Filling the ‘gaping hole’ in rural mental health services

‘So, what specialty are you going to choose, or do you think you’ll become a GP?’
 
Speak to any medical student or junior doctor and they will have heard this question, and many of us – including myself – struggle to find an answer.
 
Do I want to become a GP?
 
Growing up in rural Queensland, it took weeks, sometimes months, to get an appointment. The need has always been painfully obvious to me. 
 
But then I’m also tempted by other specialties. Although I’m definitely one of the students who corrects everyone who asks the above question – by saying that, ‘GP technically is a specialty, too’ – I do enjoy the idea of developing a niche within general practice.
 
And this is probably why I’ve been drawn by the possibilities of rural generalism.
 
The rural generalist program is commonly thought of as specialised training to work in the emergency department, working to fill a gap in emergency medicine. Or training to deliver babies to fill gaps in maternity services.
 
Much less is heard about the doctor with specialised training to fill a gap in psychiatric services. But as I’ve become more and more aware of the gaping hole in rural mental health services, I’ve become more intrigued by how this program can address these gaps.
 
I’ve seen this crevasse first hand. Having a lived experience of mental illness in rural areas, I have struggled immensely to find specialist support.
 
I, like many other rural and remote Australians, have reduced access to subsidised mental health services. People in very remote areas have 81 Medicare-funded mental health consultations per 1000 people. Our metropolitan counterparts, by contrast, have 495 encounters per 1000.
 
The town where I’m from lacks a permanent psychiatrist and as amazing as my GP is, they themselves have identified the difficulty in providing ongoing mental health support.
 
This is where the rural generalist comes in.
 
In rural Australia, where GPs are already worked to the bone and may lack the training to provide ongoing mental health treatment, the rural generalist program has the potential to address these gaps in mental health services.
 
Avenues include providing advanced-level mental health care through a primary healthcare service, such as a GP clinic or working within a regional mental health service, or a small health service. There’s also training to support culturally diverse communities and First Nations communities.
 
As a virtual learning assistant, I’ve been lucky enough to sit in on several mental health skills training sessions. It’s here I’ve been inspired by the opportunities to meet the unique needs of rural communities that specialising in mental health can bring.
 
I’ve heard too many stories in which people reach crisis point before they seek or receive help. Patients with schizophrenia who are placed under assessment orders, forced to sleep on the floor of the emergency department because there are no psych beds, or the patient with an eating disorder coming in and out of hospital because they didn’t meet the criteria for a longer stay, but also lack the support to get better in the community.
 
Having rural generalists embedded in our primary health system will help to increase the understanding of how patients are treated in an inpatient setting, and how to best help them transition into long-term community recovery.
 
I’ve spoken to many physicians through my journey to find out more about rural generalism. Among them is Dr Marty Roebuck, a training generalist who completed his advanced skills training in mental health. His advice really resonated with me.
 
‘The beauty of generalist training is that you can focus on the skills you’d like to build or you can have a look at where you’d like to be and the services that area needs and tailor your training to fit where you want to be, in addition to what you want to be,’ he said.
 
‘Ask yourself, what skills do I need to contribute?’
 
What I hope to contribute isn’t necessarily where many people see the rural generalist contributing. But it’s crucial we expand our dialogue around rural generalism to include the areas where the program may be needed most.
 
This article was originally published on MedicGuild, a community that builds conversations and resources by and for medical students and doctors. It has been lightly edited.
 
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