Remote possibilities: mental health nursing in far north Queensland

A five-minute drive is all it takes Nicole Murphy to travel to work every day in the small community of Weipa. Short compared to the road she has travelled to get here.

The day we talk, I am holed up in a tiny recording room, but she instantly transports me to the vast area she now calls home. Originally from Gippsland, Victoria, Murphy has found herself in remote Far North Queensland working for the Torres and Cape Hospital and Health Service (HHS).

Encompassing an area at the most northerly tip of the continent, this service is responsible for delivering health services to about 25,000 people widely spread across Cape York, the Northern Peninsula Area and the Torres Strait Islands.

This throws up some unique challenges for the nurses on the ground. Remote living and infrastructure problems mean this can be one of the most difficult areas of Australia in which to administer healthcare.

“I have been working for the past 18 months in the Torres Strait,” Murphy says. “There is no airport on Thursday Island or on many of the outer islands. We helicopter into the islands and first go into the primary healthcare centre. We get handover or an update from the clinic staff on our current consumers and if there are any concerns at present.”

Murphy is now a clinical nurse consultant and team leader of the Weipa cluster – covering the communities of Weipa, Mapoon and Napranum – and believes that hailing from rural Victoria and moving to Weipa via Alice Springs has eased the way for this outback adventure.

“After I left Gippsland, I worked in Melbourne for a couple of years and then I went to Alice Springs. So, my time in Alice Springs opened my eyes up to exactly what remote mental health nursing was.”

About 2480km or the best part of two days’ drive northwest from Brisbane, Weipa is the embodiment of remote rural Australia. Predominately a mining town, Weipa borders the Indigenous communities of Napranum and Old Mapoon. The latter was subject to mass evictions by the government in the mid-20th century when bauxite was discovered.

“They moved the residents of Old Mapoon up to New Mapoon, which is quite significant considering it’s around a five, six-hour drive from here,” Murphy says.

“The roads aren’t sealed, and so you could imagine it would have been even worse back then. It was quite a traumatic event and still very prominent for the community of Mapoon today.”

Unique Challenges

Two-thirds of the population in the Torres and Cape HHS identify as Aboriginal or Torres Strait Islander. And the 2014–15 National Aboriginal and Torres Strait Islander Social Survey found that in Queensland, 64 per cent had a long-term health condition, including 28 per cent with a mental health condition.

For Murphy, the root of this problem is complicated.

“Some of the unique issues are just around the real isolation and disadvantage that these communities have,” she says.

“There’s a massive lack of resources, and I’m not just talking about healthcare or service providers, I’m talking about housing, roads and other infrastructure, like electricity and running water.

“So obviously when you don’t have access to those sorts of things, that can really impact on your mental state.”

Access to patients is an obvious challenge – the weather alone can derail appointments on the outer islands – and that forces the health services to make creative solutions.

“Mapoon from Weipa sits an hour’s drive away, and that’s in good conditions. The roads are unsealed, driving out to Mapoon. During the wet season, it becomes quite tricky.

“But access to us has been improved through video teleconferencing.

“So that’s been a new frontier for the health service here, which has been quite beneficial.”

The biggest concern

According to the Australian Bureau of Statistics, between 2012 and 2016 intentional self-harm was the leading cause of death for Indigenous persons between the ages of 15 and 34, and the second leading cause for those between 35 and 44.

People who identify as Aboriginal or Torres Strait Islander are twice as likely to die as a result of suicide, compared to their non-Indigenous counterparts, and tackling this is key for Murphy.

“That’s a massive question, and you know it’s the biggest concern, absolutely.

“I recently came back from training around suicide prevention and one of the suicidologists from the mental health branch in Queensland said that we need to remember that suicide is a preventable act.”

Murphy believes that it is not just mental health professionals that can precipitate the change needed in this area.

“It needs to be a community-led initiative as well, and we need to really get the word out and try and reduce the stigma and the taboo around talking about your mental health and having thoughts of suicide. When people do open up, [it’s important to have] supports in place for the people who are listening to those talking about suicide.”

Community spirit

An isolated environment that can be demanding on the locals can be magnified for the health professionals who relocate from around the country.

Experiencing that same isolation, coupled with separation from family and friends, while dealing with others’ mental health day in and day out can be tough. This comes with the territory, but Murphy seems to take it in her stride.

“I think a lot of health providers don’t come with a plan of ‘how are we going to look after ourselves when we live here’.

“I get clinical supervision with a supervisor and I have a lot of peer supervision as well.

“I keep in regular contact with my friends and family back home, and I always have trips booked. I try and get home every six months, back home to Gippsland.”

Murphy believes the support network provided by the community atmosphere of Weipa and among the other nurses is especially important.

“I’ve got really good working relationships with the other mental health nurses that work along the Cape. I talk regularly with the team up in Thursday Island or the team in Cooktown or the guys that work in the remote communities throughout the Cape. It’s just making sure that you’ve got people to talk to and sharing all my frustrations.

“It’s very supportive and there’s lots of things going on in the community that everyone’s invited to and welcome to attend. It’s really quite a social, supportive environment outside of work. I think it needs to be to sustain people living here, for the longevity of our careers.”

Making a difference

As we talk more about the hard aspects of living in remote areas, I am struck by how Murphy naturally gravitates towards the positives. Her love of the area shines through.

“I particularly like working in remote [areas] because I feel like ... I’m able to really help people. You know, just able to do my bit, and a little bit goes a long way in these communities,” she says.

“It’s just really nice and the people here are beautiful. I love working up here.”

The challenges of mental health and remote living seem to propel Murphy, her passion evident when she talks about her profession and what drew her to mental health nursing.

“The thing that really just captured me was it was just so different from any other ward nursing that I’d experienced so far. It was much more patient-based and everything was different and no presentation was uniquely the same,” she observes.

“Someone with depression or schizophrenia – no two people with that diagnosis are going to present the same way. Their symptoms are different, their treatment, their progression – it’s really

100 per cent different. So, it’s really interesting that way.”

Mental illness is invisible and often difficult and debilitating, but seeing a positive progression in a patient can make a health professional’s day. It is one of the things Murphy loves about the job.

“[I enjoy] getting to see the change in patients, like seeing someone with depression or anxiety and then seeing their symptoms resolve and them move on with their life. [I love seeing] the improvements, like people going back to work and getting jobs, or if they’ve had a really tough time and have lost contact with family or their children, then being able to see them reunited.”

The last time I email Murphy, I ask how she is. She replies, “Just preparing for Cyclone Nora.” With that, I am again transported from my desk, safe and dry, to Weipa.

That reply encapsulates the nature of mental health nursing in the Cape, and really tells me how passionate these nurses are about what they do.

“You know there are so many good things about being a mental health nurse. I love it,” she says.