The future of regional, rural and remote psychiatry

  • Woman using laptop to talk to mask wearing woman
Dr Skye Kinder
By
the Royal Australian and New Zealand College of Psychiatrists
Dr Skye Kinder
Member, RANZCP Trainee Representative Committee
Young Australian of the Year (VIC) 2019

Associate Professor Mat Coleman
Chair, RANZCP Section of Rural Psychiatry


Issue
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Over the past year, the COVID-19 pandemic has highlighted gaps in mental healthcare in Australia. Despite an increasing need and demand for mental health services across rural, regional and remote areas, people living outside of the capital cities are currently under-served in terms of access to psychiatry and other mental health services. Recent funding announcements and recommendations from various royal commissions and inquiries will go some way to creating systemic change; however, this change cannot happen without a workforce to enact it.

It is therefore clear that in order to achieve positive outcomes for people living with mental illness in rural, regional and remote areas of this country, as well as to achieve positive outcomes for their families and carers, we need to reform and future-proof our mental health workforce outside of the major cities. The specialist psychiatric workforce remains concentrated in metropolitan locations, and while some success has been achieved in rectifying the maldistribution of psychiatrists and mental health professionals, a predominance of training programs and services continue to be administered and supported in mostly metropolitan locations.

Recognising these challenges and the clear need for change, the RANZCP is conducting a scoping project to develop a blueprint for dedicated and enhanced bi-national rural psychiatry training opportunities. This work will expand on the efforts already made to increase training rotations and experiences through the Commonwealth funded Specialist Training Program (STP) and Integrated Rural Training Pipeline (IRTP) funding initiatives.

However, additional foundational funding to support the RANZCP will be required to further develop this strategic work to improve the distribution of the psychiatric workforce into the future.

Additionally, the creation of a diploma in psychiatry would provide the opportunity for generalists, particularly those working in rural and remote areas, to seek further training in mental health and psychiatry. In the interim, while the RANZCP continue to build capacity in rural, regional and remote psychiatric services, the temporary expansion of the availability of telehealth for clinical services in light of the COVID-19 pandemic has been an unexpected but welcome development.

Psychiatrists have highlighted a number of advantages of the use of the temporary telehealth item numbers, including increased accessibility for rural people, improved patient wellbeing and engagement, increased engagement with hard-to-reach consumers and increased service availability.

Of course, access to psychiatric support through telehealth is similarly inequitable for some rural, regional and remote patients, and we have noted some people lack access to the required equipment, poor internet connectivity, and technology failures as key issues that require attention. It is therefore essential that future use of telehealth in psychiatry be informed by the basic principles of equity, accessibility and effectiveness.

Ultimately, achieving a fundamental reshaping of our mental health system will require a long-term commitment, strong planning, and co-operation across public, private, government and not-for-profit sectors, and with community members. Now is the time for us, as medical practitioners and industry leaders, to call for better support and an iron-clad, long-term commitment from our leaders and governments to addressing the underfunding and under-resourcing we face in rural, regional and remote healthcare.

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