Practising psychiatry in a rural location

The rural environment is an important and distinctive context for psychiatric practice, offering unique opportunities and challenges.

Working as a generalist

Psychiatry in rural areas demands a breadth of knowledge and expert generalist skillset to meet the needs of rural communities. There are fewer private specialists in smaller towns, with psychiatrists often treating a wider range of diagnoses than in metropolitan regions. Rural hospitals are more likely to treat patients in partnership with primary care providers.

Dr Sasha Jones

“Psychiatry in a rural location offers experiences and opportunities you simply don’t get elsewhere. You develop broad clinical skills, meaningful autonomy, and strong working relationships with both communities and colleagues. The work is varied and challenging, and you’re often able to see the impact of your care more directly.”

Dr Sasha Jones, RANZCP Rural Champion

Working as part of a team

Treatments are likely to involve a greater degree of consultation–liaison than might be usual within a metropolitan environment. It is more likely that patients will initially seek mental health support from a generalist worker, such as a GP, a community nurse or an Aboriginal health worker.

Psychiatrists in rural settings regularly liaise with other health-care professionals who are encountering mental health problems in their patients or seeing a greater degree of somatisation in their patients. This makes the promotion of mental health, both among other doctors and the general public, vitally important.

Dr Victoria Wilson

“Teams in rural settings are often highly supportive and collaborative, with a strong understanding of the realities of rural practice. Clients and families genuinely appreciate the commitment of those who choose to work in their community, which adds a strong sense of connection and gratitude to daily clinical work.”

Dr Victoria Wilson, RANZCP Rural Champion

Mental health context in rural communities

With around 7 million people living in rural Australia, the observed mental health inequalities may reflect poorer access to, and use of, health services.

A culture of self-reliance in rural areas can make people reluctant to seek help. Additionally, there can be considerable stigma attached to mental illness, even more so than in cities. Therefore, patients in rural areas may be less likely to report mental health problems.

For psychiatrists and trainees looking for a personally and professionally rewarding experience, there are many benefits to be gained from working in a rural setting.

Dr Chris Henry

“There is a profound sense of purpose in working where you are truly needed. In a rural setting, you see the tangible impact of your work on the community every day. You aren't just treating a diagnosis; you are supporting a person within the context of their whole life—their family, their job, and their town. The longitudinal relationships you build are incredibly rewarding and remind you exactly why you entered medicine in the first place.”

Dr Chris Henry, RANZCP Rural Champion

Why work in a rural area?

Travel and see new parts of the country. The chance to live and work in a rural environment is a major drawcard for many people. There is the opportunity to experience not only scenic surrounds, but a different lifestyle and a less hectic pace of life.
Have greater autonomy and experience a wider variety of patient needs. Trainees have reported that a major benefit of their rural experience was the diverse caseload, together with a wide variety of hands-on clinical experiences. They also reported that they had higher levels of responsibility than in city-based posts.
Work with professionals from a broader range of disciplines. Because of the way mental health services are delivered in rural areas, psychiatrists will likely work with professionals who have a wider range of skills than might be the case in the city.
Be a part of a committed, friendly and supportive team of professionals. Psychiatrists often describe receiving a warm welcome from their team as a vitally important team member.
Provide an invaluable service to the community. Rural practice can provide psychiatrists with a sense of appreciation and respect that can be hard to find in our busy cities.
Gain other new experiences. Examples are delivering health care using telepsychiatry, providing outreach services, and working with Aboriginal and Torres Strait Islander communities.

Dr Benjamin Vialle

“Rural and regional services are where bright and passionate trainees and psychiatrists can really shine. The demand for generalism, flexibility and creative problem-solving means we need the best – and the best, in turn, make a wonderful difference in rural and regional services.

Rural disadvantage impacts our patients and their families, and so we remain grounded in the equity and justice issues that are central to psychiatry’s social contract.

Connected communities, beautiful landscapes, and attractive housing prices of course can make it a great decision too… But most of all, the work is broad and dynamic, and we know we are serving our community.”

Dr Benjamin Vialle, RANZCP Rural Champion

Rural disadvantage impacts our patients and their families, and so we remain grounded in the equity and justice issues that are central to psychiatry’s social contract.

Dr Benjamin Vialle, RANZCP Rural Champion

Working in a small community

Small communities can provide a valuable source of support for their residents. The closeness of these communities, however, can affect patients’ willingness to seek help and engage in treatment. The highly integrated nature of rural communities can also sometimes result in the exclusion of people who are seen as different or who are new to the community.

Important social structures in rural communities may include local sporting groups and service groups such as Rotary, Lions, Red Cross, the Country Women’s Association (CWA), and the Returned Services League (RSL).

In rural areas, the regional economy is a key influence on mental health. Events such as drought, flood and bushfire can have a heavy impact, especially in agricultural areas. The mental health consequences of regional economic recession can be long-lasting.

Like many countries, Australia has a trend of urbanisation, with young people moving to the cities and rural populations decreasing in size. Local businesses and services may be adversely affected by the decrease in population. The closure of a major local employer can have consequences for an entire community.

Dr Lara North

“I see rural as a strength - the breadth and complexity of generalist clinical experiences, the trust and respect demonstrated between colleagues in close-knit teams, the autonomy and leadership opportunities that present themselves in small services, and the sense of belonging and purpose formed whilst working within a small community has strengthened my development as a psychiatrist.. and as a human being.”

Dr Lara North, RANZCP Rural Champion

Confidentiality

In a small-town environment, health-care professionals, patients, and their families and friends may share the same social networks, which can make maintaining confidentiality more challenging. Psychiatrists may even experience social pressure from well-intentioned friends or family to reveal information about their patients.

People in rural towns can be connected to each other in ways you do not expect and gossip can spread quickly. Whereas in the city, one of the clinic staff discussing their day with their partner would probably not have negative ramifications, it can be different in a small town. All these influences demonstrate how vitally important it is to maintain patient confidentiality.

Travel and transport

Many regional centres provide outreach services to smaller communities, meaning that psychiatrists’ roles may involve regular travel. It is important to think about transport issues for both doctor and patient.

Patients may have travelled in from outlying regions for treatment and it is often necessary to consider public transport and travel options when thinking about appointments and patient management plans.

Patients from remote areas requiring inpatient admission are often transferred to regional centres. This provides challenges around clinical responsibility as well as admission and discharge planning.

Overcoming the distance barrier

While access to specialist services may be more difficult in rural areas, the use of communication technology can help. Psychiatrists can deliver care remotely using telepsychiatry.

Distance can also affect psychiatrists’ access to professional support networks. The RANZCP runs a variety of events aimed at supporting rural trainees and psychiatrists continuing development.

Wellbeing

Working in rural and remote locations can be challenging. RANZCP has a range of wellbeing supports for trainees, SIMGs and Fellows.

The Royal Australian and New Zealand College of Psychiatrists has received Australian Government funding under the Psychiatry Workforce Program. This web page reflects the experience in Australia, however, the information may also be useful for psychiatrists and trainees working in New Zealand.