How mental health services are delivered

In rural Australia, most mental health care is delivered by primary care workers such as GPs and nurses. Rural towns may be too small to support a specialist mental health service, or the services that are there may have difficulty recruiting specialists. As a result, specialist services such as psychiatry are usually based in larger towns. 

	You’ll work with nurses, you will work with social workers, you will work with OT, you’ll work with families...I really enjoy working with everybody, to help somebody who is in strife...
	Dr Jeremy Blumenthal

It is more likely that patients will initially seek mental health support from a generalist worker, such as a GP, a community nurse, or an Aboriginal health worker. Non-medical professionals such as teachers and religious ministers are also frequently the first source of counselling and support for many with mental health-care needs.

Psychiatrists in rural settings regularly liaise with other health-care professionals who are encountering mental health problems in their patients or seeing a greater degree of somatisation in their patients. This makes the promotion of mental health, both among other doctors and the general public, vitally important.

Overcoming the distance barrier

People providing mental health care in rural areas often travel as a regular part of their work, for example to provide regular outreach services to outlying regions. Between outreach visits, local health professionals may deliver care. Sometimes patients will be transferred from their home to a larger regional hospital for further treatment.

Because access to health services of all kinds can often be in short supply in rural Australia, in addition to visiting specialists, health-care services can be delivered remotely using telepsychiatry. 

Mental health professionals

Psychiatrists and other specialists

In comparison with metropolitan areas there are fewer psychiatrists and other medical specialists in rural Australia relative to the population. Among psychiatrists, only one-third of the rural workforce actually live in rural Australia – the rest travel in from cities or use telepsychiatry. 

Nurses and nurse practitioners

In rural Australia nurses are the most common health practitioner and they may have broader expertise and higher levels of autonomy than their counterparts in the city. Mental health patients may be treated by registered nurses or more specialised mental health nurses. 

Rural psychiatrists frequently work with nurse practitioners or credentialed mental health nurse specialists. These nurses have additional clinical training and, within certain clinical guidelines, nurse practitioners are able to initiate diagnostic investigations, prescribe medication and make limited referrals.

GPs

The responsibilities of rural GPs often extend outside the usual scope of general practice. Many undertake additional training in mental health treatments to reflect their increased participation as the first point of contact for many people suffering from mental health conditions.

Allied health

A broad range of allied health professionals work in rural areas. Those most likely to be working in mental health are psychologists and social workers. Allied health professionals in rural areas tend to operate in visiting multidisciplinary teams.

Indigenous health workers

In areas with Indigenous communities, psychiatrists are likely to work with Indigenous health workers. They perform a variety of tasks, from cultural brokering and interpreting to education and health promotion to direct clinical care and provision of traditional healing. Titles can vary (e.g. community worker, liaison worker, women’s/men’s health worker, health promotion officer), as can the extent of training they have received.

The RANZCP has a dedicated Aboriginal and Torres Strait Islander mental health page to support mental health professionals throughout Australia.

The Royal Australian and New Zealand College of Psychiatrists has received Australian Government funding under the Specialist Training Program.This web page reflects the experience in Australia, however, the information may also be useful for psychiatrists and trainees working in Aotearoa New Zealand.