Abstract
Focus on research, training and education
As the drought bit hard and workforce shortages persisted, the spotlight in 2006 was on the needs of rural communities.
Our focus was on research, training and education. The rural symposium at the Perth congress was an energetic forum, which addressed the theme Research and education in rural setting.
Professor Ernest Hunter gave an impressive keynote speech to open the forum.
We are planning our Gold Coast congress symposium and invite your interest and attendance.
Other major outcomes of the RSIG collaboration in 2006 included the SSRS professional education project and the ongoing focus on rural training through the RASTS project. Updates on both projects are provided below.
The Rural Special Interest Group provides a great opportunity for rural psychiatrists to remind themselves of the benefits of rural practice – whilst considering strategies to promote access to quality mental health services outside of urban settings. Contact us if you would like to join our growing membership. There is much work to be done.
Response to SSRS exceeds expectations
Attendances at the first three videoconferences under the Support Scheme for Rural Specialists (SSRS) project far exceeded expectations.
About 60 people – the majority psychiatrists and a handful of trainees-attended each session at 30 sites.
Additional funding has been granted by the SSRS to accommodate larger attendances.
No distinction was made between local and international medical graduates or college members, as has been the policy of the RSIG.
An evaluation of the sessions found that Professor Gordon Parker, Professor Philip Mitchell and Professor Stephen Jurd had been well received, presenting topical information.
Professor Gavin Andrews and Professor Pat McGorry were also scheduled to present sessions.
The topics and speakers were chosen following a poll of rural and remote psychiatrists.
A summary of outcomes and future directions will be given at the RANZCP annual congress on the Gold Coast at the end of April.
Further information on the project can be obtained from Dr Tina Thomas, RANZCP head office in Melbourne (61 3 9640 0646), Ms Rachael Williams, Project Officer through the RANZCP's Western Australian branch office (61 8 9284 2138) or myself.
Study reveals “psychological dependence” on alcohol and marijuana
By Dr Tricia Nagel
An ongoing study in the Northern Territory has found that 76% of indigenous people with chronic mental illness living in remote communities have a psychological dependence on alcohol or marijuana or both.
The Australian Integrated Mental Health Initiative in the Northern Territory (AIMHI NT) is overseeing a series of indigenous mental health projects, which have been funded for five years by the National Health and Medical Research Council. The projects aim to develop simple, accessible psycho education and psychotherapeutic approaches which are relevant to remote indigenous communities.
The NT indigenous community has particular difficulty accessing specialist services given issues of distance, language, literacy and worldview [1–4]. Moreover, there is a need to marry traditional ways of understanding and treating mental illness in order to develop a therapy which is appropriate to indigenous people [1], [5–9]. Further clinical research into indigenous-specific interventions is needed, given high numbers of indigenous hospital admissions for psychiatric illness, and escalating substance misuse, self-harm and suicide rates [5], [10], [13].
The AIMHI NT research team includes indigenous mental health workers and research officers. An ongoing random control trial by AIMHI NT is comparing a care planning intervention with “treatment as usual”. The project has recruited 49 people with chronic mental illness in two remote communities [14]. The intervention reflects the principles of motivational interviewing, chronic disease self-management and traditional story telling [4], [7]. An 18-month repeated measures design with delayed treatment group was used, and data was collected at baseline, six, 12 and 18 months.
The participants were randomised to one of the two conditions. Treatment occurred at baseline in the first group, and six months in the second group. Of the 49 clients enrolled in the trial, 49% were smokers worried about their smoking, 49% were worried by a current physical illness, and 76% described psychological dependence on alcohol and/or marijuana (measured by the severity of dependence scale – cut off score of 4).
Of the respondents, 55% described worrying about their own violent behaviour, and 49% were worried by their own self-harm behaviour or suicidal ideation. This group of clients are likely to come to the attention of services other than mental health – such as alcohol and other drug services, domestic violence services, correctional services, family and children services, and primary care providers. It is particularly important that mental health professionals promote capacity to identify and treat indigenous mental illness in these settings.
REFERENCES
Barriers to rural training
The absence of any residential placements in some areas and a lack of rural placements to meet demand in other areas were the key barriers to rural training identified by the RANZCP's Rural Advanced Support Training Scheme (RASTS) project.
Regionally, the following concerns were highlighted:
Absence of any residential placements in rural South Australia.
Northern Territory has poorer access to resources and educational activities.
Victoria has a thriving rotation program, though seemingly less capacity for extended rotations or continuous rural training.
New South Wales has faced the greatest need to increase rural places and the definition of borderline rural places has at times been an issue. There has been excellent progress with the assistance of the state-funded rural psychiatry project.
Queensland has the largest number of trainees based in rural areas. There is strong representation for rural issues at the Branch level but no state-based support program as in New South Wales.
Tasmania was previously considered an area of need and did not previously have to develop specifically rural rotations. The state as a whole has recruitment/retention difficulties.
West Australia may not have enough rural places to meet expected demand over the next few years. Most rotations are remote and there may be a lack of options for those with special circumstances.
Overall, the challenges to the development of rural training included:
Interpretation of bylaws around visiting service provision and accreditation;
Allowance for trainees with special circumstances (e.g. young children);
A perception of workforce shortage in the cities, and lack of recruitment to the discipline overall;
Shortage of sub-specialist training places, particularly in rural areas;
Quality of basic infrastructure on rural rotations (e.g. accommodation);
Workplace arrangements for rotations – e.g. leave transfer, arrangements for salary sacrifice – and on-call registers;
Lack of awareness or concern for rural affairs within city-based administration.
For more information on the Rural Special Interest Group please go to http://www.ranzcp.org/publicarea/rural.asp. For more rural news and information on the RASTS and SSRS projects, please go to http://www.ranzcp.org/members/collegestructure/sig/rural.asp