Population selected: Australian aboriginal
The type of the service delivery holds prominence in the overall outcome of the service. In mental health service delivery holds significant prominence (McGorry, Bates & Birchwood, 2013). McGorry, Bates and Birchwood (2013) highlighted that proper service delivery helps to increase consumer’s participation while decreasing the cost of care and at the same time helps to improve the overall mental health outcomes. The following essay aims to highlight the advantages and disadvantages of mental health service delivery approach through face-to-face service delivery model and virtual service delivery model. The main target population include the Aboriginals residing in the remote areas of Australia and suffering from mental health complications. The essay will initiate will rational behind the chosen target population and positive and negative aspects of face-to-face and virtual service delivery model. The essay will them aim to critique the limitations and advantages of delivery counselling and community campaign through face-to-face and virtual service delivery model. At the end the essay will highlight the personal opinion of the authors and will propose the required recommendation in order to overcome the challenges of the healthcare service delivery promote professional development among the mental healthcare workers.
Australian Aboriginal have higher risk of developing unhealthy behaviours like smoking and drinking and the condition is worse in comparison to the people living in metropolitan areas (Parker & Milroy, 2014). As per the statistics 34.8% of Aboriginals resides in cities in comparison to the 70% of non-indigenous population. The statistics also highlights that 7.7% of the Aboriginal population resides in remote and 13.7% of population resides in very remote areas (Australian Bureau of Statistics, 2013). These groups of Aboriginal population residing in remote or very remote areas mainly suffer from poor mental health conditions and high rate of occurrence of chronic or other preventable disease which in turn decreases the overall life-expectancy of the population. This poor health status increasing with remoteness may be influenced by geographical and environmental factors like long distance access to services. Another condition underlying the poor physical and mental health status is guided by poor socio-economic determinants of health (Australian Institute of Health and Welfare, 2011). Thus remoteness and poor health status are the underlying causes behind their vulnerability towards poor health-related outcomes. Thus this selected group of population will be helpful in structuring a critique about mental health service delivery.
As per the guidance document published by the Australian Government Department of Health (2016) in relation to $85 million funding (2016-17 to 2018-19) granted specifically for Aboriginal and Torres Strait Islander mental health services, the mental health services must be integrated, safe and culturally competent in order to meet their mental health requirements. Aboriginals’ mental health services under this funding are specifically directed towards suicide prevention, substance abuse and effective mental health counselling in order to overcome depression and anxiety. These services are to link and complement with other closely connected activities like emotional and social wellbeing. According to Slade et al. (2014), in order to devise holistic mental health services, two main service delivery approaches that are required to be undertaken include face-to-face service and virtual service delivery.
Service Delivery in Mental Health in Aboriginal Population
Face-to-face service delivery is a condition where the staffs are required to work live within the community in order to deliver the service. The main advantage of face-to-face service delivery in mental health includes working directly with the client and thus helping to develop-person centred care plan. However, face-to-face service delivery in healthcare is associated with sudden disadvantages like cost of recruitment or employee retention, poor knowledge of the staffs about cultural competencies, occupational health risk and problem in the work life balance of the healthcare service delivery staffs (Mohr et al., 2013).
This service delivery approach is mainly given through phone, or through online video calls through skype. The main advantage of this approach is, it is cost effective and helps in easy access and prompt access of patient information through electronic medical records and thereby helping to implement effective multidisciplinary care approach (Christensen & Petrie, 2013). According to Christensen and Petrie (2013), Information and Communication Technology (ICT) at present is regarded as key towards accelerating advances in mental health. The review conducted by Hollis et al. (2015) revealed virtual service delivery in mental health through digital technology has potential to transform mental healthcare service delivery model through connecting patients, services and healthcare data from different parts of the world. However, the disadvantages of virtual service delivery through the use of softcopy data include bridging of confidentiality and transparency and accountability. Moreover, Hollis et al. (2015) also highlighted there exist a gap in the evidence based underlying these technologies.
|
Type of Mental Health Services |
Face-to-Face service delivery |
Virtual service delivery |
|
Counselling |
ü |
x |
|
Community Development |
ü |
x |
|
Education |
ü |
ü |
The study conducted by Bennett?Levy et al. (2014), highlighted that face-to-face counselling helps in effective promotion of the cognitive behavioural therapy (CBT) which helps in effective reduction in the adverse mental health consequences. However, CBT might fit under different cultural and social contexts in order to provide comprehensive care. The review conducted by Ridani et al. (2015) stated that effective face-to-face counselling is also helpful in suicide prevention via specifically targeting the risk factors of suicides like social exclusion, lack of job opportunities, domestic violence, and victims of racism or financial unrest. Ridani et al. (2015) conducted a study in order to analyse the importance of face-to-face counselling and revealed that face-to-face counselling is based on effective communication and development of therapeutic relationship, which helps the service users to discuss their problems in detail with the mental health nurse of psychologist and at the same time, helps to take informed decision making. Though face-to-face counselling is helpful in extracting effective outcome, but proves to be costly in the domain of transportation cost in the remote areas and the efforts required to encourage the Aboriginals to take part in the counselling.
Face-to-face service delivery
Providing effective mental health counselling through virtual service delivery are increasingly visualised as a potential approach in order to meet the growing demands of the mental health service (Dowling & Rickwood, 2013). However, Dowling and Rickwood (2013) highlighted that further research is required to be undertaken in order to support for the widespread implementation of online or virtual mental health service delivery through counselling. Online mental health counselling is effective from the aspect of the service provide and in reducing the overall cost of care from the service delivery approach. Because, the mental health nurses or the psychologist procuring the care are not required to commute to the remote areas and in order to cater Aboriginal communities mental health needs. This saves the cost of communication (Dowling & Rickwood, 2013). However, providing online care is not a cost-effective option for the Aboriginal communities residing in remote areas because the majority of them do not have proper internet access. Though Park (2017) stated that email and access to internet in the remote areas of Australia has promising future in mental healthcare delivery, the overall approach is not feasible at this point of time. The reason behind this is residents of remote Aboriginal communities lack skills for computer navigation.
The main advantage of community health education and awareness approach in face-to-face delivery in mental health includes direct communication and active community participation, which improves overall state of mind of the service users and increases their mental-health related awareness (North & Pfefferbaum, 2013). According to Zalsman et al. (2016), mental health service delivery through face-to-face community education and participation helps to improve mental health outcome likes suicidal approaches arising from severe depression and anxiety.
However, community development and increasing the mental health awareness among the Aboriginal communities residing in the remote or very remote areas has certain share of disadvantages. According to Parliament of Australia (2016), it is difficult to attract the mental healthcare professionals to work in the remote or very remote areas in order to serve the mental health needs of the Aboriginal communities. Poor service user to service giver ratios hampers the framing of effective community health education approaches for generating awareness among the Aboriginals with mental health complications in remote areas of Australia. The service users also experience challenges in face-to-face participation in the community health awareness and the education program. According to Morawska et al. (2013), in big city, it is easy to hide if one wants however, it the conditions are different in remote or very remote areas. Here the population density is very low and thus it is impossible to visit the local community awareness program or mental health education campaign or group counselling without the whole town knowing about it. This creates social exclusion within the community and the service users or the parents of children or young adults feel lonely due to unavailability of social relationships. Thus, they prefer to stay away from such interactive programs or awareness campaign.
Virtual service delivery
If such programs are implemented online then the free of social exclusion can be decreased as online participation through virtual media will ensure privacy and confidentiality of the participation. Moreover, the healthcare professionals will not be forced to shift their working based in the remote location thus promoting employee retention and satisfaction. However, though online education and health promotion will fail to uphold the concept of active community participation. Moreover, lack of proper internet access in the rural areas hampers the overall virtual service delivery of mental health awareness program (Morawska et al., 2013).
If I am asked to describe my position in relation to the ideas raised in the literature about the service delivery model, I would say that both face-to-face and virtual mode of service delivery is important in order to provide comprehensive healthcare coverage among the Aboriginal communities residing in the remote areas of Australia. I also feel that the disadvantages of the virtual service delivery model which is highlighted through the analysis of literature can be overcome because lack of proper internet access of lack of proper knowledge about the use of internet in mental care model are modifiable risk factors and proper implementation of teaching and training approach will help to overcome the same. In face-to-face delivery, I think it is the biased attitude of the healthcare service providers towards the Aboriginal community which is hampering overall service-delivery approach. Proper education of culturally competency and generation of cultural awareness will help to overcome the problem. I feel that proper amalgamation of both face-to-face service delivery approach and virtual service delivery approach will help to improve the overall mental health status of the Aboriginal communities residing in remote areas of Australia.
The mental healthcare professionals nurture a biased attitude towards the Aboriginal community and this is the reason that they lose interest in working for the betterment for the Aboriginal communities (Morawska et al., 2013). The study undertaken by Christopher et al. (2014) stated that the mental healthcare professional feel that there are no career progress in working under remote set-up and fewer charity services to offer support further decrease the doctors of the psychiatric ratio. These are main challenges experienced by the healthcare professionals while delivering mental health service in face-to-face counselling. Kohn-Wood and Hooper (2014) are of the opinion that the proper training of the mental health care professionals in the domain of cultural competencies and effective communication skills will help change their biased attitudes towards Aboriginals. Moreover, it is the duty of the government to come forward and increase the advantages or facilities of the mental healthcare professionals so that it encourages them to activity engage in mental health promotion for the Aboriginal population residing in remote areas in Australia.
Type of Mental Health Services
Another challenge that can be highlighted in the face-to-face mental health care delivery model (in educational campaign or counselling) is lack of adequate recruitment of the Aboriginal healthcare professionals. Kohn-Wood and Hooper (2014) are of the opinion that recruitment of the Aboriginal healthcare worker helps to increase the participation of the Aboriginals from culturally and linguistically diverse community (CLAD) in mental health promotional campaign. Presence of Aboriginal workforce increases cultural competency of the workforce and thus helping to increase the participation of the service users in face-to-face mental health campaign. Moreover Kohn-Wood and Hooper (2014) stated that presence of Aboriginal healthcare workers also help to decrease the biased attitude of the non-aboriginal workforce towards the Aboriginal mental health service users.
Kourkouta and Papathanasiou (2014) argued that training in the effective communication skills for the healthcare workers acts as a medium of the professional development. Good and effective communication between the service users and the mental healthcare professionals is important for successful outcome of individualized nursing care for each patients both under face-to-face and under virtual settings. Proper training in the effective communication skills helps the mental healthcare professionals in understanding the feelings and the thought-process of the service users and helping to devise proper care plan. Training in the effective communication skills helps in professional development as it also help in improving the intrapersonal communication skills. Moreover, proper training in the effective communication skills help the mental healthcare professionals to understand how to deal or interact with CALD and thus helping them to overcome the biased attitude Aboriginal community members suffering from mental health complications.
Conclusion
Thus from the above discussion, it can be concluded that Thus from the above discussion, it can be concluded that Australian Aboriginals residing in the remote or very remote areas are victims of the mental health complications due to lack of proper access of the healthcare services in the remote areas. Two important approach of mental healthcare delivery include counselling and community health education approach or mental health awareness campaign. This two mental health recovery approaches can be delivered either face-to-face service delivery model or through virtual service delivery model. However, both face-to-face and virtual service delivery model have sudden share of advantages and disadvantages. The main advantages in face-to-face healthcare delivery approach include easy development of person-centred care and one to one service. The challenges in this approach include cost of recruitment, employee retention, occupational health hazard, cultural safety and difficulty in understanding language for CLAD communities. One cost-effective approach in healthcare delivery is virtual service delivery as it does not demand rigorous staff requitement and employee retention. However, confidentiality and privacy issues come into consideration in case of online service delivery. Moreover the Aboriginal community members have poor access of internet or lack of knowledge of internet access and this creates a barrier in comprehensive usage. Proper training of the mental healthcare professionals in effective communication and cultural competencies will help in their professional development and thereby promote comprehensive mental health service delivery.
Counselling and associated service delivery model
References
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