S.TRUEMAN PhD THESIS 2016

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areas to regional and metropolitan hospitals because the necessary specialist skills and facilities are absent in remote areas. Primary healthcare centres do not have the capacity to admit mental health patients. Remote nurses do not have a stake in or influence over issues such as the sporadic or intermittent demand curve for mental healthcare services (e.g., the randomness of mental health crisis presentations); disjointed service delivery costs of care (e.g., costs of aero-evacuations); high, fixed and committed cost structures (e.g., cost of wages and transport in delivering remote healthcare); or lack of economies of scale (e.g., dispersal of remote population/level of recurrent expenditure) combined with resource depletion and rationing, culminating in economic deficiencies and funding shortfalls being borne by remote nurses. These economic drivers of remote mental healthcare provision force the remote nurse beyond their traditional scope of primary healthcare practice. It is a misnomer to describe remote nurses’ work in delivering mental healthcare for seriously mentally ill patients as simply ‘primary healthcare’. While this section discusses macro-scale primary healthcare models for healthcare delivery in remote Australia, the reality is that only remote nurses make this level of service provision functional and deliverable (Queensland Health, 2013; Wakerman & Humpherys, 2012). In economic terms, the ‘real’ sustainability of remote mental healthcare is fundamentally intertwined and linked to the remote nursing workforce. An example of remote nurses being critical to sustaining the delivery of remote mental healthcare is that, regardless of the time of day, remote nurses must care for a detained patient for the duration of time that the patient is present in the remote area. While still detained in the remote location, the nurse must appropriately respond to the patient’s