Mental illness and "self"-management in rural Australia: Caregivers' perspectives

Current models of chronic disease self-management incorporate an understanding that people with chronic illnesses, their carers and clinicians need to work together in addressing illness management issues (Von Korff, Gruman, Schaefer, Curry, & Wagner, 1997) and that this process enhances personal control of health (Lorig, Ritter et al., 2000). The question we ask is whether the understandings in these models, both implicit and explicit, apply to those people living with mental illness in rural areas in Australia. In-depth interviews were used to explore and examine the way in which carers of people living with mental illness in rural Victoria experienced and perceived the nature of chronic disease self-management. Our findings indicate that illness management in rural areas occurs predominantly as a partnership between the person with mental illness and the family members who act as caregivers, rather than a partnership with health professionals. This confirms that the lack of resources in the rural mental health care system results in a crisis-oriented service rather than a service that is able to respond to preventative and ongoing mental health care. This is recognised as a considerable burden for many families and requires further examination. In addition, a finding of considerable clinical and policy importance in this arena is the experience of family caregivers as partners in not only the support of the "management" aspects of self-management of mental illness, but also in supporting the person living with mental illness in the maintenance of the "self" aspect of self-management.