Are we asking the right question on workforce issues?

When we talk about mental health and wellbeing in our regional and rural communities, we know workforce issues are a critical factor in providing effective service delivery. Research indicates primary turnover of allied health professionals in remote communities can be as high as 80 per cent per annum and the question we hear asked most often is, ‘How can we better incentivise our mental health roles in the bush to ensure quality and longevity?’ This question speaks to the significant challenges faced by government funders and service providers, however we believe this is in fact the wrong question to be asking.

The uniquely close-knit nature of small, isolated and remote regions across Australia is well recognised and understood, as is the stigma around help-seeking and mental health. The combination of these two facets of rural living creates a challenging context for establishing a quality and consistent mental and allied health workforce that meets both the needs of the community and the needs of our workers.

For a potential client, sharing a small and highly connected community of people, spaces and events with your psychologist or mental health support is an extremely challenging, if not a completely prohibitive, prospect. 

For a practitioner, creating a client base within your small and highly connected community has huge implications for your work–life differentiation and capacity to develop a genuine personal peer and social network.

So, it would seem that the inherent characteristics of rural and remote life create a situation that is intrinsically bound to fail or, at the very least, be significantly less than optimal both for client and clinician.

Therefore, the question we need to ask should not focus on workforce incentives, but rather take a broader perspective and develop creative bush-specific solutions.

Outback Futures has developed a bush-informed model which is achieving significant traction in staff retention, and is in turn delivering on long-term service delivery outcomes in the Central West and North West Queensland communities we are currently working in. For the three years 2018–20, Outback Futures’ average clinical staff turnover was 10.8 per cent per annum.

Key elements of this model which contribute to staff retention include:

Extended FIFO

Wendy has been a counsellor with Outback Futures since 2013. She’s based in south-east Queensland and provides both face-to-face and telehealth support to clients in central-west Queensland. Wendy and, in turn, her clients benefit from the resources, peer support and professional development available to a clinician based in a metropolitan context, and these factors are critical to her longevity and commitment to working in remote contexts. The extended fly-in fly-out (FIFO) approach means Wendy builds trusted relationship with her clients regularly in their community when she’s on clinics. It also allows her to deliver regular and consistent interim care to them via telehealth in the safety of their own home and community, while she operates from the advantages of her best context also.

Combined face-to-face and telehealth service delivery

Brisbane-based Pam has also been with Outback Futures since 2013, developing literacy and learning skills in children, and supporting whole schools and educators. She finds the opportunities of a hybrid model powerful in seeing transformational change. Utilising traditional snail mail to send resources to remote properties and providing regular telehealth support to tutors and families works well when combined with in-person opportunities to develop long-term, trusted relationships and deliver in‑person workshops.

The model also prioritises recruiting personnel for a single region, developing community co-design and ownership of long-term goals, supporting local champions and interagency collaboration.

It’s imperative we work together with our rural, regional and remote communities to develop bush-specific solutions that deliver for both our communities and our workforce.