The Orange Declaration

Perhaps it was the 2018 Senate Inquiry into Rural and Remote Mental Health, or the earlier Obsessive Hope Disorder Report, or one of many conference programs which fueled a growing feeling that rural mental health services were not leading to better health and that doing more of the same was unlikely to make much difference.  Speaking to my research colleagues I discovered that I was not alone and completing a position paper on rural suicide reinforced the feeling that some fresh thinking was needed.

Orange in October is full of reminders of Spring, buds everywhere, longer days, new wines to be tasted and good restaurants to visit.  Why not invite a dozen interested parties from the rural mental health fraternity to take out 24 hours, enjoy a meal, develop a working partnership and rethink rural mental health: pay their own way and I would provide lunch.  There were sufficient takers to start a movement and so the Orange Declaration on Rural and Remote Mental health was born.

The meeting demonstrated the range of expertise and a surprising commonality of values.  Single, short term disjointed investments were unlikely to make a long-term difference.  The answer did not lie in one-dimensional solutions such as increased telehealth, changed funding models or obsessive competition; neither would a single model of care devised in a state capital city or Canberra work across the vast patchwork of communities that comprise rural Australia.

In international terms, Australian rural often seems to mean remote and a shortage of specialists in rural areas was often compounded by a shortage of generalists such as GPs in remote areas.  Was there any scope for a reinvestment in prevention and if so, what would that look like?  If rural mental health and wellbeing is understood as a messy problem, any solution is likely to require community participation, use of best evidence and new approaches to data to say nothing of distributed and effective leadership.

To cut a long story short, the Orange meeting was followed by the circulation and recirculation of drafts until an agreement was reached.  Those drafts were then shared with a wider group of interested parties and the final Declaration being published in the Australian Journal of Rural Health.

Publication is the beginning not the end. Members have been invited to the International Institute of Mental Health Leadership in Washington in September to test the ideas with other rural representatives.  The Australian launch took place in October 2019 at the Australian New Zealand Rural and Remote Mental Health Symposium in Melbourne.

The Declaration has found international support and was presented at the International Institute of Mental Health Leadership in Washington DC in 2019.  We are working towards an international declaration in Christchurch in 2021.  The Declaration, not surprisingly is consistent with the principles of patient (Community) – centred and integrated care and is designed to bring new light to a sadly neglected part of health service provision,

But will it make a difference?  Not if we continue muddling along as usual with simple short-term solutions to complex long-term problems.  The challenge is to engage the brain and see whether the Declaration makes sense.  If so, sign up and add your shoulder to the wheel.  Perhaps we can do something different and perhaps that will make a difference!

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Professor David Perkins

Director and Professor of Rural Health Research

Centre for Rural and Remote Mental Health