By Associate Professor Timothy A. Carey MAPS, Centre for Remote Health and Centre of Research Excellence in Rural and Remote Primary Health Care; Rachel Bell-Booth, Areana Eivers and Joe Coyne MAPS, School of Psychology and Counselling, Queensland University of Technology; and Carly Madgen and Associate Professor Reginald D.V. Nixon MAPS, School of Psychology, Flinders University

Access to quality mental health services is an ongoing problem in Australia (Morley et al., 2007) particularly in rural and remote locations, with disproportionate numbers of psychologists practising in metropolitan centres (Dunbar et al., 2007). One way to encourage psychologists to consider working in rural and remote locations is to provide placement experiences in these locations during their training. Facilitating these types of placements is one of the specific remits of the Mental Health Academic position at the Centre for Remote Health, and finding novel ways to improve access to services in rural and remote locations is a focus of the Centre of Research Excellence in Rural and Remote Primary Health Care (CRERRPHC). Course convenors of postgraduate psychology programs at various universities were contacted to gauge interest in participating in student placements in remote locations. To date, Flinders University and the Queensland University of Technology have taken up the challenge of organising placements for their students. This article describes the placements from the perspectives of the two students and their respective university course convenors.

Both students successfully applied for scholarships from SARRAH (Services for Rural and Remote Allied Health; www.sarrah.org.au/site/index.cfm) in order to fund the remote placements. One of the students was undertaking the final placement in her Master of Clinical Psychology degree, while the other had completed more than half of her Master of Educational and Development Psychology degree and this was her third placement.

The placements were undertaken in services provided by the Central Australian Mental Health Service, the Central Australian Aboriginal Congress – Social and Emotional Wellbeing Branch, and the Student Services Division of the Department of Education and Training. The placements involved assessment and treatment of Indigenous and non-Indigenous clients and their families from a range of different backgrounds and experiencing a variety of problems. Supervising psychologists and their colleagues working in these organisations were very enthusiastic about the student placements and felt the students contributed with new ideas and fresh perspectives.

The student perspective

Rachel Bell-Booth and Carly Madgen

The decision to undertake a placement in Alice Springs was motivated by a strong interest in Indigenous Australian cultures. We are both interested in working as psychologists with Indigenous people and saw the placement in Alice Springs as an opportunity to develop both professionally and personally through gaining a greater understanding and appreciation of Indigenous cultures. During the placement we were able to be involved in professional development activities, work in multidisciplinary teams, and visit remote Indigenous communities to observe and assist in the provision of psychological services.

Practical considerations needed to be negotiated in order to complete the placement. The scholarship from SARRAH made the placement feasible from a financial point of view, however, it also meant that the placement was shorter than a normal university placement and so accumulating the required hours was a challenge that required an adjustment of expectations. Other university commitments such as being able to continue working on our theses needed to be fulfilled, and this required flexibility on the part of our university supervisors as well as adequate resources in Alice Springs.

\The benefits of the placement, however, far outweighed the necessary extra organisational requirements. Through the remote placement we gained a wealth of experience in adapting our clinical, therapeutic and assessment skills in ways that could not be achieved in a metropolitan placement. We became aware of different ways of practising, we were challenged to adapt the skills we had already acquired, and we become even more attuned to the importance of understanding and applying culturally aware and sensitive practices.

Throughout the clinical placement I (CM) found myself reflecting on the difficulty in undertaking conventional therapy with Indigenous clients. During my placement I came to realise the difficulties in prescribing a ‘Western’ form of psychology to Indigenous people. From my observations and through liaising with many services, I formed the impression that work with Indigenous people in this context was generally crisis oriented and ongoing psychological therapy, of the form I was used to from previous placements, seemed rare.

The importance of creativity and flexibility was continually demonstrated to enable effective and relevant interventions. This placement taught me to constantly think outside the realm of conventional psychological therapy and highlighted a need to further educate myself and develop skills in working in a cross-cultural context with Indigenous people.

For me (RB-B), selecting appropriate psychometric tests for working with Indigenous school students whose first language might be one of the Indigenous languages spoken in Central Australia, such as Arrernte or Luritja, was also a dilemma. It is especially challenging when norms for Australian Indigenous children are not available for many tests. Questions frequently went through my mind during the placement. Is this measure appropriate? How much is poor acquisition of Standard Australian English affecting this child’s performance?

We felt the remote placement in Alice Springs was invaluable and provided greater insights into the social and clinical issues for Indigenous people and the different ways in which services and clinicians were working in these contexts. Living in the town and being exposed to how the community lives, including the challenges its members face, was incredibly valuable. Being in the remarkable Australian outback and taking time to explore the beauty of the surroundings was an added bonus of doing the placement in a remote location. We would highly recommend a remote clinical placement to all psychology trainees as a once-in-a-lifetime opportunity.

The course convenor perspective

Joe Coyne, Areana Eivers and Reginald Nixon

From a training perspective, there were many benefits in being able to access a remote placement. The placement afforded students an opportunity to work with Indigenous clients in a wide range of settings that are simply not experienced in metropolitan centres. In terms of the goals of producing graduates who are competent in ‘real world’ conditions, it was clear that the remote placement would require flexibility and the application of skills outside more familiar contexts. Similarly, while the nature and complexity of the clinical and social issues meant that the placement would be challenging, the flexibility required to work as a psychologist in this context, along with the exposure to ways of adapting the key assessment and therapeutic principles taught in coursework to novel scenarios, were considered to be invaluable. Furthermore, it was possible to access considerable support and professional development opportunities on the placement that were highly relevant to work in rural and remote communities.

There were certainly challenges to overcome in making the placement a realistic option. A practical issue was being able to complete other course requirements (such as the thesis) whilst being away from normal university supports. Careful planning was required to ensure that sufficient preparation had occurred prior to the placement as well as there being adequate access to important resources (such as computers and relevant software) whilst on placement. We were also aware that this placement would not suit all students so careful attention to student selection was important. Flexibility on our part as course convenors was also required to allow the timing of the placement to vary from more usual placement time frames. The main difficulty, however, was that the time frame of the placements was shorter than ideal due to the funding duration of the funded placement scholarship. This made it difficult to satisfy administrative and accrediting requirements. While these problems are not insurmountable, they do present barriers to a more seamless uptake of remote clinical placements.

It appears that the students benefitted greatly both professionally and personally from the remote placement. In order to make the placements available to more students, however, we would recommend that the current placement funding from SARRAH be expanded to allow the placements to be of greater duration. Ideally, it would also be useful for students to still be able to undertake coursework while on placement in remote areas. With new initiatives from Health Workforce Australia and other funding schemes, coupled with technological advances, there is the potential to set up such learning systems, and this is being trialled in some States.

Conclusions

From the experiences of students and course convenors at two different universities it seems that remote postgraduate psychology placements can provide valuable learning opportunities for postgraduate psychology students. There are certainly organisational considerations that need to be negotiated and the selection of appropriate students is also critical. Advocacy with scholarship providers such as SARRAH for increasing the scope of scholarships will make it easier to meet practicum requirements.
Living and working in a remote location, even for a limited period of time, provides opportunities for professional and personal development that cannot be similarly achieved with metropolitan placements. While the students seem to benefit from the placement, so too do the professionals with whom the students work. Importantly, the clients also benefit in both direct and indirect ways. They benefit directly by being able to work with enthusiastic and motivated trainees and they also benefit indirectly as these trainees learn more about Indigenous cultures and are able to take positive messages back to their metropolitan friends and colleagues. For a whole host of reasons, therefore, remote postgraduate psychology placements are certainly worth the effort and may be one useful way of improving mental health service provision in the bush. n

The principle author can be contacted at Tim.Carey@flinders.edu.au 

Acknowledgements

Special thanks to Bettina Bettington, Alira Capararo, Anita Chila, Sascha Kowalenko and Wendy Russ for their hard work, support, enthusiasm and involvement in the placements. For the first author’s affiliations, the Centre for Remote Health and the Mental Health Academic position is funded by the Department of Health and Ageing through the University Department of Rural Health program. The CRERRPHC is funded by the Australian Primary Health Care Research Institute. He is also employed by the Central Australian Mental Health Service.

References

Dunbar, J. A., Hickie, I. B., Wakerman, J., & Reddy, P. (2007). New money for mental health: will it make things better for rural and remote Australia? Medical Journal of Australia, 186, 587-589.

Morley, B., Pirkis, J., Naccarella, L., Kohn, F., Blashki, G., & Burgess, P. (2007). Improving access to and outcomes from mental health care in rural Australia. Australian Journal of Rural Health, 15, 4-312.