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:
The contribution that our pockets make to the nursing profession is under-recognised! Nurses are adept at filling them – inside and out… Have you ever wondered what is inside a nurse’s pocket? Recently, some new nursing students, asked me what they would need for going on prac… and so, I turned out my pockets… this is what I found…
- Smart phone – and before that mobile phones… and before that fax machine print outs!
- Scissors: 29 years ago my enrolled nursing tutor said ‘a good nurse always carries scissors’, and since then, I have never been able to shake the habit, despite the fact that there is no evidence to support the notion! I just wanted to be good! We used a short length of O2 tubing to stick on the pointy ends to avoid getting poked in the pocket!
- Pocket clip An important accessory at one point was the metal pocket clip that had 3 or 4 stretchy pen holders – you could clip it on your pocket, then fill it with pens, scissors, artery forceps – and you looked the part!
- Notebook with hand over notes. I used to have a very cute little pocket size ring binder… so stylish! It was my favourite.
- Black pen or two… someone will borrow one pen and forget to give it back! So carry two! Actually, when I started we had a blue pen for most things, green pen for recording respiration rate on charts, and red pen for noting allergies and heart rate… it was a complicated business… – and then we made pen holder contraptions our of O2 tubing and micropore tape to attach to our pockets. It was the fashion in my hospital anyway! Then we moved on the four-colour clicking bic pen… they were all the rage! Now-a-days – black pen should do the job…
- Stethoscope… Well … nearly, more likely swinging around your neck– but sometimes they will be stuffed in a pocket. Tip: Get your own… nobody want to share earwax!
- Name tag… actually it is displayed on the outside of your uniform! But – there was a time when the most fashionable place to wear your nametag, was clipped to your pocket, and embellished with stickers! Then came the horribly unhygienic lanyard… and now we prefer the plastic magnetic nametag to wear on your top shirt pocket. But whatever the style of the era… Remember to stick it inside your pocket when you go off duty, otherwise people will look at you funny in the real world outside of the hospital!
- Neuro torch there are the disposable ones… but my favourite was a very groovy little red aluminium torch that double as my night shift torch as well. It had a key ring on the end of it, so I could attach it to my scissors to keep them together.
- Chewing gum or mint tin or a box of jols help to ward of the experience of bad smells… say no more! Just chew.
- Tube of paw paw cream… or lanolin. Ever so useful in so many situations… a blog could be dedicated to the wonders of paw paw cream alone!
- Roll of micropore tape. The nurses answer to gaffer tape!
- Sachets of alcowipes. If the problem cant be solved with paw paw cream of micropore…then the alcowipe will do the job!
- $4 for a coffee just in case someone does a coffee run. Café Latte : Skim milk and no sugar thanks. But anything caffeine laden coffee style will do!
- Bungs Nothing worse than being caught bungless and with not enough hands to fix it!
- Pair of gloves…
- Torn off piece of paper hand towel probably with U/A results scribbled on it… or vital signs… of coffee order.
- Artery forceps – no cannula too tricky!
- Prompt cards for physical assessment, mental health assessment and pathology normal range values. These helped me heaps with my report writing – especially when I was starting out!
Now as an academic nurse these days, my pocket contents has been modified slightly…
- My iphone with my facebook, twitter, instragram and linkedin apps all fired up.
- Thumb drive with the lecture of the day.
- Coloured white board markers people complain about the orange and green ones… but I like them!
- Postit notes… multi-colours preferred.
- Class roll
- Groovy coloured pen – because I get sick of black… and I like nice stationary!
- A riveting journal article to read if students are late… scribbled on with a groovy pen.
- And …still have $4 for a coffee!
I asked around and here is what other nurses said on Rural Mental Health facebook page that they put in their pockets…
Dymphia said: Alcohol wipes, IV cap, scissors, clamp, 2 x black pens, whiteboard marker, neuro torch, roll of tape.
Crystal said: Alcohol wipes, IV Bungs, scissors, clamps, numerous black pens, sharper pen, white board marker , neuro torch, tape, notebook, candy or biscuits, phone, unsolve wipes, handover paper, lip gloss (LIP GLOSS!! Nice touch)
Josie said: Duress alarm
Cassie said: Stickers and bubbles….Oh… And a few nursing bits and pieces too. Lol. But mainly bubbles and stickers. #paedsnurse
Angela said: Pens, scissors, forceps, patient list, T-bag & gloves in my right pocket. 1 vial each of Suxamethonium, midazolam, a 1+3+5ml syringes & alcohol wipes in my left pocket #aneastheticnurse
SO – there you have – nurses pockets turned out… and the contents are revealed!
This year is my 29th anniversary of commencing nursing… I have nursed in a lot of different places… and I have seen a lot of human pain, and I have been privileged enough to be in a position as a nurse to alleviate some of that pain.
I love nursing – always have! There is always something happening… it is rarely dull, not if you are playing it right!
If I had to choose the one thing that is most important for a nurses pocket – here it is: the smart phone.
One of the survival strategies for striving in a nursing career is to Be Prepared! And…one way to do that is by filling our pockets with the stuff we need, or easy and convenient access! My pocket contents have changed a bit over the time… and there is one item that I prize most and I think should be in every nurses pocket all the time… that item is your Smart Phone! Times have changed… it is a tool that we will see used more and more over the coming years with more advances in smart technologies and E health.
My tip: If you don’t have a smartphone– get one! Get involved in the social media conversion amongst nurses around the globe! And, be prepared to adapt to the changes that are upon us all. Health care promotion and intervention is increasingly happening in the virtual world… for real people!
- Be more curious about everything, you will learn more that way.
- Being kind will get you everywhere you need to go.
- Not everyone will agree with you – that is fine! Don’t take critique to personally – but use it to make you more capable, resilient and strong.
- Follow your instinct with people – the right thing to do is probably the right thing to do. Trust your gut feeling.
- Read everything you can about nursing topics. Read every new journal issue you can! That way your gut feeling will be steeped in evidence!
- Learn to write as soon as you can… academic writing seemed pointless in first year… but good communication skills get you everywhere in life – and life is easier if you can write (and reference)! It does matter after all…
- There are a lot of good people out there; and there are a lot of not so nice people too. But, be nice to everyone – sometimes the background story for the not-so-nice people explains why they are not-so-nice.
- Listen more…
- Be with people more… It is risky – but I mean really be with them… emotionally, helpfully, and compassionately. Be prepared to really care.
- Remember – every time you see a naked or semi-naked person – it is an opportunity to practice your assessment skills! Don’t ever be ‘too posh to wash’.
- People are never called ‘the shower’ or ‘toileting’, ‘a turn’ or a ‘room number’. Rather, think of it as a privilege to help someone who can’t do stuff for themselves they would rather do for themselves and in private.
- You will get hurt emotionally; there will be pain. Use your vulnerability and turn it into your strength. Talk to senior colleagues about reflecting on your practice and developing your resilience early on.
- Love what you do… not everyone around you will share that joy – but it is OK to love nursing! Jump in boots and all – don’t hold back. Some of the people you care for from day one prac onwards will stay in your memory for life.
- You were right… the computer unit (where you learnt to write a program to produce an image of your initials), and the music unit (where you had to perform a solo song) did not add a great deal to your nursing skills… but you got HD’s in those units, so something good came of something you didn’t want to do! Be prepared to do some stuff you don’t want to do… and try not to grizzle too much about it.
- Stay curious, and be prepared to learn new things, whether you think they are useful right now, or not. You will be amazed at how knowledge weaves and scaffolds your nursing thinking from many different directions and disciples. Turns out E Health is big these days – something I couldn’t foresee in first year. Things change – stay nimble and ready to change and adapt!
- Remember to keep some chewing gum handy for those smelly jobs you will have to do. Don’t moan about it in the pan room either.
- Remember to keep some tissues handy for the sad jobs you will have to do.
- It is cool to wash your hands – all the time, before and after everything. Don’t wait to be asked… just do it!
- Black tea with sugar is great for recovering after you faint during a nursing procedure! (You did/will a couple of times…)
- Buy your own stethoscope…no body likes to share earpieces or wax!
- If the person/patient says they have pain – they do… believe them.
- Stay curious and read more.
Last week a Miss Universe contestant, also a nurse, told the world about her love of nursing – she dressed in a typical nursing outfit (scrubs and steth) ready for work… and … she was at the brunt of some very public ridicule for doing so.
The nursing world spoke out – a line had been crossed. Nurses are proud of their contribution to world health. Nurses contribute more human resource to world health care delivery than other other health profession. We use a multitude of tools to do that… just one of those tools is the humble stethoscope… We use it to listen to many parts of the body – to check and monitor functioning, and to assess when health is compromised. It is a basic tool that many health professionals use everyday. To be mocked for doing so is wrong… Nurses around the world have risen up and taken to social media with #NursesShareYourStethoscope .
Here is my contribution as I travelled through northern NSW and southern Qld – Australia over the weekend. I tweeted ‘selfies’ along the way to cheer on rural nurses everywhere – keeping rural people healthy See more @RhondaWilsonMHN
A big shout out to rural nurses everywhere – but especially to the ones in the towns I travelled through on my #NursesShareYourStethoscope tour:
- Armidale, NSW
- Guyra, NSW
- Glen Innes, NSW
- Deepwater, NSW
- Glencoe, NSW
- Tenterfield, NSW
- Ballandean, Qld
- Stanthorpe, Qld
- Warwick, Qld
- Allora, Qld
- Toowoomba, Qld
My challenge to all rural nurses everywhere: #ShowUsYourStethoscope !
Ten Tips I picked up this week from a very successful retiring academic colleague about securing a long and successful professional life:
1. “If you live long enough- things happen” – you’ll need endurance and tenacity
2. Make sure you can recognise luck when it comes along and don’t waste the opportunity it brings with it
3. Have broad interests – look beyond your own discipline and always be ready to learn
5. Networks are everything – build strong networks
6. Find innovative ways to manage difficult people
7. Choose your battles carefully – let some things ride…
8. Take risks…
9. For academics…Remember: Teaching pays the bills!
10. Be nice to people – listen to them… hear them… be quick to say thank you.
an 11th has been added by another highly regarded sage academic (retired) – Do not forget to privilege research and publication. Sequester time for this and guard it ferociously. So easy for it to be eaten into. Create research groups.
….and my observation to add to this list… wash all down with plenty of ‘faith’ and confidence in yourself/your abilities… and a moderate amount of Shiraz!
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).
Check out this blog ^ by Research Whisper … Twitter is a fantastic resource – but yes, you have to invest something of yourself into it to make it work…
The only point of difference for me is I am perhaps a bit more flexible with my following decisions. I am happy to follow back novice twitter nurses in particular, to assist with introducing them to nursing colleagues in the Twittersphere. Just like IRL (in real life), networking relies on investing some relationship and by gaining introductions to key stakeholders. My followship is substantial enough to enable me to ‘play nice’ enough to give others a hand along the way. So – if you appear authentic after I run my checks, and you are interested in conversations about #nursing #mentalhealth #ruralhealth #Indigneoushealth #wellbeing #research #academic #HDR … and your not trying to flog me your latest commercial book or product, or your not trying to sell me (or my followers) something – I will probably follow up back! What I will be very interested in is sharing knowledge, transferring health knowledge to real people and situations – so I will always be keen to promote scholarship (peer reviewed) whether it is mine or others. Why? Because I think it is critical to get new ideas out in the public domain – so ideas about improving the world get out where they matter… accessible to the general public and part of the conversation…