Scottish Mental Health Nursing Review

10. Theme 5: Mental Health Nursing in Rural and Islands Setting

10.1 What we heard

Population estimates for Scotland suggest that around 17% of the population live in rural or remote and rural areas, with a further 9% living in small towns and 3% in remote small towns. Rural areas constitute 98% of Scotland’s landmass (Rural Scotland Data Dashboard, 2023). Through our engagement, participants highlighted the specific challenges and opportunities faced by mental health nurses working in our rural and island areas. These included issues relating to staffing, affordable housing, and the accessibility of services often centralised within, or located out with, their local areas. It is important to note that these issues are also evident for student mental health nurses, where access to services, as well as securing accommodation during placements can be challenging.

Emergency and Urgent Care Mental Health Nurse

The post was created back in 2018/19 aiming for urgent mental health provision for

Northwest Highland utilising funded from the Scottish Government Mental Health

Strategy – Action 15. As the Emergency and Urgent Care Mental Health Nurse in Skye, Lochalsh and Wester Ross I provide assessments and short-term interventions for people experiencing mental health crisis, aiming to get people the help they need, where and when they need it, and preventing hospital admission whenever possible.

Travelling around the stunning and often challenging roads to see people in A&E, in one the 12 GP surgeries in the area, in the person’s home, or make use of technology such as NHS Near Me if people prefer.

One of the unique challenges of the role is the limited access to local resources owing to the geography and demographics of the area. As a result, remote and rural health care staff must be even more creative, resourceful and maintain a broad range of skills to deliver excellent care to support people to recover.

This development and local roles have vastly improved the experience and outcomes for people in mental health crisis living in remote and rural parts of Highland and I am proud to be a part of the team!”

NHS Highland

Research shows that Mental Health Nurses in rural and island settings often serve as the primary point of contact for mental health services and therefore, their roles, responsibilities, and geographical remit, can often be broader than those working in urban settings (Rio, 2022). For example, Mental Health Nurses in rural and island settings often must work more autonomously in decision making, which may feel more isolating and can have greater risks associated for the practitioner. We also know that issues relating to the ageing workforce is particularly acute in rural and island settings.

The Scottish Government is developing in partnership, a strategic direct support model. This model takes a sustained whole-system approach to provide rural and island health and social care employers with the help they need to overcome recruitment challenges. To help collectively deliver the model, planned resources include:

• A Rural and Island Recruitment Network,
• A Support Toolkit, and
• A Living Library

The implementation and impact of this strategic model will be regularly monitored in partnership with the Centre for Workforce Supply, the National Centre for Remote and Rural Health and Care and the Rural & Island Recruitment Network. Both qualitative and quantitative data will be analysed on an annual basis to assess the success of this model.

The Scottish Government also provides annual funding to the National Rural Mental Health Forum, chaired by Change Mental Health. The Forum supports people in rural areas to maintain good mental health and wellbeing and develops connections between communities and workforce across rural Scotland to reflect the unique challenges presented by rural life. The Forum focuses on exchanging learning and good practice about mental health and wellbeing in rural and island areas, enabling it to better understand and support rural communities.

In partnership with the Forum, Scottish Government are working to ensure rural communities have equal and timely access to mental health supports and are supporting efforts by NHS Boards to promote the use of digital access to services for rural communities.

In addition to ensuring the unique role of mental health nursing in rural and island settings are fully considered during the development and delivery of the above work, we will:

23. ACTION: Work with the existing Mental Health Nurse Leads Group to establish a Rural and Islands Mental Health Nursing Network subgroup. This will provide an opportunity for rural and island practitioners to create a community of practice, to establish strong links, sharing of learning and best practice, including with the National Rural Mental Health Forum and National Centre for Remote and Rural Health Care.

24. ACTION: Working with the above groups, we will consider if there are specific education needs for mental health nurses working in rural and island settings.