S.TRUEMAN PhD THESIS 2016

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demonstrated that a drug causes, contributes or worsens the symptoms of serious mental illnesses, and often delays or complicates treatment. Hence, excessive drug usage adds to and complicates the care provided to mental health patients by remote generalist nurses. As established in Chapter 1, it is overwhelmingly nurses who take up the role of addressing remote populations’ poor health, including the care of mental health patients. Drug and alcohol abuse increases demand for mental health services. An example is found in McCullough, Williams and Lenthall’s (2012) study, which found that intoxication due to alcohol and cannabis were the most significant risk factors to consider during an assessment of violence risk and mental health. It is well known that the combined effects of alcohol, drugs and mental illness increase risks of violence and suicide (Ferns, Cork & Rew, 2005; Sands, 2007). The addition of alcohol and drugs therefore complicates these important assessments, which in turn increases the difficulty and complexity of the workload for the remote nurse. 2.3.1 Tobacco While tobacco use does not cause mental illness, it is nevertheless a drug implicated in substance use disorders ( DSM-IV-TR , 2000). Further, the deleterious side effects of tobacco on general health are a further complication and burden on nurses when providing mental healthcare. There is a clear association between serious mental illness and increased tobacco usage (Degenhardt & Hall, 2001; Jorm, 1999; Lawrence, Mitrou & Zubrick, 2009). People who reside in remote areas have the highest rates of smoking tobacco in Australia. In 2010, a self-reported national survey (AIHW, 2011) highlighted that, since 2007, those in remote areas had been the only cohort of Australia’s population to increase rates of tobacco consumption (see Table 2.4).