RURAL COMMUNITY BASED MENTAL HEALTH PLACEMENTS RECONTEXTUALISING NURSING AND SOCIAL WORK STUDENT LEARNING

RURAL COMMUNITY BASED MENTAL HEALTH PLACEMENTS RECONTEXTUALISING NURSING AND SOCIAL WORK STUDENT LEARNING

BACKGROUND Australia is moving away from medical and illness-orientated models of care with attention to recovery-focused and community-based care Very few studies have explored the merit of community based services as viable for student mental health placements Current mental health placement models for nursing focus on the public health sector only Mental health placements for social workers are limited in rural areas due to lack of qualified supervisors. If upstream service are to be the focus for the future of healthcare it is important to have a workforce that can support this approach

DISTRIBUTION OF MENTAL ILL-HEALTH IN AUSTRALIA

RURAL CMOS AS A VIABLE OPTION FOR PLACEMENT Focus on undifferentiated mental health presentations Development of assessment skills at earlier stages of care Exposure to mental health conditions-hwa snapshot of MH CMOs - 31% reported they directly supported between 100-500 people with mental health issues and 7% reported they saw over 5,000 people annually Broader focus on care provided Opportunity to work interprofessionally

ESTIMATED SIZE OF THE MH NGO WORKFORCE A 2009 national mental health NGO landscape survey and a 2010 workforce scoping survey provide some data about the mental health NGO workforce (National Health Workforce Planning and Research Collaboration 2011). Approximately 800 mental health NGOs in Australia with a total workforce in excess of 12,000 FTE employees. Findings indicate that 43% of the workforce had a bachelor degree and 34% had a certificate or diploma level qualification (HWA 2009)

MH PRACTICE PLACEMENTS IN CMO S Placements provided in CMO s 50% 45% 46% Percentage of Respondents 40% 35% 30% 25% 20% 15% 10% 38% 15% 15% 8% 23% 5% 0% OT Nursing Psychology Medicine Social Work Other

MENTAL HEALTH CLINICAL PLACEMENT SCOPING PROJECT Funded by Hunter and Central Coast Interdisciplinary Clinical Training Network (HCCICTN) Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW Partnership between University of Newcastle Department of Rural Health, University of Newcastle, University of New England and Hunter New England and Central Coast Primary Health Network

PROJECT AIMS To investigate rural mental health placements for nursing and social work students in Northern NSW (a) Determine the suitability of the community work environment as a learning environment (b) Investigate capacity and resources (c) Redefine learning opportunities Develop potential new mental health placement providers located within the community health setting

RECONTEXTUALISING PLACEMENTS The notion of Clinical placement vs Practice placement Shifting the paradigm from acute clinical work to a recovery orientated approach taking into account the social determinants influencing mental ill health Recovery orientated practice refers to: (a) acknowledgement that the individual is the expert in their own lives (b) offers realistic approaches to build hope, develop goals and achieve (c) developing understanding of strengths (d) building personal autonomy and social identity

ORGANISATIONS SCOPED Organisation type Organisation name Interviews Counselling Centacare, Anglicare, Life Connect Counselling, Rural Financial 5 Counselling Service. Aboriginal service Pius X Medical Corporation, Maayu Mali Alcohol and Other Drug Service, Byamee Homeless Service, Birripi Medical Corporation 4 Primary health care service Smith St Practice (MHNIP), HealthWISE 2 Youth service Headspace 1 Rehabilitation and recovery Billabong Clubhouse, Richmond PRA 2 Family service Family and Community Services 1 Employment agency Peel Valley Training and Employment (PHaMHS Program) 1 Private mental health Mayo Private Hospital 1 facility**

ORGANISATION LOCATION Anglicare Pius X Medical Corporation Maayu Mali A&OD Service Byamee Homeless Service Centacare Smith St Practice HealthWISE PVTE-PHaMHS Richmond PRA Billabong Clubhouse Headspace Anglicare FACS Life Connect RFCS Birripi Medical Corporation Mayo Private Hospital

Criteria for suitability PLACEMENT CAPACITY Staff qualifications Level of governance around clinical work Level of exposure to people with mental ill health Core business of the CMO to provide learning opportunities Previous exposure to student placements

FINDINGS FOR ORGANISATIONAL CAPACITY Qualifications-7 organisations had staff that matched disciplines for nursing and social work, 9 organisations had staff with tertiary level qualifications that were non discipline specific Governance- All organisations had sound processes in place for maintaining quality of interventions-clinical supervision featured highly Exposure and core business- 10 organisations were specifically delivering mental health interventions, remaining 7 had high levels of exposure to those with undifferentiated mental health concerns Previous exposure to mental health placements- 6 organisations had previously provided support to students

COMPONENTS OF STUDENT LEARNING Theme 1:Broader learning, diversity and preparation for practice Exposure to the social and emotional pre-determinants contributing to mental ill health Higher exposure of mild to moderate presentations increasing the development of skills in early intervention and prevention. It makes for a more skilled worker they re seeing that cause and effect stuff before they (the person) gets to that acute stage of going to hospital (Organisation 14) Assists students to understand the decision making processes that occur outside of hospital

COMPONENTS OF STUDENT LEARNING Theme 2:Contribution to holistic care The emphasis on being able to learn about all aspects of mental health care and to take a broader social view Working in rural mental health requires the application of all elements of health and requires a diverse approach If you (the student) come out of that sort of training and you have a better understanding of that big wide world out there of the community welfare sector in a sense it encompasses health in a way that is different rather than the narrow focus you ve got to be better off as a worker with that knowledge and network before you get out (Organisation 13)

COMPONENTS OF STUDENT LEARNING Theme 3: Informal learning about the context of practice Students could benefit from a bigger picture view of how organisations function in rural areas where resources are scarce Teach students how to collaborate, how to integrate services, how to make a service as seamless as possible for people to see the values and strengths of each organisation and how you work together (Organisation 6) Developing an understanding of the importance and reliance on relationships with other organisations in the community.

COMPONENTS OF STUDENT LEARNING Theme 4: Populations at greater risk and understanding culture Working with Aboriginal people and farming families who have unique social stressors that impact on their mental health Students would benefit from understanding these dynamics including the skill set and approach required to work with these populations Students would be given the opportunity to understand the cultural past and the associated trauma of the rural area where they are doing their placement The biggest thing is I don t think to (just) be empathetic.the student needs to learn to listen listen a bit deeper than what you normally would listen from the point of view of understanding where that persons at, understanding some of the historical aspects and understanding in a deeper way (organisation 9)

COMPONENTS OF STUDENT LEARNING Theme 5: Commitment to rural work and engaging with community Belonging to something bigger than a professional role This town as hard as some things have been for some people it s the drive that keeps us going every day. A lot of us who are in this game don t do it for ourselves we do it for the bigger picture which is for the community and we have a sense of pride about our town (Organisation 9) Student placement should not exist in isolation to understanding the community in which the placement is occurring.

COMPONENTS OF STUDENT LEARNING Theme 6: The context of rural mental health practice Limited access to specialised services and health professionals pose difficulties in integrating care for people with complex and diverse needs Reliance on collaboration and interprofessional support was viewed as high in the rural community based mental health organisations Students observing processes of collaboration and interprofessional practice would enhance their awareness of how these principles integrate with rural mental health care

COMPONENTS OF STUDENT LEARNING Theme 7: Organisational collaboration The connection to people in other organisations and the strength of these relationships was highly valued Decision making processes in the intervention phase often involves a number of organisations to keep a person well in the community Relationships with other organisations is massively important. I need to make sure the links between services are meaningful if you don t work collaboratively you don t survive rurally (Organisation 8)

PLACEMENT MODEL Integrate student orientation for CMO with current practice for existing procedures Development of CMO learning program specific to organisation activities with clear learning objectives identified CMO staff training to meet university assessment requirements and support teaching on placement Close support from universities regarding facilitation and supervision of student placements

PERCEIVED LIMITATIONS Access to qualified staff Impact of student needs vs organisational needs Perception by students that broader practice skills may not be regarded as important in relation to clinical skills Ensuring governance is maintained between the organisation and the university

RECOMMENDATIONS CMO s utilise placement data management systems (eg ClinConnect in NSW) Universities and regulation agencies (ANMAC and AASW) commit to facilitating the development of mental health placements to occur in non-traditional rurally based community organisations Investment into university-employed liaison roles that are rurally based to locate, organise and resource future placements Adopt a flexible model to placement where students can transition across health sectors to maximise their learning experience

QUESTIONS