Workforce is one of the most recognised challenges for rural and remote communities across all industries, but especially for the health sector and, perhaps even more so, within the mental health sector.
In a rural and remote context, workforce shortages result in key challenges for those seeking mental health services including:
- poor accessibility due to the tyranny of distance and isolation
- lack of reliability and consistency of quality service due to low availability of practitioners, resulting from experienced practitioners being less willing to relocate to the bush and high staff turnover
- communities disengaged from help-seeking due to decades of poor service delivery, poor mental health literacy, and stigma associated with mental ill health in small communities.
These underlying challenges contribute to significantly poorer mental health outcomes in rural and remote Australia, compared with urban areas (Australian Institute of Health and Welfare, 2021).
Outback Futures believes that staff recruitment and retention in remote areas have two significant, and unavoidable, inherent challenges:
- Isolation, which is a deterrent for a senior experienced practitioner needing to relocate their family from a well-resourced and serviced urban location. Even if recruitment to a position is achieved, this reality leads to short tenure and high turnover.
- Professional and personal balance is almost impossible for any mental health provider when trying to develop both a confidential client base and a supportive personal social network from the same very small, close-knit and interconnected pool of people. It is a natural inhibitor of good staff retention and creates a no-win scenario for both the practitioner and the client.
Often, the identified challenges of workforce shortages focus on addressing maldistribution of resources in rural and remote contexts. Our experience suggests the common questions being asked to address maldistribution – such as how can we better incentivise our rural recruits – are not the right questions and are not resulting in sufficient change to remote service delivery.
In a rural and remote context, traditional centre-based mental health service models are more costly to establish, struggle to attract and retain professional staff, and do not effectively provide consistent and accessible service delivery.
Outback Futures has developed a proven remote area alternative to a centralised approach, known as Work In Work Out (WIWO). It is replicable and scalable.
The WIWO model was established through a process of genuine co-design and has been robustly tested over the past five years with the remote communities in which we work.
Under the WIWO model, metropolitan-based, multidisciplinary clinical teams are recruited to work within a specific remote region. These clinicians regularly visit the region to support clients through face-to-face appointments, and also provide regular telehealth appointments while working outside of the region from their home base. Regardless of where the clinician is, their focus and attention are given to a specific region.
Sunshine MacDonald is a speech pathologist who has been working with Outback Futures since 2017. She works out of Brisbane with the Longreach Region Team.
‘Being part of a multidisciplinary team provides significant peer support, particularly when working with clients with complex needs. The ability to provide telehealth services from anywhere, along with the organisation’s flexible workplace approach, has allowed me to balance my family’s needs alongside my work demands,’ says Sunshine.
To date, WIWO and the Outback Futures Community Facilitation Model are being implemented across five remote regions throughout Queensland, providing consistent, reliable and accessible mental health and wellbeing services for these remote areas. The model has proven to be successful for both clients, clinicians and communities.