Practicing psychiatry in a rural area

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

There’s a need to pick up the ways that a small community works rather than trying to impose one’s own values.
Dr Marina Vamos

Working as a generalist

Rural psychiatrists often work as generalists, treating a wider range of diagnoses than in the city. With fewer private specialists in smaller towns, rural hospitals are more likely to see more patients with less-acute needs than their counterparts in city hospitals. Instead psychiatrists may see more patients with concerns relating to anxiety and depression.

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’s likely that a psychiatrist will need to liaise extensively with primary care providers.

Different mental health context

There are key ways in which the mental health picture in rural areas differs from that in urban settings. This can affect health determinants, presentations and treatments.

Why work in a rural area?

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:

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 Indigenous communities.

Working in a small community

Small town environments can affect service provision, and in a close-knit community there can be issues with personal–professional boundaries, confidentiality, and patients’ willingness to engage in treatment. Patients may contact you outside of hours or want to discuss their health in social settings.

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 of 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 an 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.

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