Integrating services for people with serious and persistent mental illnesses in a small rural community

We have just published a paper on an integrated community service development we have been observing for more than a decade (1,2). The collaborative relationship started with the recognition that people with serious and persistent mental illnesses did not access general practitioners for physical health care despite being amongst the most vulnerable people in the community.

Mudgee is a rural town of about 10,000 people in New South Wales, Australia with an economy based on mining, wine making and tourism. It is 120 kilometres from the nearest large town and has no inpatient mental health services. Over 10 years it has developed a community based acute mental health service in which patients are treated by the Community Mental Health Team working with GPs, supported by visiting psychiatrists who attend one day per week and with access to a telephone triage and advice service.

The collaboration has achieved a level of service based on strong relationships and shared values which might be described as comprehensive – no small achievement in the Australian rural setting.

Progress has been slow, incremental and sustained but hard to spread to other communities. This mirrors findings by Greenhalgh (3) and colleagues which are discussed in a recent IJIC editorial by Goodwin titled the “Three Pipes Problem” (4). We analyse this small but important success using a framework developed by Bourke (5).

Within the highly fragmented and changing health system context in Australia, successful examples of this sort are rare but they are also instructive. Without access to project money or infrastructural investment, clinicians and managers have been able to develop a high quality and responsive service for a very vulnerable and stigmatised group.

We hope you find the paper interesting.


1. Fitzpatrick, S. J., Perkins, D., Luland, T., Brown, D., & Corvan, E. (2017). The effect of context in rural mental health care: Understanding integrated services in a small town. Health & Place, 45, 70-76. doi:

2. Perkins D, Hamilton M, Saurman E, et al. (2010) GP Clinic: promoting access to primary health care for mental health service clients. Australian Journal of Rural Health 18: 217-222.

3. Bourke L, Humphreys JS, Wakerman J, et al. (2012) Understanding rural and remote health: A framework for analysis in Australia. Health & Place 18: 496-503.

4. Goodwin N. Understanding and Evaluating the Implementation of Integrated Care: A ‘Three Pipe’ Problem. International Journal of Integrated Care. 2016;16(4):19. DOI:

5. Greenhalgh, T, Robert, G, MacFarlane, F, Bate, P and Kyriakidou, O (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Quarterly 82: 581–629, DOI:


Prof David Perkins,
Centre for Rural and Remote Mental health,
University of Newcastle, Australia