Perceived Differences in the Management of Mental Health Patients in Remote and Rural Australia and Strategies for Improvement: Findings from a National Qualitative Study of Emergency Clinicians

G A Jelinek,M F Gerdtz,N Hill,C Mackinlay,T J Weiland

doi:10.1155/2011/965027

G A Jelinek, M F Gerdtz + Show 3 more

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https://doi.org/10.1155/2011/965027

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Abstract

Introduction. We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. Methods. Descriptive exploratory study using semi-structured telephone interviews of doctors and nurses in Australian emergency departments (EDs), stratified to represent states and territories and rural or metropolitan location. Content analysis of responses developed themes and sub-themes. Results. Of 39 doctors and 32 nurses responding to email invitation, 20 doctors and 16 nurses were interviewed. Major themes were resources/environment, staff and patient issues. Clinicians noted lack of access in rural areas to psychiatric support services, especially alcohol and drug services, limited referral options, and a lack of knowledge, understanding and acceptance of mental health issues. The clinicians suggested resource, education and guideline improvements, wanting better access to mental health experts in rural areas, better support networks and visiting specialist coverage, and educational courses tailored to the needs of rural clinicians. Conclusion. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Improvements would better enable access to support and referral services, and educational opportunities.

Highlights

We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved
39 Australasian College for Emergency Medicine (ACEM) members and 32 College for Emergency Nursing Australasia (CENA) members responded to the invitation, from which a sample of 20 emergency departments (EDs) doctors (51% of those responding) and 16 ED nurses (50% of those responding) was selected for participation based on clinical role and jurisdiction
The sample was stratified according to metropolitan and rural EDs, Australian states and territories and seniority of position held in the ED

Summary

Introduction

We aimed to describe perceptions of Australian emergency clinicians of differences in management of mental health patients in rural and remote Australia compared with metropolitan hospitals, and what could be improved. Clinicians managing mental health patients in rural and remote Australian EDs lack resources, support services and referral capacity, and access to appropriate education and training. Despite rural and remote Australians having higher rates of mental illness, they lack specialist mental health services [1] This is of concern to policy makers and practitioners, and to patients who report poor quality mental health services and prejudicial attitudes from staff in rural emergency departments (EDs). In Australia, these EDs are mostly staffed by general practitioners or career medical officers Clinicians in these environments, both doctors and nurses, often have extensive generalist skills that their counterparts in urban practice do not have. There are often deficiencies in their confidence and skills in managing common mental health emergencies, and there have been calls for them to be better trained in this area [1]

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