Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697645487458.pdf (Australia)
Accessibility and quality of mental health services in rural and remote Australia NRHSN Submission The NRHSN is an initiative of the Australian Government Department of Health administered by the Rural Workforce Agency Network Consortium Accessibility and quality of mental health services in rural and remote AustraliaSubmission 25 About us National Rural Health Student Network The National Rural Health Student Network (NRHSN) represents the future of rural health in Australia.
It has more than 9,000 members who belong to 28 university Rural Health Clubs from all states and territories.

It is Australia’s only multi-disciplinary student health network, bringing together people studying medicine, nursing and allied health, encouraging them to pursue rural health careers.
The NRHSN has two aims:  to provide a voice for students who are interested in improving health outcomes for rural and remote Australians  to promote rural health careers to students and encourage students who are interested in practising in rural health care.

The NRHSN and its Rural Health Clubs offer rural experience weekends, career information sessions and professional development activities as well as providing a social base for students at university and when on rural placement.
The student network leaders also advocate on behalf of health students of all disciplines - including opportunities for more rural placements and training support.

The NRHSN is an initiative of the Australian Government Department of Health administered as a consortium by the Rural Workforce Agencies Network.
NSW Rural Doctors Network NSW Rural Doctors Network (RDN) is a not-for-profit organisation that is designated by the Australian Government as the Rural Workforce Agency (RWA) in New South Wales (NSW).

Its purpose is to improve health care for people in regional, rural and remote NSW.

Its goal is to support the provision and maintenance of adequate numbers of high quality health professionals in regional, rural and remote NSW.
Contact us National Rural Health Student Network PO Box 1111 Mascot NSW 1460 02 8337 8100 info@nrhsn.org.au or executivecommittee@nrhsn.org.au www.nrhsn.org.au 2 Accessibility and quality of mental health services in rural and remote Australia – May 2018 Accessibility and quality of mental health services in rural and remote AustraliaSubmission 25 The 2018 NRHSN priority areas are: 1.
Positive, clear and supported rural training pathways – to ensure we have positive experiences, role models and the ability to keep learning regardless of location, as students and throughout our vocational training.

2.
2.

Aboriginal and Torres Strait Islander health – improve the health and wellbeing of Aboriginal and Torres Strait Islander communities through advocating for more Indigenous students to pursue health careers and encouraging culturally responsive graduates through the provision of quality Aboriginal and Torres Strait Islander health curriculums for all health students.

3.
3.

Mental health training and awareness for all university health students – to enable us to care for ourselves and others, particularly in rural areas where mental health is a major issue.

Mental health research, awareness, individual resilience and training for health students are key areas which the NRHSN recognises as requiring immediate attention.
It must be ensured that health students who desire to work in rural or remote areas are equipped with the appropriate knowledge and skills to effectively manage mental health issues, both their own and their patients.

This is imperative to developing a competent rural health workforce to provide sustainable mental healthcare in the future.
In addition to demands associated with balancing study with relevant family, work, social, and financial commitments, our experience indicates that students in health degrees can be at particular risk of mental health issues.1 The significant number of contact hours, volume of learning materials and clinical placement requirements attached to many health courses challenge the life management skills of students undertaking them and place these young Australians at increased risk of reduced mental health and wellbeing.2 Feelings of isolation that may accompany rural placements involving a move away from family, friends and other regular support structures may add further stress.1,3 In addition, certain personality traits common among health students have been found to place them at increased risk of mental health problems.3 1 Frazer S, Johnson S (2011) Investing in the future – promoting mental wellbeing for students, by students: Proceedings of the 11th National Rural Health Conference, Perth, Australia, March 2011, accessed 07/05/2018, http://nrha.org.au/11nrhc/papers/11th%20NRHC%20Frazer_Stephanie_B1.pdf 2 Australian Medical Association (2011), Prevocational Medical Education and Training – 2011, Australian Medical Association, Canberra.
3 Henning K, Ey S, Shaw D (1998) Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students.

Medical Education 32: 456-464.
3 Accessibility and quality of mental health services in rural and remote Australia – May 2018 Accessibility and quality of mental health services in rural and remote AustraliaSubmission 25 Rural origin students may also be at increased risk as they must often additionally cope with the pressures associated with relocation in order to attend tertiary studies.1 While there is emerging evidence supporting the prevalence of depression and anxiety among medical students and junior doctors, 4 there is a considerable lack of understanding of the extent of mental health challenges experienced by students and professionals of the other health disciplines.
Recommendation 1: Research is required into the mental health challenges experienced by health students during tertiary study and rural placements.

Promotion and training in mental health must occur at the university level as it is integral to the development of resilient, healthy and confident practitioners.

Students equipped with practical knowledge and basic skills to manage their own mental health and those around them will be valuable assets to the future health workforce.
Greater confidence in handling mental health issues is especially significant for students who will later work in rural and remote Australia.
They will be more likely to take roles as mental health champions and advocates in their communities, areas that are traditionally underserved in the realm of mental health.5 The NRHSN sees an urgent need for mental health training to be made more widespread and accessible to all health students, as it may help reduce the stigma of mental illness and encourage future health professionals to actively pursue greater mental health literacy.
Mental Health First Aid is an internationally recognised course, which increases mental health literacy through improving participant understanding of common mental health problems and confidence to recognise and respond to various mental health scenarios.

Investment in Mental Health First Aid and similar training for health students will support greater levels of mental wellbeing among health students on placement and in their future careers, preventing the likelihood of experiencing professional burnout.
Recommendation 2: Ensure all health students undertake mental health training during their degree to stimulate resilience and increase awareness of challenges experienced by healthcare professionals whilst developing skills to support self and colleagues Research consistently shows service availability and access to services that is inadequate in remote and rural areas.

For example, MBS data indicates that people in very remote areas access at only one-fifth of the rate of major city residents.
To improve this situation, it is essential that there are clear governance 4 Elliot L, Tan J, Norris S (2010) The mental health of doctors: A systematic literature review, beyondblue.

5 Australian Government Department of Health and Ageing (2009).

Fourth National Mental Health Plan-An agenda for collaborative government action in mental health 2009-2014.

Commonwealth of Australia, Canberra.


4 Accessibility and quality of mental health services in rural and remote Australia – May 2018 Accessibility and quality of mental health services in rural and remote AustraliaSubmission 25 arrangements and a defined process across governments to improve service access.

Responsibility for mental health service delivery locally has been conferred on Primary Health Networks (PHNs) and Local Hospital Networks (LHNs).
The efforts of PHNs and LHNs should be underpinned by a national strategy for mental health services in rural and remote Australia.
The National Mental Health Commission (the Commission) is well placed to collate service mapping and also to monitor development and implementation of a national strategy, with their core role to provide expert advice to the Australian Government and cross-sectoral leadership on the policy, programs, services and systems that support mental health in Australia, and already with the responsibility for monitoring and reporting on implementation of the Fifth Plan.
Currently in rural and remote settings preventative mental health services in the public sector are extremely limited.

Services are confined to acute mental health services in regional hospitals.

Much of the responsibility for caring for distressed patients in smaller rural areas is carried by GPs.

More access to a range of mental health services in rural communities is urgently needed.
The Federal budget has addressed some of this in the latest initiatives, but this must be built into ongoing programs rather than short-term initiatives and must provide genuine access across rural and remote communities.

Key Recommendation There are not sufficient mental health services in rural and remote parts of Australia and it is the responsibility of all governments to urgently address this.
The COAG Health Council should be tasked to develop a rural mental health strategy, informed by a collation prepared by the National Mental Health Commission of the PHN service mapping in rural and remote areas and other key data that identifies service shortfalls.

The Commission should also be tasked with monitoring and overseeing implementation of the strategy, reporting back directly to the COAG Health Council.
5 Accessibility and quality of mental health services in rural and remote Australia – May 2018 Accessibility and quality of mental health services in rural and remote AustraliaSubmission 25