Author Details
Shafik, S. & Dollard, M.

Introduction
Rural Australia is currently experiencing the effects of unemployment, poverty, geographic isolation and environmental factors as evidenced through diverse and widespread economic, social and demographic changes (Australian Institute of Health and Welfare, 1994; Griffiths, 1996; Humphreys & Rolley, 1991).  In addition to these variables, the rural population also faces distinctive challenges associated with rural living conditions.  Consequently there is a need for psychological services in rural areas as residents often experience health issues that are unique in severity, if not in nature.  For example, there is a higher incidence of issues such as male youth suicide, drug and alcohol abuse, domestic violence, chronic disease, and socio-economic disadvantage in rural Australia (Griffiths, 1996; Harvey & Hodgson, 1995; Yellowlees & Kaushik, 1992).  However, due to a shortage of rural psychologists, the area of mental health in the rural domain has been predominantly addressed by medical practitioners, psychiatrists, community health professionals, and the nursing profession.  Although rural mental health has been historically neglected both by researchers and policy-makers (Blank, Fox, Hargrove & Turner, 1995), it is now increasingly recognised and has been highlighted as a National Health Priority Area, in Healthy Horizons 1999-2003 (Australian Health Ministers’ Conference, 1999).  Attention is now being directed towards education and training (Dollard, Shafik, & Court, 2000) as well as recruitment and retention of psychologists in rural areas.  The aim of this paper is to further explore such issues.

Deterrents to psychological service utilisation
As Bushy (1994) explains the health care delivery system in rural settings is considered not only within a framework of availability and accessibility, but also within the framework of acceptability of services.  A combination of factors contributes to the prevention of potential rural clients from seeking psychological services.  Firstly, as emphasis is placed on personal privacy, the possibility of being observed accessing psychological services is a risk of personal invasion that many potential clients are reluctant to take.  Predominantly due to limited education and understanding of mental illness combined with years of mythology and misunderstanding, a stigma associated with mental distress has evolved.  This is particularly so in rural communities and consequently potential clients are fearful of being stigmatised as “mentally unstable” (Human Rights and Equal Opportunity Commission, 1993).   Also, the issue of trust of the therapist is a major consideration as clients need to be assured of confidentiality in an environment where social opportunities are limited and proximity is inevitable. Additionally, self-reliant attitudes raise a barrier to help seeking (Sargent & Gregory, 1980).  Rolley and Humphreys (1993) explain that, in part due to the historical precedent of having to make do, local residents experience a strong sense of self-sufficiency and survival in the face of great odds and consequently are reluctant to seek help.  Furthermore, rural expectations of psychology and the psychologist’s role have an impact on utilisation of psychological services (Sears, Evan & Perry, 1998). Rural residents appear to have only limited knowledge of what psychologists do.  Knowledge is mainly based on popular stereotypes, the media and a small number of direct and indirect personal experience painting a rather narrow and “clinical” picture of psychological services (Griffiths, 1996). In addition, unsatisfactory encounters with under-trained counsellors may lead to unfavourable generalisations about the psychology profession.  Dunn (1996) explains that as a consequence the community may undervalue some non-medical services and thus services associated with mental health become stripped of their legitimacy.

Other deterrents to the utilisation of psychological services include: travel issues (distance may be 200-1000 km round trip, lack of public transport); environmental issues (extreme weather changes, limited times for travel due to seasonal work, such as planting, harvesting); insufficient number of psychologists providing outreach services; and, financial concerns (lack of Medicare entitlements); and culture (strong cultural identity may foster mistrust of the profession).

There is a demand for health services among rural residents but it is unclear as to whether such a demand extends to psychological services (Dunn, 1996).  Since rural communities are either misinformed or not fully aware of the contributions offered by psychological services (Dunn, Buchanan & Kerr, 1994 cited in Dunn, 1996) they do not feature in the priority services list endorsed by the rural sector.  Of more perceived importance to the rural community are general health services such as the local hospital, home carer, community nurse, ambulance and the Flying Doctor Service.  Yuen, Gerdes and Gonzales’ (1996) study indicated that GPs are the most frequently consulted professionals for mental health care provision.  However, the study identified, that this was the consequence of a lack of professionals who are experts in the field.  The study further indicated that where GPs had strong linkages with mental health service providers, the services were indeed utilised – perhaps reflecting the GP’s acknowledgement of the expertise and utility of mental health care providers.  General practitioners in particular have identified a need for greater psychiatric and psychological services in rural Australia (Welch, 1994, cited in Dunn, 1996).

Responding to the challenges for psychology in rural Australia
Amongst the greatest challenges of rural psychology is educating communities in order to reduce the stigma and misinformation regarding mental illness and to increase the awareness and usefulness of the role of the psychologist.  This can be achieved through the dissemination of information on the types and effects of mental disorders, prevalence in the community, treatment methods and prevention strategies (Bushy, 1994; Commonwealth of Australia, 1993).  Opportunities for this education need to be creatively seized.  Local events such as field days, show days or specific festivals can provide the psychologist with exposure to a cross-section of the rural population, and the opportunity to demonstrate products or present educational materials about psychologists and the focus of their work.  Also of importance is the issue of confidentiality and privacy as aforementioned.  To this end psychological services are best provided at a multi-functional health care centre (Griffiths, 1996).  In addition, psychologists must be prepared to meet with clients at other venues, if requested.  Moreover, being confronted by clients after hours is inevitable and, as such the psychologist needs to be sensitive to the client’s request for confidentiality.  The issue of dual relationship problems for psychologists in rural communities has been discussed at length, and this concerns the conflict arising from providing a confidential psychological service, as well as being a member of the local community (see Wilson-Barratt & Dollard, in press).

Education regarding the contribution of psychology, could also be provided to health professionals who can be made aware of the importance of referral to psychological services.  In addition, since primary care workers are often called upon to deal with people with mental health problems, educational programs for primary health care professionals need to ensure adequate coverage of mental health treatment issues (Commonwealth of Australia, 1993).  Consequently, where feasible, health professionals (such as GPs and nursing staff) can be trained by the psychologist in the provision of basic psychological interventions, such as simple counselling and behavioural techniques in order to improve the standard of mental health care (Sears, Evans & Perry, 1998). Moreover, there is a lack of adequate knowledge on the part of general practitioners in regard to psychological assessment and psychological testing, which is frequently requested.  Consequently there is a need for further education in this area.  The psychologist in rural and remote areas is also faced with providing consultative services to other health professionals both in government and non-government organisations, when they take on a case management role.  To this end the psychologist must provide a supportive and educational role in providing a psychological resource to others.

In response to the issue of consumer demands for rural psychologists, Dunn (1996) proposes that psychologists should aim to clearly define their role in relation to the other professions in order to highlight psychology’s unique contributions.  In addition, a proactive role is required so that psychologists can secure a substantive position in the development and implementation of national health policy.  Psychologists can play a vital role in for example mental health promotion, prevention and early intervention strategies, and particularly in the recognition of rural residents “at risk".  They can also inform policy and strategies which guide the provision of appropriate rural health services and particularly address the calls for priority to rural mental health (Australian Health Ministers' Conference, 1999).  Finally, given the need for psychological services, it is anticipated that the discipline of psychology would assume an active stance in ensuring an adequate supply of qualified psychologists to rural areas.

Equally important is the psychologist’s own local knowledge of the remote locality and familiarity with rural issues.  Incompetence in any of these areas may result in a view of the psychologist as being ill-equipped to meet local needs as well as in mistrust of intentions and consequently, suspiciousness of the contribution of psychology (Griffiths, 1996).  It remains the psychologists’ responsibility to ensure they are well prepared and informed or at least able to access necessary local information for the appropriate provision of services.  A rural psychologist will need to become active in the community, for example, by sitting on appropriate committees, to develop a sense of belonging to the community.

Psychologists who live and practice in rural and remote Australia are faced with unique ethical issues that are not ordinarily encountered by their urban counterparts.  These issues reflect ethical dilemmas involving professional boundaries – the reality of overlapping social relationships and the effects of these relationships on members of the psychologist’s own family, and the possibility of working with more than one family member as clients or with others who have friendships with individual clients (Faulkner & Faulkner, 1997).  Schank and Skovholt (1997) suggest that ongoing discussions between colleagues regarding these issues can contribute to the evolution of practice codes applicable to rural areas and other small communities.

It appears impossible for psychologists in rural Australia to provide a purely clinical service to local residents.  Lichte (1996) explains that this is due to the small size of the mental health service, the lack of alternative services (such as specialist services, crisis intervention teams, after hours or psychiatric rehabilitation services) and the unwillingness of clients to travel to the nearest city.  Consequently, the psychologist is expected to have a broad skills base as he/she becomes relied upon to provide such services as relationship counselling, counselling for sexual assault / domestic violence, critical incident management and child behaviour modification (Court & Dollard, 2000).  In short, the psychologist must become equally comfortable with providing services to a diverse population (for example in the elderly, adolescents, Aboriginal clients) with varied clinical and non-clinical concerns (Harvey & Hodgson, 1995).

Furthermore, the rural psychologist may need to undertake various other tasks that are time-consuming, such as arranging for the hospitalisation of psychologically unwell clients when community based treatment is not possible, or travelling to more remote areas if the clients are unwilling/unable to travel.  In addition, as Bushy (1994) explains “professionals in rural practice settings often must assume multiple roles to function in a variety of situations” (p.258) and, consequently, the role of the psychologist includes the wearing of other hats such as those of transport officer, housing officer or social worker (Lichte, 1996).  As a result, the rural psychologist is expected to be knowledgeable in general domains of life (Kenardy & Griffiths, 1996).  Moreover, there is a demand for flexibility as the psychologist needs to adjust to unforeseen changes and unexpected emergencies.   To this end, although graduate level  psychology courses are mainly oriented to metropolitan practice, academic programs are now increasingly being structured to include rural practice issues and clinical psychology master students are encouraged/funded to undertake rural placements/training to prepare them for the challenges of rural psychology (Dollard, Shafik, & Court, in press).  While this is occurring in part, the expansion and continuation of such programs is imperative.

Another area of concern for the rural psychologist is the difficulty in accessing and purchasing psychological resources.  Consequently, there is a lack of certain resources such as basic psychometric assessment tools, resource libraries, journals, test materials, computerised test scoring programs and literature relating to common psychiatric diagnoses and psychological complaints.  Furthermore, there is also a lack  of appropriate assessment tools for indigenous people.  Lichte (1996) proposes increased “State or Commonwealth funding to maintain resource development units targeting specific groups such as remote area practitioners and indigenous populations” (p.38).  It is predicted that the promotion, sale and use of such materials should become self-sustaining.  Requests for specific resources can be met through local fund-raising.

The lack of opportunities (as well as lack of financial backing) for ongoing clinical training/professional development such as educational workshops and training courses is undoubtedly a further concern to the rural psychologist especially if there is a need for the acquisition of professional development (PD) points (Rolley & Humphreys, 1993).  Furthermore, the lack of peer support or support programs could result in the psychologist becoming isolated from developments in the field.  One possible solution, recommended by Lichte (1996), is for “greater APS involvement in supporting rural and remote psychology, for example by providing occasional workshops or conferences in distant locations and to encourage urban-based psychologists to travel, who would thus gain greater awareness of the difficulties some of their colleagues face”(p.41).  Additionally, the use of video or teleconferencing facilities as well as computerised educational and treatment programs could become invaluable in this area.  The benefits and limitations of teleconferencing techniques in providing support for mental health care have been demonstrated by the South Australian Mental Health Services Telecommunication Pilot Project (Kenardy & Griffiths, 1996).  Videophones capable of generating vision of both participants has obvious utility for both client-psychologist and psychologist-professional support relationships (Court, 2000).  Technological innovations on the internet, such as email, chat rooms, and the capacity for multi-user domains, may also provide a modern solution to educational and social isolation problems often experienced by rural psychologists.  They may also provide new tools for internet counselling and telepsychology (Barak, 1999; Biggins, 1999).  Some recent innovations include an interactive CD-ROM to prepare psychologists, counsellors and other health workers for practice in rural and remote locations, and to enhance the understanding of rural psychological issues (Williams, 1999).  The International Journal of Rural Psychology, an e-journal recently launched in Australia (14th April 2000), aims to extend its current web services to provide interactive support, as well as a knowledge base, for state of the art practice in rural psychology.  Finally, the Bush Crisis Line, set up by Council of Remote Area Nurses of Australia provides a 24 hour telephone debriefing and counselling service for rural and remote health practitioners and their families.

Education and training issues for rural psychology students
University undergraduate psychology courses in Australia have certain curriculum requirements as recommended by the Australian Psychological Society (APS) and currently do not address practice issues (Dollard, Shafik & Court, in press).  Consequently, field experience and placements usually occur only at the graduate level, and even then supervised placement and employment opportunities are mainly metropolitan-based (Kenardy & Griffiths, 1996).

With the base level of education being lifted from four to six years to become an APS member from the year 2000, psychologists in rural and remote areas who do not have access to supervision, training and professional development requirements will be confronted with further challenges. In an innovative response to these needs, the Charles Sturt University has offered the Masters in Clinical Psychology degree as an external package, the first of its kind in Australia,  which will go some way toward meeting the educational needs of rural psychologists.

A number of state government departments are addressing the issue of continuing education by the active development of the technical infrastructure required to provide teleconferencing to rural and remote settings.  Pertinent to the provision of such resources is the collaboration of stakeholders such as APS, State and Commonwealth governments and tertiary institutions.

Most training programs for mental health professionals have been geared implicitly or explicitly toward urban situations (Merwin, Goldsmith & Manderscheid, 1995).  Traditionally, preparation has been inadequate for practice in rural and remote contexts mainly due to links not being made between higher education and those involved in rural practice.  Graduate courses are now beginning to include curriculum components to address rural issues (Dollard & Shafik, in press).  Universities need to confer with stakeholders such as the APS and state and federal governments, and to consult with experienced rural psychologists in the development of the curriculum for rural programs (Merwin, Goldsmith & Manderscheid, 1995).  In addition, the challenge exists to develop and maintain placement and supervisory arrangements in rural and remote settings.  To this end, funding has been made available in Western and South Australia, through the Rural Health Support, Education and Training (RHSET) program to encourage students to seek such placements (Dollard, Shafik & Court, in press).  Finally, the State and Commonwealth government can offer assistance to rural education and training of rural psychologists on various levels.  Universities can be assisted financially in providing support for placements and other onsite training for rural postgraduate students, or, alternatively, the use of private supervision can be explored as an alternative to the government funded options.  Kenardy and Griffiths (1996) explain that past evidence exists that supervised placements in rural settings do not necessarily result in continued practice in such settings.   Preliminary evaluation of the South Australian internship project indicates that students undertaking rural internships are more likely to consider rural employment opportunities (Dollard,  Shafik, & Court, in press).  Indeed universities could do more to target students with rural antecedents (eg childhood spent in rural areas) to study psychology in the first instance, and/ or offer undergraduate training in rural locations, both strategies shown in medical education to increase the numbers of doctors who prefer to work in rural areas (see Kassenbaum & Szenas, 1993; Magnus & Tollan, 1993).

Recruitment and retention of psychologists in rural Australia
According to Griffiths and Andrews (1995) allowing for differences between states, there are only 12% of all Australian psychologists who were APS members, practising in rural and remote areas.  However, the recent census in South Australia (SA) (Farrin, Dollard & Court, in press) estimated that only 6% of SA psychologists were practising in rural areas. The shortage of rural psychologists according to Harvey and Hodgson (1995), is due to such factors as lack of opportunity for spouse employment, perceived lack of educational opportunities for children, especially at secondary level, geographic and professional isolation, confidentiality issues, limited employment opportunities, lack of supervision, lack of opportunities for Professional Development points, high visibility and comprehensive workload.

In a RHSET funded study investigating factors influencing recruitment, Wolfenden, Blanchard and Probst (1994, 1996) found that the most important reasons for psychologists being attracted to rural areas were employment related as opposed to lifestyle preferences.  Positive aspects include: rural work challenges, opportunity to use their skills, scope and variety of work, professional autonomy, and varied employment opportunity.  They argue that student rural placements need to be of an adequate duration (not specified) for the student to experience and identify with the environment.  Recruitment of rural psychologists may be facilitated by fixed short term rural employment coupled with future urban resettlement as an added incentive (Wolfenden, 1996).

Low retention rates are particularly apparent for those using rural employment as a stepping stone in their career paths.  Retention is influenced by lifestyle choices and personal factors.  These include physical environment, ease of travel, relaxed lifestyle and friendships (Wolfenden, 1996).  Orientation programs linking in with social, cultural and sporting groups can be used to encourage a sense of community belonging.  Work practice autonomy  and working conditions have also been identified as influential in the retention of rural psychologists.  According to Wolfenden (1996) factors such as limited resources, lack of continuing education and/or career development, heavy workload and limited leave relief have all been identified as contributing to psychologists leaving rural practice.  Consequently, flexibility and freedom in the work combined with organisational support on matters of working conditions are potent factors for improving retention.  Organisational structure promoting possible career paths can provide a further incentive.  Also to be encouraged are professional peer and mentor support both at a face to face level and through the use of telecommunication. Training scholarships could be made contingent upon the student remaining in rural practice following course completion.  Appropriate support during the early career years could be funded – this would include, access to training, high quality locum systems, access to teleconference supervision, and the availability of rural senior psychologist (Kenardy & Griffiths, 1996).  Kenardy and Griffiths (1996) further propose that the retention of new graduates in rural settings could be enhanced by the provision of career structures and financial incentives that equal those of their urban peers.  Finally, enhancing retention rate involves the provision of appropriate skills to practice in rural settings – this includes not only the basic clinical skills but also skills as broad as those required in community development, and crisis intervention.  In conclusion, further research needs to be carried out to identify the needs of rural psychologists along with the implementation of new recruitment and retention models based on research findings.

Addressing the shortage of psychology positions in rural and remote areas
Although the shortage of psychologists working in rural and remote areas may be due to the psychologists’ own choice, it may be also due to the lack of positions available (Griffith & Kenardy, 1996).  Hill (1996) has outlined a plan for a comprehensive strategy to successfully promote the value of psychology and thus increase the number of psychology positions in rural and remote areas.  The strategy includes “selling” the appropriateness of psychological services.  This may include researching the cost effectiveness of employing rural psychologists, lobbying State and Commonwealth Health Ministers and Opposition Ministers on the value of psychology, promoting the value of psychology to key rural and remote identities such as rural general practitioners, and, defining specific professional competencies for psychologists in rural areas.  The strategy also includes changes to education and training, such as incorporating specialist subjects and placements in rural and remote Australia, facilitating links between rural psychologists and experienced practitioners for mentorship or supervision, using interactive communication technology for supervision and professional development activities, improving accessibility of graduate level training to rural psychologists, and, ensuring access to generalist and specialist PD activities.  Furthermore, the importance of taking an active role in service delivery planning and in the development of mental health policies is emphasised – this may include regular contact with State and Commonwealth Health Departments involved in rural workforce planning, ensuring representation on various rural health workforces, training and professional committees and working parties, as well as facilitating greater representation on APS working parties and committees.  Finally, psychological services may also be delivered by encouraging private practice to canvas larger areas with the use of new technologies, and by up-skilling general practitioners in assessment and preferred management of more common psychological disorders.

The problems and issues highlighted above are not new.  Therefore, we argue that radical policy changes are required to achieve a critical mass of rural psychologists in rural areas.  Firstly, the APS Board, through the Directorate of Standards and Training should consider making the study of rural psychology, either as a full unit of study, or as a significant research project, or as a rural placement (for example in the Master of Clinical Psychology programs), a compulsory part of the training of all Australian psychologists.  This strategy needs to be coupled with action by the State Psychology Registration Boards to require the study of rural psychology, either as a full unit of study,  as a significant research project, or as a rural placement, as a requisite for registration.  Many psychology training programs in the US now include a rural component (Gaddy, 1995).  Court (in press) argues that "we need to learn from this since our needs are so much more obvious than those in the US".

Current and recommended contributions by psychological bodies to psychology in rural and remote area
The profile of rural psychology within the APS has improved with some focused initiatives.  First, the Rural and Remote Psychology Interest Group has been established which assists in networking and rural policy development.  A very relevant parallel group has been also been formed, the Indigenous Psychology Interest Group.  Furthermore, an official advisory group on regional, rural and remote issues has been formed to address issues of inequities in education and support for rural psychologists.  Moreover, forums for the discussion of rural and remote issues are now conducted at the APS conferences and discounts for APS members for computer software and educational requirements are being considered.  An impressive role of the APS is in the development of position papers on issues of social importance, such as the recent paper on mandatory sentencing in Australia, and on reference manuals which are continuously revised such as the Code of Ethics, and Guidelines on Professional Boundaries.

Griffiths and Kenardy (1996) further suggest several initiatives that could be considered by the APS and the colleges in order to resolve some rural and remote psychology issues.  These include communication with existing rural psychologists in order to assess their needs, such as the assessment of the academic and professional concerns of rural psychologists nationally, and the identification of specific types of professional development (PD) and support favoured by rural mental health professionals.  Additionally, promotion of a nationally based rural network for psychologists could prove invaluable, as could the conduct of a national rural psychology census.  This would provide a national database of psychologists, their interests, areas of expertise and whether they are prepared to be considered as resource personnel or mentors.  A recent Rural Health Education and Support Training program sought to link 20 rural and remote psychologists with 20 city based senior clinical psychologists in a mentorship program (Hunter Institute of Mental Health, 1999).  The project outcomes highlighted the utility of professional support to rural practitioners.   This finding was supported in the recent census of psychologists in rural and remote South Australia (Farrin, Dollard & Court, in press).  Nearly 40% of respondents identified the provision of peer support, mentoring, and supervision as critical in the recruitment and retention of rural psychologists.

It is important that psychological bodies address issues of education and training including on-going training, such as provision and promotion of best practice models in rural and remote areas, and in liaison with the Colleges of Psychiatrists.  Moreover, significant attention must be focused on developing recruitment and retention strategies as well as educating communities regarding the benefits of employing psychologists.  Also to be considered are such matters as examining possible disadvantage rural psychologists may experience in gaining and maintaining APS membership and State Registration.  Finally, psychological bodies should encourage rural psychological research in order to build evidence based knowledge.  This could include research into  the rural experience, prevalence of behavioural and emotional disorders in rural areas, and psychological services to Aboriginal clients.

Conclusion
In contemplating the future of rural psychology, three pertinent issues need to be considered.  Firstly, it has become increasingly clear that development in the field is highly contingent upon the collaboration of the major stakeholders, such as universities, psychological bodies and national health organisations, in order to provide the rural psychologist with consistent and pragmatic support in areas of education and training, recruitment and retention and policy development.  Secondly, the vital role of research remains indisputable in advancing knowledge and in the development of evidence-based models of practice especially where conflicting information is apparent (Court & Dollard, in press).  Finally, the education of the rural population regarding the unique contribution of psychology emerges as a potential major catalyst for the encouragement of help-seeking behaviour.  The discipline of psychology is clearly faced with maintaining a commitment to addressing these issues and overcoming any related challenges that may present as a hindrance to the promotion of accessibility, availability and acceptability of psychological services for residents of rural and remote Australia.

In conclusion, to overcome the ongoing issues in the practice of Australian rural and remote psychology we believe some parallel radical policy changes are required.  Firstly, the APS Board, through the Directorate of Standards and Training should consider making the study of rural psychology, either as a full unit of study, or as a significant research project, or as a rural placement (for example in the Master of Clinical Psychology) a compulsory component of the training of all Australian psychologists.  This strategy needs to be coupled with action by the State Psychology Registration Boards to require the study of rural psychology, either as a full unit of study, as a significant research project, or as a rural placement as a compulsory requirement for registration.

Psychology has a major role to play in the improvement of health and mental health of rural Australians, but a major problem for the profession is a lack of critical mass in the bush.  This could be remedied by forcing the universities, through the policy shifts as outlined above, to provide a means for students to study issues in rural psychology, thereby improving the chances of students wishing to take up rural appointments.  Beyond health, psychology in Australia is in a good position to lead in the development of niche areas of new knowledge and practice, in rural forensic psychology and rural work psychology.

References

Australian Health Ministers’ Conference.  (1999).  Healthy Horizons, 1999-2003.  A framework for improving the health of rural, regional, and remote Australians.  Canberra: Australian Government Publications Service.

Australian Institute of Health and Welfare.  (1994).  Australia’s Health 1994: The Fourth Biennial Health Report of the Australian Institute Health and Welfare. Canberra, ACT: Australian Government Publishing Service.

Barak, A. (1999).  Psychological applications on the Internet:  A discipline on the threshold of a new millennium.  Applied and Preventive Psychology, 8, 231-246.

Blank, M. B., Fox, J. C., Hargrove, D. S. & Turner, J. T.  (1995).  Critical issues in reforming mental health service delivery.  Community Mental Health Journal, 31, 511-523.

Biggins, N.  (1999).  Telepsychology.  PhD Dissertation.  Flinders University of South Australia.

Bushy, A.  (1994).  When your client lives in a rural area , part II: Rural Professional Practice -Considerations for nurses providing mental health care.  Issues in Mental Health Nursing, 15, 267-276.

Commonwealth of Australia.  (1993).  National Mental Health Policy. Australian Health Ministers Conference, April 1992.  Canberra, ACT: Australian Government Publishing Service.

Commonwealth of Australia.  (1994).  National Rural Health Strategy.  Australian Health Ministers Conference.  Canberra, ACT: Australian Government Publishing Service.

Court, J. (in press).  Rural psychology:  New possibilities.   In, M. F. Dollard, J. Farrin, & P. Munn Eds. Rural Psychology, Volume II, Proceedings of the 4th Regional Australia Conference, Whyalla, South Australia.

Court, J. & Dollard, M. F. (2000).  Australian Rural Psychology – paradigm shifting. International Journal of Rural Psychology, www.ruralpsych.com

Dollard, M. F., Shafik, S. & Court, J.  (in press).  Rural psychology and education: Rural internships for clinical psychologists. In, M. F. Dollard, J. Farrin, & P. Munn Eds. Rural Psychology, Volume II, Proceedings of the 4th Regional Australia Conference, Whyalla, South Australia.

Farrin, J., Dollard, M. F. & Court, J.  (in press). A census of rural and remote South Australian psychologists. In, M. F. Dollard, J. Farrin, & P. Munn Eds. Rural Psychology, Volume II, Proceedings of the 4th Regional Australia Conference, Whyalla, South Australia.

Dunn, P.  (1996).  Leaving much to the imagination: Rural and remote psychology services. In R. Griffiths, P. Dunn & S. Ramanathan (Eds.).  Psychology Services in Rural and Remote Australia: Issues Paper (pp. 9-16).  Canberra: Australian Rural Health Research Institute.

Dunn, P., Buchanan, E. & Kerr, R.  (1994).  Health and Health Care of an Inland Rural Community.  Charles Sturt University. Wagga, Wagga: Centre for Rural Social Research.

Faulkner , K .K. & Faulkner, T. A.  (1997).  Managing multiple relationships in rural communities: Neutrality and Boundary Violations.  Clinical Psychology: Science and Practice, 4, 225-234.

Gaddy, C. D. (1995).  Psychology training programs offering rural focus double in the past decade.  Rural Health Bulletin, 2, 3.

Griffiths, S.  (1996).  Issues in rural health: The utilisation and perception of psychological services. In R. Griffiths, P. Dunn & S. Ramanathan (Eds.).  Psychology Services in Rural and Remote Australia: Issues Paper (pp. 17-24).  Canberra: Australian Rural Health Research Institute.

Griffiths, R. & Kenardy, J.  (1996).  Role of psychological bodies for psychological services in rural and remote areas.  In R. Griffiths, P. Dunn & S. Ramanathan (Eds.). Psychology Services in Rural and Remote Australia: Issues Paper (pp. 17-24). Canberra: Australian Rural Health Research Institute.

Griffiths, S. & Andrews, H.  (1995).  Issues in rural and remote psychological practice.  Proceedings of the 30th Annual Australian Psychological Society Conference.  Australian Journal of Psychology, 47 (80), Supplement.

Harvey, D. & Hodgson, J.  (1995).  New directions for research and practice in psychology in rural areas.  Australian Psychologist, 30, 196-199.

Hill, C. (1996). The future of psychology services in regional Australian. In R. Griffiths, P. Dunn & S. Ramanathan (Eds.). Psychology Services in Rural and Remote Australia: Issues Paper (pp. 49-52). Canberra: Australian Rural Health Research Institute.

Human Rights and Equal Opportunity Commission.  (1993).  Human Rights and Mental Illness: Report of the National Inquiry into the Human Rights of People with Mental Illness.  Vol. 2. Canberra, ACT: Australian Government Publishing Service.

Humphreys, J. & Rolley, F.  (1991).  Health and Health Care in Rural Australia.  Armidale, NSW: University of New England.

Kassebaum, D. G., & Szenas, P. L. (1993).  Rural sources of medical students, and graduates' choice of rural practice.  Academic Medicine, 68, 232-236.

Kenardy, J & Griffiths, R.  (1996).  Education and training for rural psychologists. In R. Griffiths, P. Dunn & S. Ramanathan (Eds.). Psychology Services in Rural and Remote Australia: Issues Paper (pp.  31-36).  Canberra: Australian Rural Health Research Institute.

Lichte, C.  (1996).  The delivery of psychology services in rural and remote Australia.  In R. Griffiths, P. Dunn & S. Ramanathan (Eds.). Psychology Services in Rural and Remote Australia: Issues Paper (pp. 37-42).  Canberra: Australian Rural Health Research Institute.

Magnus, J. H., & Tollan, A. (1993).  Rural doctor recruitment:  Does medical education in rural districts recruit doctors to rural areas?  Medical Education, 27, 250-253.

Merwin, E. I., Goldsmith, H. F. & Manderscheid, R. W.  (1995).  Human resource issues in rural mental health services.  Community Mental Health Journal, 31, 525-537.

Rolley, F. & Humphreys, J. S.  (1993).  Rural welfare – the human face of Australia’s countryside, In T. Sorensen and R. Epps (Eds.).  Prospects and Policies for Rural Australia.  Melbourne, Victoria: Longman Cheshire.

Sargent, M. & Gregory, G.  (1980).  Rural Health Issues.  ARAU Bulletin No1.  Armidale, NSW: University of New England.

Schank, J. A. & Skovholt, T. M.  (1997).  Dual-relationship dilemmas of rural and small-community psychologists.  Professional Psychology: Research and Practice, 28, 44-49.

Sears, S. F., Evan, G. D. & Perry, N.W.  (1998).  Innovations in training: The University of Florida Rural Psychology Program.  Professional Psychology:  Research and Practice, 29, 504-507.

Wilson-Barratt, E., & Dollard, M. F. (in press).  Dual relationship dilemmas. In, M. F. Dollard, J. Farrin, & P. Munn Eds. Rural Psychology, Volume II, Proceedings of the 4th Regional Australia Conference, Whyalla, South Australia.

Welch, R. (1994).  Identifying health needs in rural communities.  In D. McSwan and M. McShane (Eds.), Conference Proceedings, Issues Affecting Rural Communities (p. 94-99).  Townsville:  James Cook University of North Queensland.

Wolfenden, K.  (1996).  Enhancing opportunities: Recruitment and retention.  In R. Griffiths, P. Dunn & S. Ramanathan (Eds.). Psychology Services in Rural and Remote Australia: Issues Paper (pp. 31-36).  Canberra: Australian Rural Health Research Institute.

Wolfenden, K., Blanchard, P. & Probst, D.  (1994).  Rural information  for mental health staff: Project report.  Canberra, ACT: Commonwealth Department of Human Services and Health.

Wolfenden, K., Blanchard, P. & Probst, D.  (1996).  Recruitment and retention – Perceptions of rural mental health workers.  Australian Journal Rural Health, 4, 89-95.

Yellowlees, P. M. & Kaushik, A. V.  (1992).  The Broken Hill psychopathology project.  Australian and New Zealand Journal of Psychiatry, 26, 197-207.

Yuen, E., Gerdes, J. & Gonzales, J.  (1996).  Patterns of rural mental health care: An exploratory study.  General Hospital Psychiatry, 18.