When it comes to mental health, things are a bit different in the bush. But one thing that all Victorians share, no matter where they live, is a failing mental health system.
Victoria's system is woefully underfunded. It cannot cope with current demand, let alone provide for the future.
A failure to invest in Victoria's mental health affects us all. It means that Victoria's mental health system does not provide for those who are most in need of high-quality treatment, care and support, their families or carers.
About a quarter of Victorians live in regional centres, country towns, farms and small settlements. Some places are remote from the day-to-day services available in urban areas. That includes access to general health care, let alone specialised mental health services.
While the prevalence of mental illness and psychological distress is much the same regardless of where you live, there are points of difference. One is the significantly higher levels of anxiety and depression self-reported by adults in rural regions.
Another is the disturbingly higher rate of suicide and self-harm among people living in rural and regional Victoria.
In the past decade, suicide deaths were 40 per cent higher than in metropolitan Melbourne. Men aged 35-54 years were particularly at risk.
It's estimated that two in five people who live with severe mental illness in rural and regional areas are not getting access to mental health services for various reasons. That means about 20,000 people with acute needs - equivalent to more than the entire population of Wangaratta - do not receive adequate treatment, care or support.
Centralised mental health services are stretched across many geographic boundaries, including large regional towns, small rural communities and even state borders.
The Royal Commission into Victoria's Mental Health System travelled widely to learn about the challenges of living with mental illness in rural and regional Victoria.
More than half of our community consultations were held outside metropolitan Melbourne. The commission sat in the central Victorian town of Maryborough. People living in regional and rural Victoria also made many individual submissions.
Many people told us about the "tyranny of distance", but there are other reasons that make living with mental illness different from the city.
Rural communities often create strong bonds, especially during bad times such as drought and natural disasters.
Equally, these can be deeply isolating events and sometimes the "last straw" in many ways, accompanied by high rates of post-traumatic stress, depression and high levels of psychological distress.
Social connectedness in rural areas can be a great strength.
But while there can be an incredible sense of belonging, there's also the issue of everyone knowing everyone's business. This can be challenging for people living with mental illness. Stigma, discrimination and prejudice are strong in some places, creating a barrier or reluctance to seeking help.
One farmer put it eloquently: "Farmers are good at helping each other, but we're not good at asking for help."
Along with calling for a new model to increase investment in mental health across Victoria, the commission has made recommendations that will improve the delivery of services in rural and regional areas.
The commission has recommended expanding follow-up care and support for people after a suicide attempt, including additional clinical outreach services in rural areas.
Aboriginal social and emotional well-being teams will be developed to provide services that meet the needs of Indigenous communities across Victoria.
A new Aboriginal social and emotional well-being centre will also lead to clinical, research and workforce support.
We acknowledge a shortage of mental health workers in rural and regional Victoria. The commission has recommended workforce reform that begins the process of addressing this need.
The commission's work is ongoing. Most of our recommendations will be in the final report to be delivered next October.
We need a mental health system that is fair and compassionate, that values the contributions of all Victorians.
Real change comes at a cost. It is a cost we all must share.
Everything we have heard so far will continue to form part of the commission's redesign of Victoria's mental health system.
The views and experiences of those in rural and regional Victoria will very much be part of that.
Penny Armytage is chairwoman of the Royal Commission into Victoria's Mental Health System
- If you or someone you know needs help, call Lifeline on 13 11 14 or beyondblue on 1300 22 4636.