Sara is a GP based in Mallacoota in East Gippsland, with more than 20 years’ experience working with regional and rural communities.
Sara says that communities in regional and rural areas are often more engaged with their local GPs as a familiar and trusted way to access health care.
Throughout her career, Sara has seen how important GPs can be in local communities. She says they are often required to fill the gaps to provide the kind of specialised health support that would normally exist in bigger centres.
A lot happens in rural General Practice to ensure access to the full breadth of health services that rural and remote patients need, including acute, preventative and emergency general mental health care.
Sara talks about some of the challenges that regional and rural communities like Mallacoota face, such as their limited access to hospital services and allied health. She also notes that applying models of care can be more difficult across greater distances.
Ultimately, our access to tertiary services is dependent on the goodwill or a motivation by those services to provide access to rural patients. We are at the mercy of those services as to whether or not they feel it is necessary to support rural patients.
When talking about access to mental health care, Sara explains that some of the current commissioning and funding arrangements can be detrimental to the viability of local GPs being able to meet the needs of their communities.
I think the important thing for health agencies to understand is that if you support GPs and doctors with a broad scope of practice, and you support the viability of private general practices in small communities, then you are supporting a breadth of treatments in the community … GPs are gap fillers and can be podiatrists, paramedics and psychologists.
In my view, if you want to provide any sort of primary health care, you need to actually have clinicians on the ground to do it. If you don’t have a clinician visiting in the town, you don’t have the service; it simply doesn’t exist as far as our community is concerned.
Following the 2019 bushfires, which deeply affected Mallacoota and other areas in East Gippsland, Sara says she saw the impact of trauma on the local community. She notes that initially, many people with treated mental illness were coping well, and others with untreated mental illness came forward to seek help, but that some of the mental health consequences for the community will become more apparent in the longer term.
In Mallacoota, we are beginning to see more serious mental health issues come to the fore. I am now seeing people with reactivated serious mental illness; for example, people with previous psychosis or long histories of PTSD who are now re-traumatised. Three months after the bushfires, these people are requiring services. We also anticipate that depression will present six to 12 months after a traumatic event.
Sara believes that one of the most important parts of helping a community that has experienced crisis is to provide ongoing and consistent support.
Providing a service regularly is far more effective than providing a service twice.
Source: Witness Statement of Dr Sara Renwick-Lau, 19 May 2020.