototypic online platform.
To find out more, download our supplement ‘Evaluating engagement with a prototypic online platform to improve the mental health of young people in disadvantaged communities‘ from the peer-reviewed Medical Journal of Australia.