Nearly a million Australians living in rural and remote areas will experience a mental health disorder each year. Reduced access to health services, engaging in high-risk occupations such as farming, exposure to hazardous working conditions, and environmental adversity such as flood, bushfire and drought severely impact on their health. Yet, throughout Australia and New Zealand, there is a significant ongoing maldistribution of the psychiatry workforce across regional areas. Rural psychiatry requires practitioners to have broad knowledge and a generalist skill set to meet the demands of regional communities. This includes being able to work across the lifespan within a range of clinical, administrative, leadership and educational settings, as compared with their urban colleagues.
Health professionals are more likely to work in rural and remote locations if they are local to an area or have resided there during their training. Rural connectedness is the foundation of future recruitment efforts. Governments have sought to capitalise on this by supporting the delivery of undergraduate and health professional training in rural and remote areas. Two government initiatives have been established to facilitate specialist rural training systems:
- The Integrated Rural Training Pipeline (IRTP) is providing greater opportunities for medical graduates interested in rural careers to maintain connections to rural communities while completing their postgraduate training.
- Regional Training Hubs, which serve to identify medical students with an interest in practising rurally, support their access to networked training opportunities and clinical training supervisors, and address the needs of the regional medical workforce.
Despite these government initiatives, traditional metropolitan-based and -administered postgraduate specialist training programs have remained the status quo. Reform in structuring, promoting and supporting dedicated rural training specialist pathways is desperately needed. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has committed to addressing this challenge by instigating a bi-national scoping project supporting regional, rural and remote training.
The Specialist Training Program team at RANZCP, in collaboration with Australian Healthcare Associates and a RANZCP scoping project steering group, have consulted with over 200 key stakeholders to gain a deeper understanding and appreciation of the issues, barriers and enablers to expanding psychiatry training across jurisdictions in regional, rural and remote areas. Post locations, training delivery modes, educational support and networking, workforce initiatives and frameworks, career development and funding requirements have been explored, along with schemes for the ongoing future expansion of existing rural training opportunities and initiatives. Attention has also been given to the personal and social challenges and advantages of living within a rural community.
The scoping project has created a roadmap for a dedicated and robust rural psychiatry training pathway. The roadmap is purpose-designed to deliver the RANZCP Fellowship Program in rural locations, with an emphasis on generalist psychiatry, and is intended to maximise training opportunities and increase the availability of rural psychiatrists. Comprehensive short- and long-term action plans have been developed for its implementation, along with strategic recommendations for advocacy with state and federal governments, planning authorities and health services.
Aligning with other medical workforce strategies of the Australian and New Zealand governments, RANZCP endeavours to deliver an equitable purpose-fit postgraduate specialist training program in rural and remote areas to develop a sustainable rural mental health workforce for the future.