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Project Background

Rural Newfoundland and Labrador

Community members in rural and remote regions typically have little access to mental health services (Strasser, 2003). Health care professionals in these areas often feel unprepared to manage the complex social, psychological, and psychiatric needs of their communities (Yuen, Gerdes, & Gonzales, 1996). In addition, rural health care providers often work in isolation from collegial and specialized mental health support and the result of this work environment is often burnout and high staff turnover `rates (Cornish, Church, Callanan, Bethune, Robbins, & Miller, 2003; Barer & Stoddart, 1999). Other professionals in the community, including teachers, clergy, paramedics, and police officers also feel unprepared and unsupported in their efforts to respond to mental health crises.

Despite these shortcomings, rural communities have natural strengths and respond effectively to community concerns. Families tend to be supportive of each other through difficult times, natural networks exist in small communities, and health care professionals are open to working collaboratively.

In an effort to increase health care efficiency (Boone, Minore, Katt, & Kinch, 1997; Davidson & Elliot, 1997; Pion, Keller & McCoombs, 1997), governments and health care administrators have encouraged or required health care professionals to work more collaboratively with each other (Government of Newfoundland and Labrador, 2003); Liedtka & Whitten, 1998; Tucker, 2001) and with community members (Buchan, Carter, & Manning, 2002). Shared care among mental health professionals and primary health care providers has also been promoted as a means of enhancing productivity (Davis, 1993). Interprofessioanl collaboration in rural regions is different from collaboration in urban areas due to the geographical distances, the smaller number of professionals and the broader service demands placed on general practitioners. It has been suggested that greater collaborative efforts among primary health care providers in rural areas has the potential to reduce fragmentation and enhance coordination, incr4ease patient satisfaction, enhance patient and population outcomes, and enhance recruitment and retention efforts (Barer & Stoddart, 1999).

The primary challenges facing Newfoundland and Labrador have been identified as the general health status of the population, demographic changes, the quality and accessibility of health services, and the sustainability of services (Healthier Together: A strategic Health Plan for Newfoundland and Labrador, 2003). This province has seen the largest overall population decline in Canada, particularly in rural areas where outmigration has increased substantially. Traditional family supports for seniors and others requiring long term care have decreased accordingly. Despite efforts to improve community-based health services there is still a lack of services for those who suffer with mental illness es. Appropriate services and supports are crucial for this population.

Appropriate services and supports, tailored to the needs of each community, their values and their shared vision, are crucial for this population. The advantage of interprofessional collaboration is their familiarity with the internal workings of the community and the lives of the people in them.

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