Mental health referral role of rural financial counsellors.

Objective: To quantify the proportion of rural financial counsellors' (RFC) clients requiring social, emotional and stress-related (SESR) assistance and the referral of these clients to other services.

Design: Survey of all Australian RFCs.

Setting: Rural and remote agricultural locations in Australia.

Participants: Australian RFCs employed over the months of November and December 2004.

Main Outcome Measures: The proportion of counsellors' clients who required assistance with SESR problems and the proportion of these who were referred. Counsellors' usual referral networks, rating of referral difficulty and ranking of strategies to improve referrals.

Results: Counsellors reported that on average 20% of their clients required SESR assistance and half of the counsellors referred more than 75% of these clients. Referrals were mainly to GPs, mental health teams, personal counselling and health and welfare organisations. Almost half (49%) reported that referrals were difficult because of rural clients' reluctance to acknowledge such problems and use mental health services, as well as the lack of these services. Counsellors were placed in a practical role dilemma when clients raised personal issues that were beyond the counsellors' role but were linked to the financial reason for presentation. Strategies identified to improve referrals were to network with mental health and personal counsellors in the region, training and a referral guide.

Conclusions: Because RFCs are a first contact for rural people in crisis, they could be brought into a local counselling network. This network could improve the process of referrals and build local mental health system capacity.