Aeromedical retrievals of people for mental health care and the low level of clinical support in rural and remote Australia

Abstract

Objectives: To characterise the people retrieved by the Royal Flying Doctor Service (RFDS) for treatment of mental and behavioural disorders, and to assess mental health care provision in rural and remote areas.Design: Prospective review of routinely collected RFDS and Health Direct data.Setting, participants: RFDS aeromedical retrievals of patients from anywhere in Australia except Tasmania during 1 July 2014 – 30 June 2017 for the treatment of mental or behavioural disorders.Main outcome measures: Retrievals by ICD-10 mental and behavioural disorder diagnoses.Results: 2257 patients were retrieved by the RFDS for treatment of mental or behavioural disorders, including 1394 males (62%) and 863 females (38%); 60% of patients were under 40 years of age, 35% identified as Indigenous Australians. The most frequent mental and behavioural disorders were schizophrenia (227 retrievals, 16.5% of retrievals with ICD diagnoses), bipolar affective disorder (185, 13.5%), and depressive episodes (153, 11.2%). Psychoactive substance misuse triggered 194 retrievals (14.2%), including misuse of multiple drugs (85, 6.2%), alcohol (61, 4.5%), and cannabinoids (25, 1.8%). The mean age of patients retrieved for treatment of substance misuse (29.6 years; SD, 11.6 years) was lower than for retrieved patients overall (37.0 years; SD, 19.3 years); 38 of 194 patients retrieved after psychoactive substance misuse (19.6%) were under 19 years of age. Most retrieval sites were rural and remote communities with low levels of mental health care support.Conclusion: Mental and behavioural disorders are an important problem in rural and remote communities, and acute presentations trigger a considerable number of RFDS retrievals.