S.TRUEMAN PhD THESIS 2016

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With reference to Table 1.1, as a percentage of Australia’s total population, only 1.4% reside either remotely or very remotely ( n = 525,020). This number is spread across 85.7% of Australia’s landmass, or approximately 6.0 million km 2 . In terms of spatial density, these figures equate to an average of one person for each 11.5 km 2 . Compounding this sparseness is the fact that the remote population tends to cluster into relatively small populations, through historical influences such as old mission stations or mining and farming communities and townships. This wide dispersal of such a small population is fundamental to the challenges concerned with economies of scale and mental healthcare delivery. It is also the key to why the most prolific and permanent sector of the health workforce, remote generalist nurses, are central to the continued sustainability of delivering remote mental healthcare. The dispersed nature of the remote population in Australia drives its remote health workforce. Models of delivery of remote primary healthcare (including mental health services) address diseconomies of scale by aggregating a critical population mass: evidence indicates that a minimum population of approximately 2000 to 3000 people is required for remote communities to support a range of primary healthcare service activities (Wakerman et al., 2006). Many remote and particularly very remote communities have nowhere near this number of community residents; for example, Oodnadatta had a population of 166 in 2011 (National Census, ABS, 2011b). In the provision of minimal healthcare services in remote areas of Australia, individual remote nurses are used to partially fill the void of otherwise nonexistent healthcare caused by unsustainable population numbers.