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!
At the moment, the media is laden with calls for reform for youth mental health in Australia. My research informs the debate:
My research specifically addressed the problem of rural young people accessing mental health care. Following one Masters (Hons) and one PhD examination of the problem, I have formed some evidence-based views on ways forward: Here is an extract (Thesis Chapter 5: pages195-197) one that relates to headspace and the potential nurses have to be a more effective contributors to early mental health care if funds were redirected from headspace for a more equitable distribution to help young rural people:
Implications for policy…
- The national mental health strategy headspace, does not currently possess the capacity to be extended to every rural community in Australia. E-headspace does have some scope to contribute a useful component to a rural youth mental health strategy if rural e-mental health knowledge brokers are available in community rural nursing settings or Medicare Local centres to facilitate this strategy in the rural environment.
- The headspace initiative should be reviewed by the Department of Health and Ageing with an aim to facilitate the redistribution of federal funds to include a contribution to the operational costs of rural nurses to act as e-mental health knowledge brokers for young rural people on a per capita basis, so that at least population-based equity of distribution of youth mental health financial resources is available in all communities, rather than, as is currently the case, restricted to one service centre in one regional community in the study site region.
- Further reform of youth mental health services is required to ensure that rural young people have reasonable access to mental health services in keeping with international progress and development about youth mental health services that challenge the traditional paradigms of youth mental health service delivery (Coughlan et al., 2011, 2013). There is wide agreement in the literature that young Australian people are underserviced in early mental health care, and that for rural young people this circumstance is further amplified (Coughlan et al., 2011; Mendoza et al., 2013; Rickwood, 2012; S. P. Rosenberg & Hickie, 2013).
- Rural nurses should be adequately funded to support e-mental health kiosks in appropriate community settings such as hospitals, multi-purpose health facilities, community agencies, schools and police stations. Rural nurses are able to collaborate with professionals from all of these sectors in such a way that collaboration of mental health helping and capacity building in rural communities is achieved and coordinated. The architects of health, social and law policy will need to accommodate the inclusion of new and innovative roles in the future. In particular, the function, role description of rural nurses, and specifically the role of rural community nurses will need to be expanded so that meaningful mental health help can be provided to early mental health help-seekers.
In press now:
Wilson, R.L. & Usher, K. (2015) Rural nurses: A convenient co-location strategy for rural mental health care of young people. Journal of Clinical Nursing. (in press April 2015).
I love the buzz of a nursing conference… I am attending this one: http://www.rcn.org.uk/__data/assets/pdf_file/0019/620317/RCN-2015-research-Book-of-Abstracts.pdf
These days – a prerequisite to getting the most out of conference attendance is making sure you have a Twitter handle – here is mine @rhondawilsonmhn You need one of these so you can follow the Twitter concurrent Twitter conversation which extends the discussions a great deal. Conferences usually have a hashtag to follow… this one is #research2015. Putting the hashtag in the twitter search engine and saving it allows you to visit and participate in the conversation. I think I got about 25 new followers yesterday alone by doing this – that extends my professional network and puts me in touch with nursing colleagues around the world. Meeting people #IRL (In Real Life) is then made easier – because you already have had an introduction connection. Here are the social media analytics for yesterday!
78 Avg Tweets/Hour
6 Avg Tweets/Participant
My twitter network started to expand at breakfast yesterday with meeting Dr Camille Cronin from Essex –@ – sharing some ideas about nursing scholarship.
Then – at registration, caught up with a colleague that I first met on Twitter a couple of years ago (in Perth Australia!)… We follow each other on Twitter… a mental health nurse academic @ from Scotland.
Then the snowballing commenced! So many interesting people to meet over coffee and so many mints to collect in exhibition area.
Day one (yesterday) 20 April, 2015 was a buzz! Here are my highlights from the sessions:
The big theme shining though: The essential and most valued work of nursing are the invisible interventions, actions, the caring, the listening, the being with and sitting with, the provision of kindness and comfort, being engaged and present… those are the nursing attributes that matter to our patients. Nursing is not limited to bunch of skills: how well we can write our notes, administer a pill, insert a tube… it is about how we engage when we are doing the technical work… Very motivational.
- Prof Jill Maben spoke about the soulless factories of healthcare… and called for a humanising of health care for patients and nurses…a refreshing reminder to value the listening and being with our patients – to engage, connect and care. My tweet:
- Aussie Nurse, Elizabeth McCall – presented her research findings about brief interventions to address alcohol harms in a rural A&E department… she urged ED nurses to take the opportunity to ensure that they deliver appropriate brief interventions in A&E. A good qualitative study by a research active practitioner. My Tweet:
- Then – off to hear Dr Paul Gill (Cardiff) give a great presentation encouraging Nurse PhD success. My tweet:
- Jill Taylor (somewhere in Scotland) gave a impassioned presentation of her PhD about the work of Health Visitor nursing and the emotional labour involved – the stories in her data were compelling listening. My Tweet:
- Prof Lesley Wilkes (Australia) gave a fascinating report of her research about the experience of Refugee Health Nurses working in NSW, Australia. Loved this one… and really made me think… I wondered how it might be if the Refugee Health Nurses of the future had their own lived experiences of asylum seeking…
- John McKinnon (Lincoln, UK,) spoke about empathy… my pick of the day… I was glued to the whole presentation – the ways that nurses use empathy as a vital nursing intervention is a critical nursing experience… I heard a rumour he has a book coming out…. I will be lining up to buy it!
- Austyn Snowden gave a terrific presentation about the challenges of achieving ethics approvals – very impressive presentation: View it here
The bar has been set high… Day two is about to start… I am inspired by my colleagues and the company I am in here…
…. no Robin Hood sightings yet…
Last night the media revealed a government mental health report that highlights the need for improved funding of community based mental health services in Australia, triggering a diverse social media conversation about some of the pertinent issues.
Key highlights include people reporting:
- barriers to accessing mental health care
- major challenges when seeking mental health care for the first time
- being turned away from mental health care when help was needed
- suicides related to lack of timely access or followup to mental health care
- the suicide rate has been largely steady in Australia for many years – a failure to reduce mortality
- recognition that suicide is preventable – and especially so if we can improve access and point of care service delivery for mental health help seekers
A recommendation from the leaked report is reportedly that a significant investment be injected into improving community based mental health services. This is a good idea. It is not a new idea – there have been many advocates and voices bringing forth this suggestion. More mental health professionals at the the cutting edge – in primary health and in community health and other settings. More investment in helping young people – enabling their care, not inserting more barriers and waiting until they become so unwell that hospitalisation is the only choice. Community mental health care is a poorly funded and barely accessible – unless you get lucky. Luck is not a sustainable commodity on which to base the ongoing mental health of the population. The social media discussion is one that should generate some pressure to release the report to the public and to invite the public to generate new ideas to address the challenges of providing a fair, equitable and accessible mental health service to the population.
Here are some of the links to the recent social media conversation:
Mental health nurses have a great deal to contribute to the development of improved models of mental health care delivery for Australia, and they need to leading and consulting in the current debate. Some are bring more prominence to the debate by reminding the community that mental health nurses are here to help, an that they should not be overlooked in the develop of new models, policy and governance. mental health nurses should be included as full members of committees that seek to bring progress and improvement to what many are terming a ‘broken service’ (mental health service). Using the hashtag #heretohelp , nurses are advocating for inclusion and for improvement. If you see a #heretohelp hashtag – consider retweeting it or sharing it to show support for mental health nurses.
Nurses do an amazing job working to care and prevent many deaths caring for people with a wide range of mental health problems. In our acute services they are working with people in crisis and restoring many people to health and wellness. Among health professionals – nurses are the great proportion of clinicians caring for people with mental illness. That position gives nurses an important perspective on the delivery of mental health care. Nurses need to be listened to, and their work considered carefully in future planning.
I am a mental health nurse, bucket loads of clinical experiences and plenty of research experience as well… I have published work that makes recommendations for improving the delivery of mentla health care to rural people… here are soem of my ideas and recommendations in this portfolio of papers: https://www.researchgate.net/profile/Rhonda_Wilson3
I am #heretohelp – join me!