Introduction to Suicide in Rural Areas
The issue of rural suicide is a complex one. While there is no question that suicide is a serious health and social concern in rural Australia — aggregated ABS data for the period 1991–1995 show the rural suicide rate to be approximately 50 per cent greater than the urban suicide rate for all states and Australia (Commonwealth Department of Health and Aged Care, 1999, 51) — it is difficult to accurately measure its impacts and extent; and the motivational factors that trigger suicide are often complex and not easily identified.

Statistical information about the extent of the problem provides only part of the picture, as the actual number of suicides is estimated to be considerably higher than the number of registered suicides. This is because the true intent of some deaths is difficult to determine, especially with causes of death such as drowning, drug overdoses and car accidents. The social stigma attached to suicide, and the resultant socio-economic and emotional implications it can have for families of the victims, and the wider community, might also prompt some cases to be represented as other than suicide (Australian Bureau of Statistics, 2000). Studies have shown that family members and peers of those dying by suicide face increased social, personal and psychological risks and that parents, in particular, show up to a seven-fold increase in the risk of depression (Commonwealth Department of Health and Aged Care, 1999).

In economic terms, the costs of suicide are difficult to estimate because of the hidden costs of flow-on effects. Raphael and Martinek (1994) estimate the health cost and earnings lost in Australia in 1989–1990 at $460 million for suicide deaths and similar for suicide attempts. This sum excludes the substantial community costs incurred through the impacts on survivors (both family and peers), the need for community and welfare responses, and police and coronial work.

Suicide rates are therefore a significant social and economic burden on rural Australia, requiring holistic whole-of-government and whole-of-community approaches to address the problem. As the NSW Regional Communities Consultative Council (2000) has noted:

"The ability of health and other services to achieve a perfect model of suicide prevention alone is unrealistic without community involvement at all levels. The need to have better integration and a holistic approach between the economic, educational, health and social groups within a community must be forged firstly from government integrating with community at every step of the process."

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Barriers to Professional Development and Support
Underpinning ACROSSnet is a strong awareness of the unique challenges faced by rural workers in mental health and associated fields in comparison to their urban counterparts, as they strive to practice ethically, advance professionally and meet the needs of clients and communities. Such difficulties can negatively impact on the quality of client care. These challenges include:

• Professional isolation due to the limited contact with other mental health professionals (eg Guscott, 1998; Mitchell et al., 2000; Morrissette, 2000);
• Deficient support services for professionals dealing with suicide (Sacco, 1994);
• Lack of continuing education, training and supervision opportunities (eg Doolan and Nichols, 1994);
• Limited opportunities for networking (Hodgson et al. 2000);
• Lack of back-up support systems (eg to cover staff absences) (Hodgson et al., 2000);
• Demands to provide extra services with limited referral options (Bridges, 1994);
• Inadequate access to resources and information (Hodgson et al., 2000); and
• The need to be multi-skilled (Hodgson et al., 2000).

Mental health and community workers also experience social and personal challenges related to the blurred differentiation between work and private life. Workers in small communities encounter clients in both professional and social settings and thus need to manage overlapping relationships. This gives rise to a range of personal, professional and ethical concerns such as loss of anonymity, loss of formality in the client–counsellor relationship, a lack of personal privacy and loss of the ability to exercise control over social contacts (Saba, 1991; Sacco, 1994). Young urban-trained workers who relocate to rural areas may find particular difficulties in applying ethical and professional skills in this more complex environment.

Lack of professional development opportunities and low peer support contribute to poor recruitment and retention rates of isolated health professionals (eg Clark, 1996; Watson et al., 1999). The Australian National Rural Health Network’s study of attitudes of health science students revealed as many as 5,000 students would be willing to practice in rural areas if increased support and professional training were available (Sager, 2000). This need to increase levels of support and training was also identified by the National Inquiry into Human Rights for People with Mental Illness, particularly for isolated professionals working with children and adolescents with mental health difficulties (Burdekin, 1993).

Despite its increasing acceptance as a potentially effective means of delivering education and training, national and international literature exploring the role of online technology as a tool for professional development remains scant. In one of the rare studies in this field, Queensland’s Allied Health Outreach Support Service found that technological supports are recognised by rural counsellors as alternative solutions to issues of distance and isolation (Hodgson et al., 2000). The limited discussions in the literature, as well as prior fieldwork by the researchers, support this view, noting that existing support structures are inadequate and that online networking is an important future solution for isolated workers (Seinen et al., 2000). As a result, some service providers have begun to introduce email support groups and limited hours chat rooms. Online technologies have the potential to provide support and educational opportunities for isolated workers, however, in a broad range of ways.

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Benefits of Online Technologies for Professional Development
In rural and remote areas, an online support system can promote professional development through access to information and educational opportunities, increased availability of supervisor and peer support, and enhanced networking opportunities. An online support system can provide:

• Increased access to information by helping workers keep up-to-date with the latest policies, legislation, recent trends in treatment, new research projects, funding opportunities, and conferences in a timely way not previously available. This has significant potential for data sharing and collaboration among people and organisations located nationally and internationally.
• Increased access to supervision via email, enabling supplemental consultation with supervisors. In regional areas, job demands, distance and a paucity of qualified supervisors restrict access to support and supervision from experienced staff (Mitchell et al., 2000). One counsellor found email supervision to be supportive by offering ideas for interventions, reducing his feelings of isolation and communicating feelings of acceptance and encouragement (Myrick and Sabella, 1995).
• Online peer support by enabling workers to consult, debrief with peers, share information and ideas, and explore professional and ethical issues (Sacco, 1994). Peer support networks that enable workers to access support, information and encouragement can reduce professional isolation (Finn, 1999).
• Enhanced networking opportunities via regular contact with other professionals. Online groups encourage participation by workers globally, and increase access to new perspectives and expertise that cannot be accessed locally by workers in remote locations (Mitchell et al., 2000). Liaising online with more experienced professionals may encourage professional commitment and skill development (Myrick and Sabella, 1995).

The National Office for the Information Economy (1997, p. 4) noted in their guide to technology for community organisations that resources for disadvantaged populations can be maximised by empowering the organisations that provide support and services to these populations. By supporting those who work with at-risk populations, online technologies have the potential to improve client care in rural communities, contribute to community health and wellbeing and reduce problems associated with suicide.

On the other hand, significant barriers continue to limit more widespread implementation of online solutions, particularly in terms of resolving major ethical concerns such as confidentiality and client screening. Many service providers lack the time, resources and/or skills to systematically address such concerns. For this reason, existing online support systems are often limited in scope, ad hoc in nature, and lack evaluation. Through ACROSSnet, we aim to address these barriers so the potential benefits of online support mechanisms can be fully realised.

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References

• Australian Bureau of Statistics (2000). Health Special Article — Suicide. Year Book Australia. Retrieved from here.
• Bridges, D. (1994). A Public–Academic Partnership to Train Psychiatric Residents in a Rural Mental Health Program. Hospital and Community Psychiatry, 45 (1), 66–69.
• Burdekin, B. (1993). Human rights and mental illness: Report of the National Inquiry into Human Rights of People with Mental Illness. Human Rights and Equal Opportunity Commission. Canberra.
• Clark, S. (1996). Four priority areas for telehealth in Australia. Paper presented at the 2nd International Conference on Open Learning.
• Commonwealth Department of Health and Aged Care, National Youth Suicide Prevention Strategy (1999). Setting the evidence-based research agenda for Australia: A literature review. Commonwealth of Australia. Canberra. Retrieved from here.
• De Leo D, Schmidtke A, Diekstra RFW (eds) (1998). Suicide prevention: A holistic approach. Dordrecht/Boston/London: Kluwer Academic Publishers.
• Doolan, T. and Nichols, A. (1994, 10-15 July). Training for rural practice: the way ahead. Paper presented at the Issues Affecting Rural Communities conference. Townsville.
• Finn, J. (1999). An exploration of helping processes in an online self-help group focusing on issues of disability. Health and Social Work, 24 (3), 220–231.
• Guscott, A. (1998). Preceptorship: A model to empower nurses in rural health settings. The Journal of Continuing Education in Nursing, 29 (4), 154–162.
• Hodgson, L. Spundle, N. and Belovic, T. (2000). Supporting rural counsellors. Allied Health Outreach Support Service. Queensland Health.
• Mitchell, J.M., Robinson, P.J., Seiboth, C. Koszegi, B. (2000). Evaluation of a network for professional development in child and adolescent mental health in rural and remote communities. Journal of Telemedicine and Telecare, 6 (3), 158–162.
• Morrissette, P. J. (2000). The experiences of the rural school counsellor. Professional School Counselling, 3 (3), 197–207.
• Myrick, R. D., and Sabella, R. A. (1995). Cyberspace: new place for counsellor supervision. Elementary School Guidance and Counselling, 30 (1), 35–44.
• National Office for the Information Economy (1997) Making the net work. Canberra: Department of Communication, Information Technology and the Arts. Retrieved from here.
• Raphael, B., and Martinek, N. (1994). The suicide experience. Paper presented at the National Conference on the Public Health Significance of Suicide Prevention Strategies, Public Health Association. Canberra.
• Regional Communities Consultative Council (2000). Beyond desolation — understanding suicide in rural NSW. August. Retrieved from here.
• Rural Women and ICTs Research Team (1999). The new pioneers: Women in rural Queensland collaboratively exploring the potential of communication and information technologies for personal, business and community development. Brisbane: The Communication Centre, Queensland University of Technology.
• Saba, R. (1991). The rural school counsellor: Relationships among rural sociology, counsellor role, and counsellor training. Counsellor Education and Supervision, 30, 322–329.
• Sacco, M. (1994). Skills and requirements of rural human service organisations. Paper presented at the Issues Affecting Rural Communities conference, July 10–15, Townsville.
• Sager, R. (2000). 5000 health science students may want to work in rural Australia: But they need a little more encouragement and support. Statement by National Rural Health Network. National Rural Health Network. Retrieved from here.
• Seinen, Anita, Daws, Leonie, Wood, Leanne and Simpson, Lyn (2001). Creating Rural Connections final report book 3: Online service delivery and support. The Communication Centre, QUT. Brisbane.
• Tatz, C. (2001). Aboriginal suicide is different. Criminology Research Council, Australian Institute of Criminology. Canberra. Cited in Regional Communities Consultative Council (2000) Beyond desolation — understanding suicide in rural NSW. August. Retrieved from here.
• Wadsworth, Y. (1997). What is participatory action research? Retrieved from here.
• Watson, J., Bannan, G., Clark, S. and Timmerman, L. (1999, March). Strengthening connections in the bush: On-line communication and collaboration in allied health. Paper presented at the Leaping the Boundary Fence: Using Evidence and Collaboration to Build Healthier Rural Communities, 5th National Rural Health Conference, and Adelaide.
• Yellowlees, P. (2000) SHARK-net: Systems Helping At Risk Kids. Retrieved from here.

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