In Australia, moves are afoot to review and implement changes to the mental health services and programs on offer – including those offered to young people. Change always produces some tensions, and that will be the case again in this situation… but something had to give… change was needed to see equitable improvements, and none more obvious than for rural young people with mental health problems. So here we go – join me on the slippery slope of mental health care reform roller coaster!
The media have labelled the staged funding reductions to early psychosis services as “Futures will be lost. Health fears as youth pychosis program dropped” Read about it here: http://www.smh.com.au/federal-politics/political-news/futures-will-be-lost-health-fears-as-youth-psychosis-program-dropped-20160429-goi1hu.html
This begs more questions: The future of who…? Who will be advantaged…? And, who will be disadvantaged…? How do we achieve fairer and more equitable care for all of our young people throughout Australia? There are no easy answers or solutions… to suggest there are is to reveal a flippant disregard for the complexity of meeting the mental health needs of young people today.
I’m an optimist…
I hope that the government have got this right… and that a redistribution of youth psychosis program money will benefit young rural people more equitably as a result… Of course, advocating for the equitable mental health needs of young rural people has been my long-term professional activity of mine! So, I can only hope that this new direction to send funds to the primary health networks – will in fact work for rural and regional young people where the gaps are larger! There are some risks to note. For example, how will people be mobilised from their comfort zones to take up work in new geographical regions…? Will this be supported in the recruitment of appropriate servicing of populations? Will it really be equitable? Or just equal? Will health professionals be contracted using brokerage models as they are ‘commissioned’ for services? And, if they are, how will this new model ensure that health professionals are able to be fully employed at reasonable pay rates, in keeping with their level of expertise? How will we mitigate the risk of under-employment of people in low population communities yet maintain equitable service levels? How will the ‘gaps be filled’? Has this been fully considered?
I don’t think that the new approach to funding of youth mental health care this is such a bad thing for rural and regional young people. I have been calling for a more equitable and inclusive distribution of the mental health dollar for many years now… (eg https://www.researchgate.net/publication/275340216_Rural_nurses_A_convenient_co-location_strategy_for_rural_mental_health_care_of_young_people )
… it has not always made me popular…
The harsh reality is that rural youth often have much longer durations of untreated mental illness, poorer access to mental health services and poorer prognosis as a result… And, the largely urban-centric models of specialist youth mental health care have not met the demands for rural youth with mental health care needs. Something needs to give a little… perhaps this new funding model will be it… But – it needs to explain how it will include nursing expertise to promote mental health among young people at its core… Because, nurses are already there in all communities… and they represent a present resource that can be better engaged in primary care.
How will nurses be engaged in the primary mental health care of young rural people? The role of nursing in the models of care continues to be vaguely described at best in current strategy offerings… Only using nurses for managing chronic care (ie the Mental Health Nurse Incentive Program) is a sure-fire for short-changing the mental health of young people… becasue… young people have simply not lived long enough to have ‘achieved’ chronic mental illness status… rendering them ineligible for government supported nursing care in the main! Thus, how will this new model of funding utilise the expertise of nurses to deliver primary mental health care to young people and mitigate the early identification and intervention end of the care spectrum problems? Remembering of course that nurses make up the largest proportion of health professionals representing and the largest proportion of human resource for mental health service delivery throughout the country? Nurses need to be a large chunk of the journey towards successful new models of care – yet they seem to be overlooked in the latest iteration of change. Why?
I am not yet convinced the the Primary Health Networks will be the solution… but I am prepared to be open-minded about the possibilities… I hope we are seeing the beginnings of something substantially more useful than reshuffling deck chairs. I think closer federal collaboration with state health, education, family and community services and police/ justice services will bring more profitable benefits. But, while a two tier government approach persists in mental health service delivery (Federal and State/s), problems in administering equitable services will also persist with bureaucratic double-ups inevitable, ultimately soaking up some of the direct clinical and research spend potentials.
I agree with McGorry, that many gains have been achieved through the concentrating of specialist expertise in a small number of specialist services, and that it would be a shame to lose this. But, having built this considerable national human resource – if it were mobilised and dispersed across the country (for example, the experts geographically relocated) this have a benefit of authentically redistributing the talent and in doing so benefit more people over time. Is it time to mobilise the specialist population for greater good in health service delivery? A question for health geographers and health ecologists to ponder. Will redistribution of funding trigger a wider set of conditions in communities such that mental health is more effectively promoted? I think that this is possible: https://www.researchgate.net/publication/280134451_Rural_Mental_Health_Ecology_A_Framework_for_Engaging_with_Mental_Health_Social_Capital_in_Rural_Communities
It is not all bad news, a new model could bring with it ‘catch-up’ conditions to more vulnerable and harder to reach young populations who should have convenient access to local mental health support where and when they require it. The challenge is for mental health professionals to work together using digital technologies to bring us together, it is after all what we expect of our clients these days! That is, to be satisfied with e mental health/ telehealth and digital gateway (triage) delivery….
Perhaps health professionals will also need to adapt our practices in the ways that we work and collaborate with each other – building virtual centres of excellence rather than geographical catchments of excellence. In doing so, some castles will be dismantled – and new ones will emerge… shifts in the sands of time across the landscape of mental health service and evidence development and delivery are inevitable.
It is clear that the health budget in Australia will never be able to fund sufficient levels of mental health service delivery for Australian young people – our present budgets don’t go near sufficiency. Finding ways to squeeze a few extra drops of oil out of the rag are always going to be critical… the challenge is out for mental health researchers to be prudent in devising ways in which we can continue to do more, with less, and for politicians and policy makers to take heed of evidence as it emerges… And finally, for clinicians to be ready to adapt to the changing times as they evolve. None of that is easy!
Relevant other links:
I heard a leading rural public health professor speak last night (at the Robb College (@robbcollege) annual Health Lecture and Dinner – University of New England @healthune) about the challenges and opportunities that exist in rural and regional health in Australia and across the world. I was spurred on… motivated… inspired… to keep pressing forward in contributing to rural health progress. Professor Ian Wronski, Deputy Vice Chancellor – James Cook University, shared some of what he has learnt along the way while working in public health in rural Australia.
Some of what got me thinking…
- When you get stuck without many resources… try new things!
- Rural politics… often not enough marginal seats to attract funding and resources…
- Sustainability in the primary care workforce is vital for the health of rural communities. Not limited to a sending-in style of health care delivery… but embedding and internally generating health workforce within rural communities.
My entire health career has been played out in rural committees… These three points struck a chord with me because they aligned with what I know of rural communities. A dollar, please, for every time I have had to innovate my practice because the oily rag needed to be squeezed a little tighter!
Trying new things is something that rural people are good at! Using our strengths! That is, the skills that are so much second nature to us that we sometimes forget that they are indeed special skills. Trying something new, and finding a way to make something work, finding the work-around solution, finding a new way using the resources we have at hand… that is innate rural culture. That is… what rural people do extremely well… but of course – there are limits!
Rural people conduct themselves resourcefully. They are not wasteful of resources because they work hard to obtain the resources that are carefully matched to the needs, ensuring they get the last drop of ‘oil out of the rag’. They make do! Where I grew up we had one (thinking back – very small!) water tank to collect rain water for household use. Nobody wasted a drop – it was valuable, it was used wisely and recycled where possible. Never a tap was left to drip… the sentiment permeates and translates to rural life and culture in general. I think these are key characteristics of rural people and communities, and these attributes help to make up the social capital and the human ecology of rural communities. I have written a bit about that... and have explored the contributions that nurses in particular make to the mental health care of young rural people.
There is something to be said about the dynamics of rural politics though. Political pressures underpin resources allocation for public health and especially in regard to mental health of rural people. The national and state spend on rural mental health (or mental health generally) is consistently poor. Nationally this bears out with a stable suicide rate over the past ten years – not a reduction… but rather a complacent stability, with rural communities bearing a disproportionate burden. The reality is that many rural political seats are ‘safe’… and one of the limitations that is associated with this political condition impacts adversely on public health resource allocation. It is a bit like the water tank of my childhood never benefiting from sufficient rains to fill it up… and for us constantly monitoring the water level by tapping the sides of the tank to listen for the tympanic changes to signal volume levels. Worrying about how much water was left and guessing how far it might need to go before the rain came again… reducing our use to reflect the remaining residue, and not having enough to do anything extra. I could still show you the corrugation groove around the one third full mark that changed the mood in our family to austere use of water and restrictions for our family – indelibly marked in my psyche! When the rain doesn’t fall in the rural mental health budget – there is never enough resource to do the prevention, mental health promotion and early intervention care because those elements of health care provision can be thought of as when the tank is only one third full – so restrictions need to heeded and the valuable resource only used for the most serious circumstances – often too little, too late. But – in marginal seats – it appears that the weather forecast is often more promising… Try someone new might be a good rural political slogan for the future… ?
Professor Wronski had Six Tips to enhance rural public health:
1. Invest in locally driven solutions because local proximity to the problem drives finding solutions. (Rural people are close to the problem so they are likely to also be close to the solution)
2. Take intellectual risks. (Think about things and then do things!)
3. Use evidence to drive decision making. (Not whims and hunches… but take the time and effort to generate and gather the evidence – then apply it!)
4. Fail fast and use it to learn from. Then, Retry, Retry and Retry again. (Fail fast… I like that… but don’t give up especially if you are doing 3 & 4 above… learn more – try again… love it!)
5. Facilitate collaboration and co-creation. (Working together)
6. Identify scalable solutions that will have disproportionate impacts as you scale them up. (‘From little things – big things grow’)
A lot of good advice! Some good signposts for keeping public health on track – out back!
The time has come – health professionals should embrace social media and use it to promote health, well-being and recovery to the multitudes!
There are a great many opportunities to enhance the health of people and communities which can gain a foothold in the social media environment. And – I think nurses in particular should be a the forefront, leading the charge to a healthier future… I think that so much, I gathered up several other colleagues over the last year, and together we reviewed the literature to figure out just how this could be achieved…. and now we have published our first paper on the topic….. Here is the link:
You can read the abstract at the above link, and the journal article itself is available through health and academic library subscriptions…..
Here are a few facts from our paper:
Global expansion in internet and smart phone availability has led to rapid expansion of social media
2.7 billion subscribers (39% of world population) to the internet with 77% of these coming from developed countries
750 million of households globally are now connected to the internet which represents approximately 41% of households across the globe
75% of the developed world population now have a smart phone
Facebook has 11.5 million Australian users and half of them check facebook at least daily
LinkedIn has 2.7 million users
youtube has 11 million Australian users
Skype is used by about 280 million users around the world with and average of 7 minutes use per user per day.
Australia has 12.2 million internet service provider subscriptions -1/2 are wireless and 3/4 are households.
- There are 17.4 million smart phone subscription in Australia – and rapidly rising.
- Four out o five professionals use some form of social media.
- Young people have a high uptake, and proficiency, of social media.
- Increasingly health care will need to communicate and offer services and health promotion utilizing social media, because that is fast becoming the standard mechanism for convenient communication with people.
- Social media represents the beginnings of a new era of communication and offers a platform from which health interventions and health communication can develop in the future
- There are new potentials for e-health practice
…and if the isn’t convincing enough – this is what nurses have been up to using Twitter at conferences:
At the Congress of Nurses Conference in Melbourne, Australia May 2013. Delegates and non-delegates participated in a dynamic, unplanned and spontaneous Twitter conversation prior to, during, and after the live face-to-face conference of about 4000 delegates. A total of 221 individual tweeters engaged in a lively conversation about nursing issues during 19 May – 25 May 2013, using #ICNAust2013 (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). Conference organizers did not organise or encourage the Twitter conversation, however it developed without any organized effort with tweeters self-initiating and participating in conversations. ……. Most of the posts consisted of an exchange of ideas about paper presentations. Other conversations developed where colleagues arranged to meet face to face using Twitter as a communication tool. A total of 3000 tweets using #ICNAust2013 occurred during this period, half of the tweets and mentions amongst the top ten influencers identified in their usernames a connection with one university in Australia (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). …. The top ten influencers (made up of nine nurses and one health journalist) for the #ICNAust2103 were users with larger cohorts of followers and these users developed a cumulative impression footprint which numbered 1 million connections, while the total cumulative impression for #ICNAust2013 was 1.4 million. Thus the conversation of the wider conference of just 4000 face to face delegates had a wider SoMe impression that extended to 1.4 million Twitter users (www.symplur.com/healthcare-hashtags/ICNAust2013/analytics). The actual impact and the impression footprint are quite different; however the potential for influence should be noted.
And more recently… at the 39th International Conference of Australian Mental Health Nurses in Perth, October 2013, Nurses were again out in force on Twitter! About 400 face to face delegates were present but there were over 140 individual Tweeters producing in excess of 1000 tweets and with a digital impression of about 600,00 using #ACMHN2013
There is much good that can come out of nurses and other health professionals embracing social media, developing proficient skills in using social media, and becoming advocates for fair, equitable and healthy changes for people and communities.
Challenge – Let’s see how much good we can achieve!
What ideas do you have to contribute to get the ball rolling…..?