Factors Impacting on Retention Amongst Community Mental Health Clinicians Working in Rural Australia: A Literature Review

By Cosgrave, Catherine; Hussain, Rafat et al. | Advances in Mental Health, April 2015 | Go to article overview

Factors Impacting on Retention Amongst Community Mental Health Clinicians Working in Rural Australia: A Literature Review


Cosgrave, Catherine, Hussain, Rafat, Maple, Myfanwy, Advances in Mental Health


Background

In rural Australia, there is a heavy dependence upon the public sector for health service provision. In respect of rural mental health services, public sector community mental health is an essential service which is especially relied upon by those living with serious and persistent mental illnesses. Recruitment and retention difficulties are a major and ongoing challenge facing Australia's rural mental health service sector, and community mental health is no exception (Health Workforce Australia, 2013).

Long-term unfilled positions and high staff turnover are commonplace throughout Australia's rural community mental health services. These have been attributed to negatively impacting upon job satisfaction, contributing to burnout and resulting in high staff turnover (Drury, Francis, & Dulhunty, 2005; Lloyd, King, & Bassett, 2002; Perkins, Larsen, Lyle, & Burn, 2007). The impact of these workforce challenges arguably effects the ability of rural community mental health staff to provide quality client care and to support new staff effectively.

Given the heavy reliance on community mental health services in Australia's rural communities, there is an urgent need for appropriate interventions aimed at improving workforce retention. Effective policy interventions are particularly needed to address avoidable staff turnover. Factors impacting on retention are known to be multifactorial and involve considerations across the various life-domains including work (place and role), profession (career), personal (and family) and community (social connection) (Mills & Millsteed, 2002; Patton & McMahon, 2006; Schoo, Stagnitti, Mercer, & Dunbar, 2005). To address avoidable staff turnover, there needs to be a better understanding of the conditions encountered by rural community mental health staff concerning their workplaces, doing their jobs, their professional and career-building needs, as well as any relevant personal and social factors.

This paper begins by setting the context of Australia's rural community mental health workforce. It includes a discussion of the impacts arising from the de-instutionalisation of Australia's mental health sector. It also includes a summary of the known challenges and opportunities across the life-domains that affect health professionals working in rural positions.

The paper then presents the findings from recent literature on factors impacting on retention amongst clinicians working in Australia's rural community mental health services. These key findings centre on: the nature of the work; the multidisciplinary team; and the attractors and detractors of working rurally. The paper concludes with a discussion about research quality, gaps in the literature and suggestions for future research.

Context

Definitions of some key terms used

Health service workforce supply is a factor of both recruitment and retention. Recruitment is the process relating to the selection of staff to a particular service, team or role. Retention defines the length of time between commencement and termination of employment of staff (Humphreys, Wakerman, Pashen, & Buykx, 2009; Humphreys et al., 2007). Workforce turnover is commonly used to gauge retention and is a measure of staff terminations in a specified time period. Workforce turnover can also be seen as an indication of the extent of workforce flux (Rural Health West, 2013).

Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) system was established by the Australian government in 2001 to allow quantitative comparisons between Australia's urban and rural areas. The system includes five classifications ASGC-RA 1-5: major cities (1), inner regional (2), outer regional (3), remote (4) and very remote (5) (AIHW, 2004). This paper is interested in community mental health professionals working in the ASGC-RA classified areas 2-5. When the term 'rural' or 'regional' or 'remote' is used in this paper it denotes this ASGC-RA defined geographical area. …

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