How Access Has Changed Emergency Mental Health Care in the Bush
11 March 2015 Last updated:
25 March 2015
Many rural and remote towns have limited access to mental health specialist services and local providers bear the responsibility for emergency mental health care. The Mental Health Emergency Care – Rural Access Program (MHEC-RAP) is a telepsychiatry program established in western NSW to provide accessible specialist emergency mental health care and is available 24 hours 7 days a week.
MHEC-RAP is changing the local provision of emergency mental health care. Local providers are no longer ‘flying blind’ as this has changed their practice and perspective. This study will be available in publication (see references).
To understand the experience and use of Mental Health Emergency Care – Rural Access Program (MHEC-RAP) and its impact on access to specialist emergency mental health care for people living in rural and remote communities across western NSW.
- Improved access to specialist emergency mental health care for people living in rural and remote communities across western NSW.
- Improved understanding of the importance of patients receiving emergency mental health care locally.
- Improved mental health outcomes for people in rural and remote communities.
- Improved support for staff to provide emergency mental health care locally.
Project dates: This study was conducted in 2013-2014.
Project status: Sustained - The project has been implemented, is sustained in standard business.
With the difficulty of maintaining and recruiting specialist in rural and remote communities across Australia, local providers are bearing the responsibility for mental health care. Mental health emergencies are unpredictable and require timely and appropriate care. However, these local providers may lack specific mental health training, the confidence, time, or the facility to care for emergency presentations.
MHEC-RAP is a telepsychiatry program established in western NSW to provide accessible specialist emergency mental health care. It was developed by the former Greater Western Area Health Service (now the Western NSW and Far West Local Health Districts).
It provides access to a regionally-based team of mental health specialists for everyone across the region via a freecall number, 1800 011 511 and is available 24/7. It offers relevant and responsive support, information, and clinical services.
MHEC-RAP provides advice and support as well as emergency clinical services– emergency triage and video assessments via telehealth technologies for local providers.
Broken Hill University Department of Rural Health conducted the research for the Western NSW and Far West Local Health Districts.
MHEC-RAP is available across Western NSW and Far West Local Health Districts.
This study analysed 12 interviews with local Emergency Department (ED) providers to understand their experience and use of MHEC-RAP and the impact on access to services.
Interviews were conducted with ED providers from hospitals across western NSW who use the program. ED providers were purposely chosen because the video assessment clinical service is currently only available through hospital EDs.
The Penchansky and Thomas1 theory of access was applied across the evaluation to assess whether MHEC-RAP was accessible. The theory of access identifies five concepts of access – accessibility, availability, acceptability, affordability, and adequacy. A sixth concept - awareness - was included in the analyses. The theory of access and the concept of awareness were used to analyse the interviews.
From this, it was determined that MHEC-RAP is accessible, responding to all concepts of access and awareness. MHEC-RAP has changed patient and provider access to specialist care and support, as well as provider practice and perspective, and with it, local providers are no longer ‘flying blind’.
- The importance of access and designing health services that respond to all concepts of access and awareness.
- There is place for telepsychiatry in emergency mental health care.
- The model is transferable to other health settings and is already informing the development of other telepsychiatry programs.
Reference to the theory of access:
- Penchansky, R. and J. W. Thomas (1981). "The Concept of Access: Definition and Relationship to Consumer Satisfaction." Medical Care 19(2): 127-140.
Publications from the evaluation of MHEC-RAP (to date)
- Saurman, E., D. Lyle, D. Perkins and R. Roberts (2014). "The successful provision of emergency mental health care to rural and remote NSW-an evaluation of the Mental Health Emergency Care-Rural Access Program." Australian Health Review 38(1): 58-64.
- Saurman, E., D. Lyle, S. Kirby and R. Roberts (2014). "Use of a mental health emergency care-rural access programme in emergency departments." Journal of Telemedicine & Telecare 20(6): 324-329.
- Saurman, E., D. Lyle, S. Kirby and R. Roberts (2014). "Assessing program efficiency - a time and motion study of the Mental Health Emergency Care-Rural Access Program in NSW Australia." International Journal of Environmental Research and Public Health 11(8): 7678-7689.
- Saurman, E., J. Johnston, J. Hindman, S. Kirby and D. Lyle (2014). "A transferable telepsychiatry model for improving access to emergency mental health care." Journal of Telemedicine & Telecare 20:391-399.
- Saurman, E., S. Kirby and D. Lyle (2015). "No longer ‘flying blind’ - how access has changed emergency mental health care in rural and remote emergency departments-a qualitative study." BMC Health Services Research in review.
Department of Rural Health
Broken Hill University
Phone: 08 8080 1206
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