Objective: To report on self-reported physical and mental health of informal carers in rural regions of New South Wales, Australia. Methods: A cross-sectional community-based sample (n=222) of carers completed a questionnaire incorporating self-reported measures of health from validated international instruments including Medical Outcomes Study Scale (SF-36), the Centre for Epidemiology-Depression (CES-D) and Kessler-10 (K-10) Psychological Distress Scales, along with information on participant demographics and other key caregiving characteristics such as health condition of care recipient. Results: Rural carers' self-reported health was poor as evident on the SF-36 Physical and Mental Health component scores as well as each individual domain of the SF-36. Results from the CES-D and K-10 scores indicated very high rates of depressive symptoms and psychological distress. Over 70% of carers within the current study had CES-D scores indicative of depressive symptoms. Scores on the K-10 indicate almost half the carers were experiencing high levels of psychological distress, which is over 4 times the rate reported in the general Australian population. Conclusions and implications: Results from this study were compared to Australian population normative data and were found to be significantly below Australian age-matched population norms for SF-36, CES-D and K-10. These findings illustrate the poor health profile of informal carers relative to the general Australian population, especially in terms of depressive symptoms and psychological distress. This highlights the need for additional support for rural carers in order to ease the accumulated mental and physical health burdens of this group.

Background: Informal carers play a vital role in our society particularly in rural areas where options for health services are limited. Informal carers receive minimal support from organisations, financial assistance from the government, and burnout is commonly described as a problem in the literature. Approach: A survey of informal carers designed as a pilot questionnaire was conducted with 225 participants from regional northern New South Wales. Questions on demographics, perceptions of health services, support groups, validated measures of mental and physical health (SF36, CESD and K10) were also used to assess the status of this group. Outcomes/results: Most carers were female (86%), primary caregivers (83%) who resided with the care recipient (75%). Many respondents had low physical and mental health scores, the latter correlating with clinical levels of depression. Carer Support groups were seldom utilised (27%). Take home message: • This cohort is a vulnerable group and without appropriate intervention and support experience poor health which may compound social and economic disadvantage. Preventative health measures need to be put in place to alleviate vulnerability. • A study with a larger sample size to better understand the interplay between geographic and other disadvantages is recommended to best advise rural policies for intervention.

Background Individuals with intellectual disability (ID) have a higher likelihood of exposure to identified risk factors for suicide when compared with the general community and have been recognised as being both capable of forming intent for suicide and acting on this intent. However, in spite of research outlining these concerns from the 1970s, there remains a dearth of studies that examine suicide amongst the population of people with ID. Method An online cross-sectional survey was purposively developed, with questions aimed at identifying both the experiences and current practices of support staff who assist people with ID in relation to suicide, suicidal behaviour and suicide assessment. It was undertaken across both rural and metropolitan areas in Australia. The survey was open for a period of 12 months. A total of 139 respondents (109 female/30 male), with a mean age of 41 and an average 12 years of experience in supporting people with ID, completed the tool. Results A total of nine suicides by people with ID were reported. Seventy-seven per cent of the respondents reported that they had individuals with ID display suicidal behaviours, and 76% noted that a person had specifically talked about wishing to end their life. Only four participants (3%) noted that they did not support individuals with a dual diagnosis of ID and mental health concern. Sixty per cent of participants reported that no one in their organisation had ever completed a suicide risk assessment, and only 28% reported that they would do a suicide risk assessment if an individual that they supported was diagnosed with a mental health issue. Conclusions The current findings indicate that support staff recognise the capacity of people with ID to conceptualise suicide, note the existence of suicidal discussions and behaviours and report on actual suicides. This represents one of the few Australian studies that has specifically considered suicide amongst this cohort of people and reinforces the fact that suicide is not unknown in this population. The data indicate a possible divide between the reports of people with ID actively talking about and acting on suicidal thoughts and the lack of any proactive use of any tools to assess for this risk.

Aim: There is an emerging need for end-of-life care for people with intellectual disabilities; however, there is limited research that concurrently examines support issues within both rural and metropolitan localities. The aim of the current study was to gain insights from paid carers in both city and country areas of Australia in order to identify facilitators and barriers to the provision of appropriate end-of-life care support. Method: Seven focus groups with a total of 35 participants were conducted in metropolitan (Sydney and Brisbane) and rural (Armidale, Inverell, Lismore and Warwick) locations using a semi-structured interview guide. All focus group data were independently transcribed, and thematic analysis was undertaken. Results: There were seven main themes recognised in the data. These were Training and Staff Support; Health Services; Relationships; Policy and Practice Barriers; Pain and Medication Management; Quality of Life; and Infrastructure. Similarities and differences based upon geographic location were identified. Conclusion: The differing end-of-life needs of rural and metropolitan residents are nominated. Specific recommendations are made for Australian-based services regarding changes to daily practice that better support people during their end-of-life.

Background: Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods: Focus group interviews were undertaken with 35 direct-care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed. Results: Frequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of 'isolation,' 'support from doctors,' 'general health support access' and 'internal staffing issues.' Conclusions: Improved access to end-of-life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers.

Background: Access to support services in rural areas is known to be problematic both in Australia, and in other countries around the world, but the majority of research on the population of people ageing with learning disability has so far focussed on metropolitan residents. The authors report about select aspects of the lived experience of older adults with learning disability resident in rural locations in two states of Australia. Materials and Methods: This pilot project examined data drawn from 34 semi-structured interviews conducted with 17 older adults and 17 carers. Responses were analysed for thematic areas. Results: It was observed that the capacity of certain rural areas to support meaningful choice-making was limited due to constraints of access to key services, including community-based aged care, generic and specialist health services, and both supported disability and aged-care residential options. Responses indicated that those living in both small- and medium-sized congregate care settings (such as group homes and residential aged-care facilities) had more limited choices and only partial (if any) control over their living situation. Conclusion: An understanding of the needs of older adults with learning disability resident in rural areas is important to ensure that both aged-care and disability support structures are built on individuals' needs.