Recruiting and sustaining a rural mental health and well‐being workforce: A Victorian initiative
Year: 2023
Type: article
Abstract: A flagship reform of the Royal Commission into Victoria's Mental Health System was the planned establishment of 50–60 Mental Health and Well-being Locals.1 Locals aim to ensure adults and older adults experiencing mental illness or psychological distress can access integrated treatment, care and support in the community. The Benalla, Wangaratta and Mansfield (BWM) Local is one of the first six Locals established.1 A significant barrier to meeting the ambitious goals of the Mental Health reform is recruiting and retaining a rural workforce. Rural Australia's workforce issues are well-documented, with few solutions identified.2 Workforce was identified as a primary risk in establishing the BWM Local. The leadership team has worked creatively to build and sustain a local workforce and, in its first 9 months of operations, has been able to successfully recruit and retain >95% of positions. A focus of the BWM Local is expanding services in our catchment. While staff recruitment from adjacent mental health services would meet BWM Local recruitment targets, it would augur against increasing access to care. This would create additional strain on fellow mental health services and likely impact on the harmonious integration of services, a core aim of BWM Local service development. Resultantly, less than five per cent of staff were obtained from area mental health services. When employing these staff, a priority was how they would improve the integration and working relationships of all mental health services impacted. In a similar vein, when nearby mental health services were decommissioned, the BWM Local focused on transitioning staff to ensure that valuable skilled staff could be retained in the area. The BWM Local marketed itself as an exciting development needed for the area. In doing so, the BWM Local was able to attract staff with previous connections to the area and the community to return and develop the BWM Local. Second, through partnerships with established national organisations (Wellways, Albury Wodonga Health and ACSO), the BWM Local successfully recruited several staff from distant locations including better-serviced metropolitan regions. Recruiting staff with a rural/regional community connection remained key.3 A priority was to support staff in relocation and establishing them in the community. A third focus was recruiting people with experience in an array of industries (education, corrections, welfare and employment) who were not currently working in dedicated mental health roles. These staff were identified as having the right temperament and skillset to enrich BWM Local service offerings. A commitment was made to orient, train, support and supervise these staff to transition to mental health and well-being roles. The BWM Local recognised that transitioning staff from other industries, which provide wrap around support to the mental health of the local community, could have a net zero or negative effect on population mental health. Significant recruitment came from local industries that were going through restructure or service change, whereby staff were at risk of job loss or having to relocate. In some other instances, people were looking for a career change. To further reduce this risk, the BWM Local has an arm of our service dedicated to building community capacity. This team has performed a stellar job in reducing any net zero or negative effects through social prescribing, upskilling, training and integrating the BWM Local with community needs. Early in recruitment, it was clear that not all planned roles could be filled. Rather than lamenting local staff shortages, the BWM Local focused on defining goals for these roles and aligning them with available staff profiles. Table 1 exemplifies BWM Local's employment and service development approach for initial recruitment goals. A central focus was placed on the participant's experience and adapting evidence-based service directions to available local resources underpinned by BWM Local planning. This was balanced with ensuring that staff always worked within their defined relevant scope of practice.4 To facilitate this approach, significant resources were committed to training and education. Employing a training coordinator optimised training available through our partners while also enabling access to the array of external training funded in response to recognised workforce gaps.2 The BWM Local has aimed to build an inclusive environment where staff feel valued and heard. Providing staff with opportunities to extend themselves and pursue their interests has been paramount in the success of the BWM Local. The BWM Local has adapted roles within its structure to fit staff career goals and has fostered education opportunities for staff, which in turn has both increased staff satisfaction and the workforce skillset. Mentoring opportunities are provided to staff to share their speciality knowledge with others. This provides a mutually beneficial relationship that strengthens the team's knowledge and ability to work collaboratively. In addition to formal and informal discussions and supervision, a fortnightly poll has been conducted to check in with the team around caseloads, well-being and role satisfaction. The anonymous poll allows staff to provide honest feedback, helping the leadership understand the team's current state, identify necessary improvements and adapt service focus and capacity based on the provided information. A large part of the BWM Locals ability to recruit and retain staff is attributable to the value and priority placed on lived and living experience. The leadership team has fostered an environment where bringing your whole self to work is encouraged, which allows staff to feel safe and their lived experience valued; reducing barriers between the lived experience and clinical arms of the service. As the BWM Local continues to develop, intentional decisions are being made to ensure that lived and living experience remains at the core of the service. Changes have been made to ensure that there is equal representation of designated lived and living experienced roles within the leadership team; that clinical staff are educated on the role of peer workers; and that processes are optimised to ensure the voice of the peer workers are being heard. A key example has been the establishment of lived experience-led participant planning sessions, rather than classical clinician-led multidisciplinary meetings. The leadership has created a 'one team' environment where everyone's opinion holds equal weight. A strength of the BWM Local has been its ability to adapt to feedback, ensuring a safe and accessible service for all. Implementing the Royal Commission's vision requires creative and innovative approaches to designing and recruiting the workforce needed to meet the ambitious reform agenda. Employment roles need to be adapted to reflect the needs of local communities and available workforce. Services need to focus on training local people with the right skillset to flourish as valued team members. Once employed, staff need to feel emboldened to use the skills they have developed to help participants on their recovery journey. Having sufficient staffing and a focus on well-being reduces the risk of staff burnout and assists in retention. Positive examples of recruitment in rural Australia should be celebrated and shared so that future Locals can grow on the learnings of early models and ultimately improve outcomes for the people they serve. Harry Hill: Conceptualization; writing – original draft; writing – review and editing; methodology; project administration; visualization. Julia Henning: Conceptualization; writing – original draft; writing – review and editing. Gary Croton: Conceptualization; writing – original draft; writing – review and editing. Nathan Castle: Conceptualization; writing – original draft; writing – review and editing. Stuart McIntosh: Writing – original draft; project administration; writing – review and editing; conceptualization. Cat Hunt: Conceptualization; writing – original draft; writing – review and editing; project administration. The authors received no financial support for the research, authorship and/or publication of this article. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. Ethics committee approval was not required for this article. Consent was obtained, from involved parties, for the writing of this paper.
DOI: 10.1111/ajr.13044
Authors: Harry Hill, Julia Henning, Gary Croton, Nathan Castle, Stuart McIntosh, Cat Hunt
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,240
OpenAlex ID: W4387002581