Drawing upon their own experiences of living and working in rural communities, academics Dr Tegan Podubinski and Robyn McNeil examine Labor’s mental health promises, and caution that the proposed investment risks “reinforcing rather than resolving existing inequalities” that affect rural communities.
It is unclear how the announced investment would address the specific barriers that shape rural access, which are “longstanding, complex challenges that will not be solved by scaling up current models or simply replicating city-based approaches in rural areas”, they write.
Tegan Podubinski and Robyn McNeil write:
The Labor Government’s recent $1 billion mental health commitment is a welcome election promise, particularly given its focus on young people and expanded training opportunities for mental health professionals.
Whilst the headline figures sound promising, the announcement rests on an assumption that services will reach all Australians equally. Yet experience demonstrates that this often not the case.
Nor is it clear how these investments will be rolled out; it is crucial that rural communities are involved in the decision making and implementation.
Access to mental healthcare is not just about the presence of services.
It’s also about whether those services are truly accessible; are they appropriate, sustainable, responsive, and fit-for-purpose?
This means acknowledging that these communities are not homogenous. They differ significantly in geography, culture, population, health needs and government funding, making local context essential.
The authors bring lived experience of working and living in rural communities, and this article focuses on those insights – while recognising that similar, and often more severe issues exist in other underserved geographical areas.
Without deliberate, targeted planning that takes these complexities into account, potential new investments risk reinforcing rather than resolving existing inequalities.
Rural realities
Rural Australians experience poorer mental health outcomes than their urban counterparts.
Suicide rates are significantly higher, and access to services is limited across almost every indicator, from waitlists to workforce availability to physical distance from care.
Although more First Nations people live in urban and regional areas than in rural and remote areas, the proportion of First Nations people increases with remoteness, from 1.9 percent in major cities to 32 percent in remote and very remote areas.
Rural communities are also disproportionally impacted by current climate change effects, which negatively impact mental health. These are projected to worsen over time as climate-related disasters increase in frequency and duration.
While Labor’s election commitment is welcomed, it is unclear how the announced investment will address the specific barriers that shape rural access.
These are longstanding, complex challenges that will not be solved by scaling up current models or simply replicating city-based approaches in rural areas.
Workforce matters
Rural specific issues like workforce shortages, distance to services, privacy concerns in small communities, appropriateness of care, and poor digital connectivity all affect whether people can and will access care.
These challenges are the result of policy and planning that often frames rural areas through a deficit lens, focused solely on geographic location, rather than recognising the structural drivers of poorer health outcomes and the strengths of rural communities.
A shift is needed towards a spatial justice lens – the idea that where people live should not determine their access to essential resources and opportunities – including healthcare. This approach recognises that geographic location can create structural barriers to care and wellbeing.
By accounting for the specific needs, challenges, and strengths of different communities, spatial justice supports resource allocation that is not just equal, but equitable [1].
Spatial justice extends to workforce planning – rural communities are dealing with longstanding and persistent workforce shortages in the mental health, primary care and community support sectors.
These shortages are not simply a numbers issue. They reflect entrenched structural problems with how we train, place and support our healthcare workforce, which need to be addressed.
Without a local workforce, new services risk becoming empty buildings.
Attraction and retention
Developing a mental health workforce in rural areas is not just about training more health professionals. We need to address the conditions that make rural practice possible and sustainable.
Rural career pathways need to be scaffolded and supported from early training through to advanced practice.
Just as importantly, social needs and infrastructure needs to be part of the solution for attracting and retaining professionals and their families, for example: many rural communities are childcare deserts, and housing is in critically short supply.
These social considerations are real barriers to relocating and staying in rural areas — especially for women, who make up most of the mental health workforce.
Until governments confront these broader systemic issues, they will continue to struggle to fill rural roles – no matter how many graduates they produce.
Metro-centric training
Currently, most specialist mental health training remains concentrated in metropolitan settings.
This not only limits access for rural students, but it also means urban-based trainees often do not experience exposure to rural contexts, shaping their understanding of “normal” practice through a metro-centric lens.
Mental health education and training opportunities need to be located in rural areas, through universities and registered training organisations, developed with rural professionals and communities.
In parallel with this, there is a need to ensure mental health education in metro-based universities considers rural competency development by prioritising rural placements and curricula.
Post-qualification, we need all levels of government to develop structured and supported career pathways in rural areas, from graduate to experienced practitioners. This would ensure that there are viable careers for those wanting to work in rural areas.
Part of the solution
Any new funding must be informed by rural communities, service providers, and people with lived experience.
This is particularly important when considering the needs of different populations in rural communities, including First Nations people, people with disabilities, and people with alcohol and drug issues.
A one-size-fits-all solution will not work.
Rural communities are diverse, and service planning must be locally led and embedded in community priorities, utilising community knowledge and strengths, not using default urban centric ideas from city-based decision-makers.
Without meaningful rural engagement in planning and governance, we risk creating services that look good on paper but fail in practice.
Moving forward
Without a rural lens, the promised investment risks deepening the divide between urban and rural Australia.
We need mental health policies that don’t just deliver more, they need to deliver context-specific solutions, especially for communities that have historically been left behind.
With this announcement and renewed focus on mental health, now is the opportune time to rethink how all levels of governments, universities and registered training providers plan, fund, train and support the mental health workforce – with rural realities front and centre.
If rural communities are to benefit from this next wave of investment, we need more than services and extra professionals — we need a system that understands and responds appropriately to serve rural Australians.
Author details
Dr Tegan Podubinski (L) is Research Fellow, Department of Rural Health, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, on the Country of the Bpangerang People (Wangaratta).
Robyn McNeil (R) is Research Fellow, Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, on the Country of the Wadawurrung People (Ballarat).
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