S.TRUEMAN PhD THESIS 2016

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otherwise stated, the ‘unit’ is population (usually an AGSC-RA classified population) and the ‘period of time’ is 12 months (calculated either on a calendar year or financial year basis). 2.2 Remote Population Health Profile in Australia The health of Australians in remote areas is generally poorer than that of people living in metropolitan and regional areas (AIHW, 2008a, 2008b, 2012, 2014; Humphreys, 2002; Phillips, 2009; Smith et al., 2008). Mental health is a significant component of this health gap. In addition, it is common among people with a mental disorder to have comorbid illnesses and diseases. Research has demonstrated that people with a serious mental illness, like schizophrenia, have increased occurrence of physical illnesses (De Hert et al., 2011; Happell, Scott, Platania-Phung & Nankivell, 2012; Jacobi et al., 2004; Scott & Happell, 2011). People with comorbidities, like schizophrenia and diabetes, are more disabled and consume more health resources than those with only one disorder (AIHW, 2007). This is relevant for two reasons. First, the demands generated by such a disadvantaged population (remote mental health patients) on the time and available resources of limited number of remote nurses necessarily means that remote nurses are obliged to ration their time and to work under pressure. Though they may periodically become overwhelmed, they must continue to cope; however, this pressure is likely to have a negative effect on the delivery of remote mental healthcare. Second, remote mental health patients with complex comorbidities require multifaceted interventions and a greater level of nursing skills, creating an additional burden on the remote nursing workforce. The burden of the relative incidence and chronicity of poorer remote health, exacerbated by the