Estimates: Rural Mental Health Services

Senator WRIGHT: I have some questions regarding rural distribution of mental health workers. It is well understood that people living in rural and remote Australia generally experience mental illness at levels equivalent to people living in metropolitan areas, but rural Australians face greater challenges as a result of a lack of access to services and specialised health professionals. Is the department undertaking any measures to address the unequal distribution of health professionals between rural and urban areas and, if so, what measures or programs are there?

Ms Shakespeare: We have a lot of programs that are designed to attract different health professionals to rural areas. I can run through them if you would like. For doctors we have a range of programs that are aimed at attracting people to rural practice-first of all, while they are undertaking university education. We have the Bonded Medical Places Scheme-25 per cent of all Commonwealth supported university places are allocated as bonded places and once students have finished their training they are then required to work in a district of workforce shortage which is not an inner metropolitan area. So that ends up in doctors going to work quite often in rural areas. We have Medical Rural Bonded Scholarships, which provide 100 additional Commonwealth supported university places each year to students, plus they receive a $25,000 scholarship. Those students are bonded to work for six years in rural areas of Australia, so that could be in rural remoteness areas 2 through to 5. Scaling applies, so if people work in more remote areas they can complete that bonding quicker.

We have undergraduate medical scholarships for medical students from a rural background. This is to encourage rural students who have financial needs and a demonstrated commitment to working in rural areas. We have about 120 new scholarships each year. We have the rural clinical training scheme, which provides funding to encourage universities to establish rural clinical training opportunities for students. We fund 17 rural clinical schools. We also have requirements under that program that universities have at least 25 per cent of their students undertake at least one year of their medical training in a rural area. University departments of rural health also encourage health professional students-that is, not just doctors but also other health professions-to study in rural settings. We have the John Flynn Placement Program, which provides undergraduate medical students with opportunities to work in rural areas during their undergraduate medical studies.

We then have a range of programs for people who have completed their university training and are then undertaking their junior doctor training. At that point, people are probably earning an income, which would require them to repay their HECS debt. We have a scheme where their HECS can be reimbursed if they complete their training in rural areas. We also have the postgraduate general practice placement program, which provides placements for people undertaking their junior doctor intern year so that they can work for 12 weeks in a general practice setting, and 50 per cent of the placements under that program need to be in regional rural areas. Once doctors have finished their junior doctor training year we then also have programs for people who are undertaking vocational training. HECS reimbursement also applies during people's vocational training. Under the Australian General Practice Training program we fund the training costs for people who want to train to be GPs, and 50 per cent of new training places that are now being provided under that program need to be in regional, rural and remote areas. We have the Remote Vocational Training Scheme, which provides support to people who are working in very remote, very small towns. They will not usually have other doctors to supervise them. That supports them by providing remote supervision through the internet and teleconferencing. The Specialist Training Program, under which the government is this year funding 600 specialist training posts, is expanding at the moment as well. Fifty per cent of the new training places that are being provided under the Specialist Training Program need to be in rural and regional areas of Australia.

We have the General Practice Rural Incentives Program, which I mentioned earlier. That pays incentives to registrars as well as doctors while they are completing their training in rural and regional areas. We have the Rural and Remote General Practice Program, which is funding for Rural Health Workforce Australia to provide recruitment services in rural areas. We have the Rural Procedural Grants Program-funding to GP proceduralists who work in regional areas so that they can maintain and upgrade their skills. That is in things like anaesthetics, obstetrics and emergency surgery. We have locum schemes which provide support for specialist obstetricians and GP anaesthetists who are working in regional and remote areas. That covers locum services and travel costs. We also have a program called Rural LEAP, which provides up to $6,000 so that urban GPs can undertake emergency medical training if they commit to doing 20 days of rural locum work, which exposes them to rural practice.

For other types of health professions we have the Practice Nurse Incentive Program, which encourages practices to employ practice nurses, and there is a rural loading of up to 50 per cent on payments under that program. We have the Nursing and Allied Health Rural Locum Scheme, which supports locum placements for nurses, midwives and allied health professionals so that they can take leave and have their positions backfilled. We also have the dental schemes that I mentioned earlier being introduced now. They are focused on getting people into rural areas. So there is a very large number of programs.

Senator WRIGHT: Thank you for such a comprehensive answer.

CHAIR: Do you have all of that on one document? After you have just gone through all of that effort, do you just have that on a document that you could give to Senator Wright? It might be useful.

Senator WRIGHT: Thank you-I would appreciate that. But obviously I can see the transcript. I will ask you to take these on notice I think-you may have the figures handy but probably it will save time. I am interested in better understanding the extent of the uneven distribution of mental health professionals between rural and urban areas now. I am going to ask you about how many psychiatrists are based in rural or remote areas compared to those based in urban areas. I would be seeking both the numerical figures and the percentages for psychiatrists and, similarly, for psychologists, mental health nurses and-I am not sure whether you would be able to provide this-social workers working as allied health professionals in the mental health field, so that I get a sense of the distribution of health professionals working in mental health particularly and the distribution in rural and regional areas as opposed to in urban areas. Is it possible for you to get those perhaps on notice for me?

Ms Shakespeare: It may not be possible to identify subcategories of particular professions that are specifically working in mental health, but we will have a look at it and see what we can provide on notice.

Senator WRIGHT: Thank you. I appreciate that. There is a lack of specialised mental health professionals in rural settings and as such the task of providing these specialist services often falls to local GPs. I have been talking to quite a lot of local GPs and getting some understanding about the difficulties and the pressures on them to be trying to carry out what is essentially often specialist work with the pressures and strains that are on them anyway. I am interested in to what extent the department provides any support, assistance or training to GPs to respond to this demand, particularly in relation to providing specialised mental health work, and what programs or initiatives are provided. I notice that you mentioned some training in relation to anaesthetists and obstetrics and on so on, but I did not hear you mention mental health in that answer that you gave previously. Are there programs or initiatives in relation to training of that kind?

Ms Shakespeare: Not within the health workforce bundle for outcome 12. We do have the Mental Health Nurse Incentive Program, but I am not aware of any programs for doctors. But we can check to see if there are other programs under other outcomes.

Senator WRIGHT: Thank you very much. I would appreciate that. I will put the rest of my questions on notice.