Primary mental health care in a rural community: patient and illness profiles, treatment and referral.

The objective of this study was to determine the extent and nature of psychosocial morbidity and patterns of treatment and referral in rural general practice in a West Australian community. The research design was a survey based on structured questionnaires completed by the general practitioners about patients consulting with mental health problems in Bunbury in the rural south west region of Western Australia. Twenty-two general practitioners from five surgeries collected information on 428 patients, pertaining to socio-demographic characteristics, reasons for encounter, diagnoses, social problems, chronicity, counselling, medication and use of referral services. The positive stereotype of patients (i.e. most likely to be identified) consisted of a female preponderance in a ratio of 3:1, a high prevalence in the middle years (35-54), an overrepresentation of the divorced and separated, unemployed men and housewives. Neurosis was the most prevalent diagnosis at 68.5%, chronicity at 55%, and the most frequent social problems reported to the GPs related to relationship difficulties with partner, and being physically ill. Only a quarter of the patients were referred to other counselling services and social problems were an important reason for referral. Particular attention needs to be given to the negative stereotype in general practice of young people under the age of 25. With the bulk of psychosocial disorder concentrated in general practice, with the evident association of mental illness with physical illness and social problems, and with the lack of specialist resources in rural areas, innovative ways of support from other mental health professionals need to be addressed.