Community Affairs Legislation Committee
Wednesday 17 October 2012
Health Workforce Division
Senator WRIGHT: These are general questions in relation to the rural mental health workforce and strategies to deal with the challenges of that. In previous answers to questions on notice, the department has recognised that the percentage of mental health professionals living in major cities is 85.8 per cent of psychiatrists, 78.7 per cent of psychologists, 75 per cent of social workers and 65 per cent of mental health nurses. But when we compare these figures with the percentage of the general population living in regional rural and remote areas, which is 32 per cent, I ask: does the department recognise that there is a significant disparity between the percentage of the general population living in nonmetropolitan Australia and the percentage of mental health professionals working in those areas?
Ms Shakespeare: The figures that we have provided are based on surveys over a number of years. I think for the psychologists that was from 2006. There may be lags in some of the data, and we are not sure if those are the same percentages currently. But, based on that data, there are discrepancies between the proportion of health professionals in those categories and the general population living in rural areas.
There are a number of strategies, though, to provide services to people in rural areas. For instance, you mentioned psychiatrists. The majority of those are based in metropolitan areas; however, the government has introduced Medicare rebated items for telehealth services provided by medical specialists, including psychiatrists, which is another way of providing services to people in rural areas.
The categories that you have mentioned also do not include general practitioners, who also provide mental health services to people in rural areas. We have a number of strategies to increase the general practice workforce in rural areas. We have strategies which increase the nursing workforce in rural areas. We are also funding a number of programs to train allied health professionals, including psychologists, in rural areas, with the expectation that people who are trained in rural areas will be more likely to remain in those areas and work. So we certainly hope to see improvements in the number of allied health workers, general practitioners and nurses as a result of those programs over time.
Senator WRIGHT: Thank you for that, Ms Shakespeare. You have pre-empted my follow-up question. I am wondering if you could take on notice and give a bit more detail about those particular programs that you have outlined-the strategies to increase the nursing workforce in rural areas, and particularly in relation to mental health trained nurses, and also the allied health professionals and psychologists and the training of people from rural or in rural areas. I think that was what you were referring to there, as some of the current strategies that are being employed.
Ms Shakespeare: Yes, there is the University Departments of Rural Health program. We also have scholarships and locum support schemes for rural nurses and rural allied health workers to provide support and expand the workforce. I can certainly provide more detail about those programs on notice to you.
Senator WRIGHT: Thank you for that. I would also be interested-and I might ask you to take this on notice because I do not imagine that you will have this readily available-in the total cost currently and for the forward estimates of rolling out those particularly related mental health workforce strategies that you have identified and any others that you might want to identify as well.
In light of the strategies that are being employed and the consideration of this discrepancy issue, what will be the major mental health workforce capacity issues and challenges faced by regional, rural and remote Australia over the next three to five years?
Ms Shakespeare: Are you asking me to take that on notice?
Senator WRIGHT: I am asking you if you can identify what they might be. Is the department able to say at this point what those capacity issues and challenges will be over the next three to five years?
Ms Shakespeare: We can certainly provide information about what we expect workforce challenges to be over the next three to five years. HWA may also be able to provide some more information-potentially not just specifically about the mental health workforce but workforce challenges more generally. They have completed some modelling 'Health Workforce 2025', which looks at parts of the health workforce out to 2025 and the challenges.
Senator WRIGHT: I have some questions for them too, but I am really interested in drilling down specifically to mental health. That is my particular interest, and I have been doing some consultation and some of the issues that are coming up time and time again in my consultations concern the workforce. If you could provide that information, I would be grateful for that-as in projections and consideration that the department is giving over the next three to five years about where those challenges will be.
Ms Shakespeare: I will take that on notice and possibly talk to my mental health colleagues.
Senator WRIGHT: Thank you. And the projected costs, I suppose, of what the strategies might be for dealing with those challenges.
I am interested, in particular, in what strategies the department has developed or implemented to address particular barriers that I have come across in my consultations. There are three that I have identified. One is the unavailability of mental health services in regions. Another is a lack of internet services to access e-mental-health services. An example there is the fact that obviously, in a country with the distance issues that Australia, e-health holds a lot of promise but it does rely on the ability of people to access computers and the technology and also have the literacy to be able to operate them. For instance, are there any strategies to ensure that there is technology available in Indigenous communities? The last of the barriers would be privacy-the issue of privacy and taboo in small towns and the issues that that creates in terms of conflicts of interest, stigma and so on. Has the department addressed any of those barriers?
Ms Flanagan: It might be best if we take this on notice. This outcome has mainly to do with workforce. We have the workforce experts here but, as Ms Shakespeare has said, we would need to consult with our colleagues that deal with the mental health policy and that think about the whole range of delivering mental health services into Australia. So we will get back to you on notice on that.
Senator WRIGHT: Thank you. Perhaps I have not asked the questions in the right area, so thank you for that. I have a couple of others, and I hope you are able to answer these. Has the department provided or considered providing mental health training in regional, rural and remote communities for non-mental-health workers in order to expand capacity, such as police, firefighters, maybe staff in local government, teachers and community leaders? If so, what programs or strategies are there, in what communities and regions have they been implemented, and what is the cost of that?
Ms Shakespeare: We have a program called Rural Health Continuing Education which is funded at $3.2 million in 2012-13. It has three streams. One of those is funding for the Rural Health Education Foundation, which operates the Rural Health Channel. Now it has a digital channel that is available throughout Australia via satellite. They provide programs in the nature of continuing professional education, but it is not limited to health professions; many other people in rural communities are able to access that resource. So that is one mechanism we have to deliver information about health issues that are of particular interest in rural communities.
Senator WRIGHT: Are you aware of whether any other consideration has been given to mental health training for non-mental-health workers to expand the literacy and the capacity of people to respond to challenges where there are not professionals?
Ms Shakespeare: I probably would not like to say no. I am not aware of any programs, but again I would like to talk to my mental health colleagues and take that on notice.
Senator WRIGHT: Thank you for that. I have some more that I will put on notice. I just have one other issue that I would like to ask you about. I have been consistently told about the negative mental health impacts of fly-in fly-out work. Is that an issue that the department is aware of, and are there any specific strategies that are being developed or are in place to address those issues? Again, is this the right place to ask about those?
Ms Halton: The mental health issue is probably a question more for the mental health people, but Ms Shakespeare can tell you a little bit about the whole-of-government aspects. There is a discussion in the whole of government about fly-in fly-out. I do not know if this will be the pre-eminent feature, but undoubtedly it will be on their list.
Ms Shakespeare: There is an interdepartmental committee looking at issues around both fly-in fly-out and drive-in drive-out workforces across Australia and a range of impacts that that has. It involves people from the Department of Health and Ageing and the Department of Regional Australia, Local Government, Arts and Sport-DRALGAS-Education, and other departments that have an interest.
Senator WRIGHT: Can you take on notice specifically which departments are involved in that interdepartmental committee. I was not aware of that, and it is very interesting to me that that is there.
Ms Shakespeare: It is discussing issues. There are no specific outcomes I can report to you from it, but certainly there are discussions going on within government, crossing over portfolios.
Senator WRIGHT: Thank you very much for that.