Is rural mental health workforce a policy imperative?

Roberts, Russell; Maylea, Chris

doi:10.1111/ajr.12541

Cited by 13 publications

(5 citation statements)

References 5 publications

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“…40 The findings also identified significant challenges in developing and maintaining a local workforce of help providers that can continue supporting mental health and well-being in communities affected by disasters and the pandemic. This is positioned in relation to pre-existing shortages of mental health professionals in many parts of Australia and outside metropolitan areas, 41 which indicate the probable need for multi-component approaches to addressing workforce issues in the context of multiple disasters. These may involve the maintenance and expansion of flexible service delivery options that can help distribute and reduce demand on local providers, for example, via provision of telehealth services and online support programmes, as well as 'fly-in-fly-out' service providers (which, although imperfect, can all help to supplement and reduce burdens on the local workforce).…”

Section: Discussionmentioning

confidence: 99%

Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires

Cowlishaw,

O'Dwyer,

Bowd

et al. 2024

BJPsych open

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Background The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the ‘Black Summer’ bushfires of 2019–20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. Aims To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. Method We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. Results Six themes were produced: (a) ‘Pulling together, pulling apart’, describing experiences after bushfires and prior to impacts of the pandemic; (b) ‘Disruption of the ‘normal response’, encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) ‘Escalating tensions and division in the community’, describing impacts on relationships; (d) ‘Everywhere you turn you get a slap in the face’, acknowledging impacts of bureaucratic ‘red tape’; (e) ‘There are layers of trauma’, highlighting intersecting traumas and pre-existing vulnerabilities; and (f) ‘Where does the help come from when we can't do it?’, encompassing difficulties accessing services and impacts on the helping workforce. Conclusions This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.

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Section: Discussionmentioning

confidence: 99%

Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires

Cowlishaw,

O'Dwyer,

Bowd

et al. 2024

BJPsych open

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“…Additionally, since 2014, new mental health strategic plans have been developed in every state and territory of Australia which have implications for rural mental health workforce. However, rural factors are considered in only 3.5% of occasions when workforce is mentioned (Roberts & Maylea 2019). The government has significantly improved the availability of total FTE for mental health professionals at the national and state/territory levels.…”

Section: Discussionmentioning

confidence: 99%

Spatial inequities of mental health nurses in rural and remote Australia

Sutarsa

Banfield

Passioura

et al. 2020

Int J Mental Health Nurs

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Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer‐grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task‐shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer‐led, telemedicine and community‐based groups.

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“…Multiple readmissions, a higher risk of completed suicides, and extended durations of inpatient stays could further affect clinical care due to the prevailing purview of managed care organizations to transition into community-level interventions [120]. These transitions are difficult due to the serious shortage [121] of community-based mental health services [122,123] in rural areas [124] and a lack of EIS services. Lastly, healthcare disparity is graver in rural areas, where copayments for expensive antipsychotic medication further affect nonadherence [125].…”

Section: Challenges Within the Mental Health Systemsmentioning

confidence: 99%

“…Roberts et al [121], Fontanella et al [122], Lambert and Agger [123], Summers-Gabr [124] Community shortages of mental health services in rural USA.…”

Section: Author and Year Key Findingsmentioning

confidence: 99%

Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia

Gupta¹,

Gupta²,

Esang³

2023

Cureus

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Early-onset schizophrenia (EOS) is a heterogeneous condition that has a serious, insidious clinical course and poor long-term mental health outcomes. The clinical presentations are highly complex due to the overlapping symptomatology with other illnesses, which contributes to a delay in the diagnosis. The objective of the review is to study if an earlier age of onset (AAO) of EOS has poor clinical outcomes, the diagnostic challenges of EOS, and effective treatment strategies. The review provides a comprehensive literature search of 5966 articles and summarizes 126 selected for empirical evidence to methodically consider challenges in diagnosing and treating EOS for practicing clinicians. The risk factors of EOS are unique but have been shared with many other neuropsychiatric illnesses. Most of the risk factors, including genetics and obstetric complications, are nonmodifiable. The role of early diagnosis in reducing the duration of untreated psychosis (DUP) remains critical to reducing overall morbidity. Many specific issues contribute to the risk and clinical outcomes. Therefore, issues around diagnostic ambiguity, treatment resistance, nonadherence, and rehospitalizations further extend the DUP. There is hesitancy to initiate clozapine early, even though the empirical evidence strongly supports its use. There is a growing body of research that suggests the use of long-acting injectables to address nonadherence, and these measures are largely underutilized in acute settings. The clinical presentations of EOS are complex. In addition to the presence of specific risk factors, patients with an early onset of illness are also at a higher risk for treatment resistance. While there is a need to develop tools for early diagnosis, established evidence-based measures to address nonadherence, psychoeducation, and resistance must be incorporated into the treatment planning.

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Is rural mental health workforce a policy imperative?

Cited by 13 publications

References 5 publications

Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires

Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires

Spatial inequities of mental health nurses in rural and remote Australia

Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia

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