S.TRUEMAN PhD THESIS 2016

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As a nurse participant stated: We had GPs there … in business hours, so … we often referred to our GPs and our GPs dealt with a lot of these issues [mental healthcare]. [T20, p. 9] Most contact by remote nurses is with a regional district duty medical officer, such as Health Direct Australia (‘after hours’ GP helpline) or through the RFDS’s 24 hour/7 day on-call medical officer. As participant psychiatrist stated: We [psychiatrists] wouldn’t consult with the RFDS doctor about whether to evacuate or not. That decision would be made by the remote area nurse, usually in conjunction with someone like the RFDS doctor. (T24, p. 16] The paramount reason for contacting GPs mirrors the reasons for contacting a psychiatrist. There appears to be little difference in the reasons for initiating mental health advice in times of a mental health crisis presentation, particularly if there is a violent and aggressive presentation. The major reason for seeking GP assistance is usually to obtain a medication order for sedation. The second major reason concerns organising and obtaining authorisation for evacuation of mental health patients. While MHNs are usually part of the decision-making process, they do not have authority to unilaterally authorise the aero evacuation of a mental health patient. Remote nurses then escalate the decision-making process to the psychiatrist once the request has been vetted by the GP. Should a GP reside in a community, remote nurses expressed that at time of mental healthcare crisis they became a resource which considerably eases stress for them. One remote nurse participant described GPs who live in the community during a time of a mental health crisis presentation as a