Overall aim:
To investigate whether hegemonic masculinity traits and social factors influence mental health (MH) and wellbeing of rural men and their access to MH services in rural and regional (RR) settings in Australia.
Literature review:
Emerging literature indicates that stereotypical masculine traits (e.g., stoicism, strength, power, being independent) influence men’s health. Rural and Regional (RR) men’s MH is referred to as a “silent crisis”; men report lower rates of mental health problems but have higher rates of suicide. However, little is known about whether hegemonic masculinity, a dominant form of masculine traits, shapes men's accessibility to rural MH services. The AMA stated: “Beliefs about masculinity and manhood are deeply rooted in our culture. Often, they are supported by social institutions and play a role in shaping the behaviour patterns of men in ways that have negative consequences for their health. Masculinities are influenced by several factors (socioeconomic class, culture, ethnicity and age), which affect men’s health behaviours. Further, limited services, availability of professionals, and access to primary and acute care contribute to inequality in MH support for those in RR areas.
Study design
Study 1 will use an online survey to identify relationships between psychological distress, men’s health behaviour and hegemonic masculinity. Measures include the DSM-5-TR Level 1 Cross-Cutting Symptom Measure – Adult (23 Items), Courtney’s Behaviour Inventory (HBI, 28 items), the Conformity to Masculine Norms Inventory – 30 items (CMNI-30) respectively. Questions about attitudes to accessing mental health services will be included. Study 2 uses semi-structured interviews with RR men, and MH service providers to investigate whether the current model of MH services caters RR men’s MH needs and have potential to collaborate with community organisations nationally.
Conclusion
This study explores the perspectives of men’s mental health issues and the challenges faced by service providers in RR settings.

Post the Richmond report, in the flush of optimism about the deinstitutionalisation of mental health patients (as they were then identified), too little thought was devoted to the "who, what, where, when and how" of implementation. I watched as people with little preparation and fewer skills were sent into an unknown world.
Although there have been many changes since, in rural areas in particular, there remain many barriers to equitable and effective mental health support for all stakeholders: clients, families and service providers. Increases in theories, medication and other treatment options haven't overcome the stresses of modern life, complicated in rural areas by fires, floods and droughts.
To examine how inclusive practice might improve the situation in rural areas, I have identified four principles from the many listed under that aegis, as follows:
i) Rights are both a human entitlement and a legislated requirement. Although seen as an uncontested term, the reality is complex and open to interpretation.
ii) Choices must be part of inclusion, however limited resources equals hard decisions.
iii) Control requires workers to ask, "of what? by whom? to what end(s)?
iv) Communication to be effective requires skill, self- insight, honesty and relevant self disclosure.
To alter the way services and workers approach work within the mental health sector requires an investigation of the experiences of all the stake holders, through qualitative interviews and using the action research loop to provide feedback, while maintaining confidentiality and ethical actions.
In rural areas, due to the proximity of all stakeholders, whose children and families share schools, shops, sporting events etc. the maintenance of professional boundaries is problematic and Aboriginal workers in particular are pressured for confidential client Information.
Ultimately, there is no inclusion without empowerment and no empowerment without communication, built on shared knowledge and respect.

Traditionally, a good father was defined as the breadwinner and the protector of the family. However, within the current changing socio-political structure of the family, fathers are still rewarded for fulfilling their role of a breadwinner but are also expected to contribute to caregiving responsibilities. The juggling between the traditional masculine gender role and the egalitarian gender roles may be stressful for some fathers. To overcome this stress, some fathers may be reconstructing their masculine gender roles. The aim of this article is to explore whether men from regional and metropolitan cities are reconstructing their traditional gender roles during fatherhood to promote egalitarian gender roles. A semi-structured interview format was used to interview 13 fathers from regional and metropolitan cities. An in-depth look into fathers' perspectives using interpretative phenomenological analysis showed that fathers found a balance between traditional and egalitarian gender roles resulting in reconstructed fatherhood.

Aims:

Digital mental health services are effective and can improve access to evidence-based treatment. This longitudinal phased engagement study aims to evaluate and tailor the integration of an established digital mental health service by clinicians in rural and remote areas.

Methods:

We conducted iterative surveys of rural and remote clinicians registered as THIS WAY UP prescribers and identified by postcode. Fixed and free-text survey questions were used to scope patterns of digital mental health service usage and key barriers to use in these settings.

Results:

380 clinicians responded to the initial survey between Oct-Nov 2020, including General Practitioners (n=129), Psychologists (n=95), other Allied Health (n=108), Nurses (n=38), and Medical Specialists (n=10). The majority of respondents (76%) used THISWAYUP to complement their routine practice, with 50% using it as an adjunct to enhance telehealth or in-person sessions. 77% of clinicians used the service alongside other interventions. Half the cohort (49%) used the service while clients were waiting for other care, demonstrating a clear need and utility of digital mental health treatments in the rural and remote context. Results from the second phase survey will be used to inform ongoing collaborations and development of tailored resources.

Relevance:

The uptake of digital mental health interventions can augment traditional care and overcome barriers to accessible treatment which are compounded in rural and remote areas. These results demonstrate a recognised need for digital mental health services and a strong desire among rural and remote clinicians to use such services to enhance care provision.

Conclusions:

THIS WAY UP is used to facilitate access to timely treatment for patients in rural and remote areas awaiting other care. Unique challenges to integrating digital mental health services in rural and remote settings were identified. Tailored support for the rural and remote clinical workforce is critical to service integration.

In 2021, the House of Representatives Select Committee on Mental Health and Suicide Prevention released a report that outlined the mental health, suicidality, and social and emotional wellbeing crisis that currently exists in Australia. The report particularly emphasised the opportunities in rural Australia to improve accessibility of mental health services and increase rural mental health workforce. One recommendation from the report was the need to leverage clinical placements in rural areas as opportunities for multidisciplinary, hybrid mental health hubs that integrate digital services and face-to-face services.

In response to this, Three Rivers Department of Rural Health, Charles Sturt University is in the process of creating a mental health multidisciplinary training hub which will commence operation in 2024. The purpose of the hub is to create high-quality work-integrated learning opportunities for health students that address community need through the provision of low-risk mental wellness activities. Indirect outcomes of the hub also considered in the design are interprofessional education related to mental health and pathways into rural mental health careers. This poster outlines the processes undertaken to create the hub, including stakeholder mapping, community consultation, student learning outcomes, and governance arrangements. A preliminary model for the hub will be diagrammatically represented and provide an opportunity for feedback and discussion.

Introduction: Dialectical behaviour therapy (DBT) is an effective treatment for Borderline Personality Disorder (BPD). However, there are many barriers to making this sort of therapy available within routine care in rural areas. Service managers, clinicians and consumers struggle with the poor access to appropriate treatment for this group of people.

Methods: A collaborative and telehealth-based model of delivering DBT in rural areas for people with BPD is currently being trialled in the Hunter New England and Murrumbidgee Local Health Districts. The skills-based group therapy (the most labor-intensive component of treatment) is delivered by telehealth and the individual therapy component is delivered by rural clinicians trained in this model. Three months after starting treatment delivery, qualitative interviews and standardised questionnaires have been used to understand consumers’ and clinicians’ early experiences of this model of treatment delivery.

Results: A total of 21 clinician interviews and 9 consumer interviews have been conducted. Over all, clinicians reported finding immense value in the program as clinicians and for their consumers. Clinicians weren’t concerned by the hybrid telehealth model. However, there are sustainability concerns amongst clinicians in regards of staffing issues within some regions and the service pressure to prioritise acute crisis work. Overall, consumers reported improved outcomes, valuing the program and the telehealth component being tolerable (for some it was seen as a positive feature). However, some consumers reported not enjoying DBT as a therapy model, wishing that there was a face-to-face option for group therapy, and being frustrated by clinician turnover.

To provide a culturally safe environment for the Aboriginal community to receive mental health care by establishing a weekly Outpatient Mental Health/Wellbeing Clinic located within the Njernda Wellbeing Unit.

It has been recognised now for some time that Aboriginal community do not feel culturally safe attending appointments at Echuca Community Mental Health.   It has been reported by the patients, families, carers and the wider community that Aboriginal people are most likely to attend services within Njernda Medical Services.

The Clinic has now been running successfully for five years. Constantly evolving to adapt to social and political environments such as the Covid pandemic.

State Library Victoria and Public Libraries Victoria work in collaboration to ensure public libraries can deliver inclusive and relevant services to their communities.

Since 2020, the collaboration has focussed on how public libraries can support health and wellbeing in the community.

This work has resulted in a framework that clearly articulates where libraries sit in the health continuum; a research report that provides the data and evidence on how public libraries positively impact community health and wellbeing; and a series of innovation grants that have enabled public libraries to work with their communities on health and wellbeing projects and programs.

The collaboration has also partnered with VicHealth on a co design project to improve the mental wellbeing of young people by ensuring libraries are welcoming and inclusive.

This presentation outlines the role local public libraries play in partnering with primary health services to support community health and wellbeing.

This presentation will explore the development and implementation of the MyStep to Mental Wellbeing Program in the Western Riverina district of NSW. It will evaluate the strengths and challenges of providing stepped care services across multiple programs and the embedding of a therapeutic program within the wider Murrumbidgee Local Health District Mental Health and Drug and Alcohol Services. The model of care will be discussed and the impact of this model on service delivery will be reviewed. Clinical outcomes and consumer stories will be provided to demonstrate the effectiveness of providing continuity of care across mental health service levels.

This world-first study developed an understanding of the health, safety and wellbeing influences on Compassion Satisfaction (CS) and Compassion Fatigue (CF) of rural and remotely practicing rehabilitation healthcare workers. Rehabilitation healthcare workers are health professionals representing a growing Australian workforce engaged in disability management, psychological and medical rehabilitation, occupational rehabilitation, and injury management/prevention. Information presented may assist employers in identifying changes needed to models of care in rural/remote locations, and identifying new ways to meet Work Health and Safety (WHS) obligations to provide a safe work environment by reducing the risk of CF.

Key Performance Indicators (KPIs) and client conduct were identified as stressors which significantly increase WHS risk by influencing the development of CF. Participants perceived employer profit (meeting KPIs) is prioritised over staff safety, with most female participants experiencing inappropriate client conduct including verbal abuse, physical assault, and sexual harassment. When participants reported WHS concerns to their employer, they felt their experiences were minimised, resulting in participants normalising this as an expected part of the role. Sources of CS for some were sources of CF for others, however most participants described elements of poor organisational governance of WHS, and this was identified as a significant risk for the development of CF.

Although there are similarities in CS and CF experiences with other remote healthcare professionals, for rehabilitation professionals KPIs were a unique concern. This is likely attributed to the uniformity of KPIs regardless of location, without consideration to the complexities of rural/remote practice. Urbanised models of care were used across all geographic locations which resulted in increased workload with unrealistic and unattainable KPIs. This resulted in participants reporting symptoms linked to CF including anxiety, depression, and burnout. It is critical that further work is undertaken to identify how CS can be increased and maintained to minimise CF.

It is no secret that we are in the grips of a mental health crisis and frontline workers are struggling to cope with the increase of referrals for mental health treatment and support. Since COVID-19 mental health clinicians have seen a significant increase in demands and stressors of their roles with many experiencing burnout and fatigue and some closing their books altogether.
At Access Psych we recognised the high risk of burnout for clinicians and have provide a different type of workforce for our team of both provisional and registered psychologists; allowing them to work in a hybrid role with a partner organisation and being flexible in their work approach. For those that choose to work full time with us we have broken up their roles to include diversity such as training and education instead of clinical treatment.
This has seen a higher engagement in staff, a reduction in staff burnout and the Access Psych continues to grow with psychologists seeking a new way of working and a team that prides itself on supporting frontline clinicians. We have provided in-house supervision, including group sessions to ensure the team have continual development and support.
We would like to invite an open discussion on how we set up our clinic to support our psychologist, the feedback we have received from our team and how we can continue to think outside the box into the future to support frontline psychologists in the workforce.

This presentation will explore the development and implementation of the MyStep to Mental Wellbeing Program in the Western Riverina district of NSW. It will evaluate the strengths and challenges of providing stepped care services across multiple programs and the embedding of a therapeutic program within the wider Murrumbidgee Local Health District Mental Health and Drug and Alcohol Services. The model of care will be discussed and the impact of this model on service delivery will be reviewed. Clinical outcomes and consumer stories will be provided to demonstrate the effectiveness of providing continuity of care across mental health service levels.

Accessible, evidence-based, culturally sensitive services remain a critical area of need for young children in Australia. Unfortunately, the availability of early intervention services is lacking across Australia. Accessibility of such services remains of paramount importance, particularly in light of ongoing post-pandemic mental health concerns. Based in South West Sydney, Karitane remains a pillar of state-wide mental health service provision for young children and families. Recently, Karitane has expanded its breadth and depth of services due to and following the COVID-19 pandemic. Within Karitane, the toddler clinic provides families with a variety of treatment options. Parent-Child Interaction Therapy (PCIT; McNeil & Hembree-Kigin, 2010) is an evidence-based treatment for toddlers aged 14 months – 4.5 years of age presenting with emotional and behavioural challenges. The treatment can be delivered virtually (Internet Parent-Child Interaction Therapy) or face-to-face. An adaptation of PCIT, entitled Parent-Child Interaction Therapy with Toddlers (PCIT-T; Girard, Wallace, Kohlhoff, Morgan & McNeil, 2018) focuses on the specific developmental needs of toddlers aged 12-24 months and can also be delivered in a face-to-face or virtual format. Briefer service options are also available and include a group treatment program and phone call-based brief intervention service model. Such options aim to provide accessible, inclusive, flexible treatment for children and families with a variety of needs.

This presentation will provide an in-depth overview of treatment and professional training options within the Karitane Toddler Clinic. Karitane invites referrals for young children and families seeking assistance with behavioural and emotional management.

References:
Girard, E., Wallace, N. M., Kohlhoff, J., Morgan, S., McNeil, C. B. (2018). Parent-Child Interaction Therapy – Toddler: An Early Intervention Program to Improve Attachment and Emotion Regulation. New York, NY: Springer.

McNeil, C. B., & Hembree- Kigin, T. L., (2010). Parent child interaction therapy (2nd ed.). New York, NY: Springer Science & Business Media.