S.TRUEMAN PhD THESIS 2016

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their urban counterparts to die by suicide. (National Mental Health Commission, 2013) This is consistent with the AIHW (2012) report’s findings as outlined in Table 2.6. Table 2.6 Standardised Mortality Ratio for Suicide, by Remoteness (as Percentage of Total Population and Incidence According to Remoteness Classification Index) (AIHW, 2012)

Major Cities

Inner Regional

Outer Regional

Remote

Very remote

Suicide

1.00

1.18

1.43

1.78

2.89

There is no evidence that higher rates of suicide are due solely to mental illness in remote areas (Brumby et al., 2011). The cause of these higher rates (2.8 times higher in very remote areas compared to major cities per capita) is complex, and is attributable to factors such as a lack of early diagnosis, restricted access to mental health services, the distance-decay effect, poor physical health, access to firearms (Brumby et al., 2011), socio economic deprivation (Cheug, Spittal, Pirkis & Yip, 2012) and social isolation and alienation (Inder et al., 2012), particularly in men aged 65 and over (Longman, Passey, Singer & Morgan, 2013). No matter what the cause, the rate of suicide in remote areas is disturbing, and from the researcher’s remote working experience, takes an emotional toll on nurses. In relation to remote Indigenous populations, in 2008–2012, the suicide rate for Indigenous Australians was almost twice the rate (1.9) for non-Indigenous Australians (based on age-standardised rates). For 15–19 year olds, the rate was five times as high as the non-Indigenous rate (34 and 7 respectively per 100,000 population) (AIHW, 2015b).