Develop the strength to do bold things

In the past few years, Australia has seen it all: drought, bushfires, floods and then, to top it off, a pandemic. Our rural and remote communities, which were already struggling, needed mental health care more urgently than ever before. But mental health services were already thin on the ground.

Rural and remote Australians are 28 per cent of our population. The folk out bush have poorer health but lack the access to healthcare services that their urban peers enjoy. This is very noticeable in mental health. Australians experience mental illness at similar rates across the nation but in rural and remote communities, where access to mental healthcare services is poor, there are higher rates of self-harm and suicide.

During COVID-19, the Australian Government called upon all jurisdictions to accelerate change and implement actions listed in the National Mental Health and Wellbeing Pandemic Response Plan. This was a nationally consistent, whole-of-government approach. This rapid response closed some critical gaps – demonstrating that health systems and policy can be changed rapidly and responsively.

Telehealth was a major part of that response and has been an effective stopgap measure. However, it is not proposed as an appropriate replacement for comprehensive face-to-face mental health, primary care or rehabilitation services. Sometimes telehealth is cited as a solution for failure of service provision in rural communities, but rural consumers tell us that they want access to care close to home, with continuity of healthcare provider. Hybrid telehealth and face-to-face models of care can provide that if they are place-based and codesigned with the community. But blanketing rural and remote Australia with telehealth care will not solve the problem.

We can learn from the pandemic response and reflect upon our approach to rural and remote health care. A new course can be determined; we should codesign with communities place-based models of care using multidisciplinary rural and remote healthcare teams. It must not be forgotten that rural and remote health care includes primary and secondary health care, mental health, emergency and retrieval services, with strong links to tertiary care.

In June 2022, key rural and remote health stakeholders came together to discuss rural and remote multidisciplinary health teams. The goal was to draft a consensus statement and guiding paper for use in rural and remote healthcare policy and the design of rural models of care.

We want to see rural and remote communities having the infrastructure and support to enable local, integrated, fit-for-purpose, multidisciplinary primary healthcare models of care specific to the community. These would need high-functioning and sustainable teams of health professionals, with rural generalists from multiple disciplines at their core, working together across rural and remote regions.

We need to plan for these teams by selecting students who have rural origins and increasing the availability and duration of rural training placements for all health professional students. Rural generalism must be recognised as a specialist field within general practice and the National Rural and Remote Nursing Generalist Framework must be recognised and used as a basis for curriculum development. The Allied Health Rural Generalist Pathway must be supported and expanded with nationally consistent training. National consistency should also be evident in industrial frameworks for the rural generalist scope of practice in all professions.

All of these bold things can be done. We just need to look at the system differently and acknowledge what works in rural and remote health care and also what doesn’t work.

With timely and wholistic intervention and treatment, physical and mental illness can be successfully managed in rural and remote Australia. Solutions require strong national leadership, adequate resources, flexible funding and local service planning.

I will leave you with an old but gold quote. We must ‘Develop the strength to do bold things, not the strength to suffer.’ (Machiavelli, 1513)