The covid-19 pandemic has highlighted the continued pressure on New Zealand’s rural health system, where mental health services are deemed by many to be inadequate, according to a new mental health and wellbeing report.
The Te Hiringa Mahara – the Mental Health and Wellbeing Commission report “The impact of Covid-19 on the wellbeing of rural communities in Aotearoa New Zealand”, was released this week and outlines the challenges rural communities faced during the pandemic.
The key issues identified in the report were isolation and poor connectivity because of a lack of internet infrastructure, workforce challenges, access to mental health and other health services, and the uncertainty around the economy.
The report – the third of eight prepared by the commission looking at the wellbeing impacts of the pandemic – looked specifically at the rural sector. About 16% of NZ’s population live in rural areas, and 35% live outside of large urban areas (nga waahi taone). The figures are higher for Māori.
It found covid “highlighted and exacerbated” pre-existing challenges across healthcare service, including mental health services. A lack of facilities, centralisation of specialist services, and workforce challenges mean there is an uneven availability of, and access to, local health services for rural people.
“Rural living is associated with higher mortality rates, with poorer access to mental health services, and with higher suicide rates than in the general population,” the report says.
“The pandemic, both through covid 19’s increased demand on health services, and its disruption for the people that deliver those services, has exacerbated the existing stresses in rural health systems.”
Rural communities (hapori taiwhenua) had worse access to covid vaccinations than those in cities. The rural rate of vaccination in late 2021 was 11% lower than in urban areas.
Initiatives are underway by various agencies to address mental health in rural communities.
“However, mental health services are considered by many to be inadequate to meet the demand for services, which is perceived as having worsened since the outset of the pandemic,” the report says.
The arrival of covid placed farmers and growers under additional stress as market and staff options dried up due to border closures.
Farmers adapted by working longer hours, as did family members, or calling on local sources of help, “which was essentially an unsustainable response creating additional stress”.
Te Hiringa Mahara director of wellbeing system leadership and insights Dr Filipo Katavake-McGrath said the geographies, economies and cultures of rural communities present challenges to mental health and wellbeing outcomes.
“This is particularly true with respect to isolation and connectivity, workforce challenges in the economy and health services, and uncertainty in rural economies.”
Poor connectivity means more people are struggling to get help, advice and support, with older people even less likely to be online.
The closure of social hubs, such as schools and libraries, during lockdowns also affected communities.
“Our report highlights the challenges presented to the rural community by these issues, and with a higher rural population, rural issues disproportionately affect Māori,” Katavake-McGrath said.
“It is important to remember that life has not ‘returned to normal’ and the need for support has not gone away.”
Strong local connections proved invaluable during the pandemic, particularly in rural Māori and Pacific communities.
“During lockdowns, iwi, marae, community hubs and communities banded together to support one another, share information, kai, and resources, and reduce the some of the worst psychosocial impacts of the pandemic,” Katavake-McGrath said.
By working together and engaging with government agencies and resources, rural communities have taken practical action to protect and support themselves, he said.
“To keep the momentum going, we call for greater involvement of rural communities (particularly rural Māori) in planning and decision-making and better understanding of the diverse needs, challenges and experiences of rural communities.”
