S.TRUEMAN PhD THESIS 2016

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to increased anxiety (Stockwell, Hodgson & Rankin, 1982). Such comorbidities need to be treated simultaneously if treatment is to be effective (Kenny et al., 2006). Further, a lack of remote specialist services and facilities results in an increase in the number of violent and aggressive mental health presentations (Kenny et al., 2006) and levels of mental illness due to insufficient treatment. Finally, the lack of specialist facilities for treatment of comorbidities involving drugs or alcohol increases the burden on remote nurses in another way. Often, withdrawing from a drug will induce a variety of mental health symptoms such as depression, anxiety and psychosis. For example, withdrawal from alcohol use can induce symptoms of depression or anxiety (Raimo & Schuckit, 1998) and psychotic symptoms can be induced by withdrawal from amphetamines, cocaine or cannabis (Kavanagh, 2008). Hence, ironically, a remote patient with a substance use disorder attempting to withdraw from their addiction, unassisted by specialist services, may actually increase their need for mental health services from remote nurses. 2.5 Suicide Use of drugs and alcohol is one of the risk factors for suicide; where remote populations lack specialist treatment for drug and alcohol misuse, that risk is not being addressed. The National Mental Health Commission’s 2013 Report Card included data on Australian suicide rates, noting that: [T]here are stark geographical inequalities in suicide rates … People living in non metropolitan areas are more likely to die by suicide than those living in capital cities and we know that men not living in major cities are almost twice as likely as