S.TRUEMAN PhD THESIS 2016

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behaviours (whether insightless, violent, abusive, uncooperative or irrational), contain their movement and maintain constant observation of them. While this is not primary healthcare per se, it is care that is necessary and expected. Accordingly, when delivering mental healthcare in such circumstances, remote nurses are necessarily forced to extend their scope of practice beyond primary healthcare (which is their role description), thereby supporting and facilitating patients entering secondary and tertiary care. 2.16 Primary Healthcare Delivery Models in Remote Australia In the first systematic review of Australian remote and rural primary healthcare service delivery (necessarily inclusive of mental healthcare), Wakerman et al. (2008) found: the different … models [of primary healthcare delivery] relate to different geographical contexts, with a notable association with population size and remoteness. While larger rural communities are generally able to support a greater variety of local, discrete, more specialised healthcare services, increasing remoteness and diminishing population size and density constrain service model options and increase the impetus for the development of more integrated and comprehensive primary health services in order to maximise the economies of scale and use of existing health workforce. (p. 5) There is no ‘one size fits all’ model for provision of care in different areas; different model types suit different locations. The major reason for this is that the nature of the population distribution in Australia is the critical factor in designing primary healthcare services: ‘Successful models address diseconomies of scale by aggregating a critical population mass, whether it is a discrete population in a country town or a dispersed