S.TRUEMAN PhD THESIS 2016

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the Australian College of Nursing can use their influence to advocate for remote area nurses in this policy arena. • Increased consumer expectations : The spread of information about healthcare through the internet has increased questioning about and demand for healthcare. • Alternative models of delivering services : Deinstitutionalisation of mental health patients, rationalisation and centralisation of health services has caused increased demand for home and community care, although this has not always been funded, especially in remote areas. • Increased role of technology : Advancements in medical care have apparently lessened the need for extended hospitalisation. At the same time, the high costs, need for centralised expertise, and increased service threshold requirements have resulted in diminished access to care for many remote populations. • Changing emphasis from treatment to wellness : Over recent years there has been greater focus globally on public and population health. The importance of ‘damming the river upstream’ rather than coping with ‘the deluge downstream’ requires a health system response to key risk determinants operating in remote areas in order to facilitate effective primary prevention and early intervention. This is the critical challenge for the future of remote mental healthcare delivery (Humphreys & Wakerman, 2008). All of these issues will continue to buffer remote nurses delivering remote mental healthcare in any service model. It is the nursing workforce who will have the greatest adaptation to make, because compared to other remote health professions, they are the dominant and most permanent workforce in the field.