Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2025
Summary
Evidence based disaster mental health frameworks provide the prescription; this project redesigned the dispensing for remote Queensland, improving trust, access, and recovery outcomes.
Dates: March 2025 - December 2025
Implementation sites: South West Hospital and Health Service
Partnerships: Education Queensland, RHealth, Royal Flying Doctor Service.
Aim
To adapt evidence-based disaster mental health frameworks in a scalable, community-embedded delivery model that enable seamless, culturally safe mental health journeys across all phases of disaster in remote settings.
Outcomes
- Increased uptake and sustained engagement with mental health services across acute, recovery, and chronic phases
- Reduced stigma and improved trust through informal, relational care delivery
- Improved continuity of care and reduced service drop-off following surge withdrawal
- Strengthened cross-sector collaboration between South West Hospital and Health Service (SWHHS), Education Queensland (EQ), Royal Flying Doctor Service (RFDS), numerous non-government organisations (NGOs), and community services
- Established a replicable framework for remote disaster mental health deployment
Background
The Australian Institute for Disaster Resilience (AIDR) and Australian Red Cross provide robust, evidence-informed frameworks for disaster mental health care. These guidelines outline what communities need following disasters - psychological first aid, phased recovery responses, strengthening local capacity, and fostering resilience. In effect, they provide the prescription of community care.
However, in remote contexts, the challenge is not the prescription ; it is the dispensing of the care.
In March-April 2025, catastrophic flooding impacted Thargomindah and surrounding South West Queensland communities, displacing residents, disrupting livelihoods, and creating prolonged psychosocial stressors. Whilst evidence-based frameworks guided the response, early indicators revealed low engagement with traditional service models. Service hubs, visiting clinicians, and telehealth-heavy approaches did not align with local patterns of help-seeking. Sociocultural differences between responders and remote residents created barriers of trust and uptake. In small communities where clinicians are also neighbours, teachers' friends, sporting club members and customers at the local store, mental health care cannot be delivered as a detached, clinic-bound intervention.
Remote communities frequently express mistrust toward practitioners perceived to lack understanding of rural realities - sometimes described as 'geographic narcissism' where metropolitan assumptions inadvertently shape service delivery. Additionally, centralised mental health pavilions can inadvertently reinforce stigma, limiting engagement particularly amongst men, primary producers, and community leaders. This can result in fragmented care journeys marked by missed opportunities for early intervention, disengagement following surge withdrawal, and delayed presentations during later recovery phases.
Emerging disaster research suggests that early recovery phases - particularly the heroic and honeymoon phases - provide opportunities to harness community cohesion, altruism, and shared purpose as foundations for resilience and intra-traumatic growth. Without relational community, however, communities often enter later disillusionment phases vulnerable to emotional turbulence, cumulative distress, and escalating mental health complexity.
This project addressed the central question:
How can evidence-based disaster mental health care be dispensed in remote communities in ways that create seamless, trusted journeys from crisis response to sustainable wellbeing?
Rather than redesigning the prescription, this project reimagined the dispensing model - shifting from episodic, centralised, externally delivery care toward embedded, relational, community-integrated practice led by local service, ensuring continuity, trust, and culturally congruent care pathways across all phases of disaster response.
Methods
This project implemented a locally led, community embedded mental health response model across acute and early recovery phases (April - December 2025), with transition into chronic recovery from January 2026 onward. The intervention maintained alignment with the AIDR and Red Cross frameworks (the prescription) while redesigning delivery mechanisms (the dispensing) to enable seamless care journeys in a very remote contact.
1. Embedded Relational Delivery Model:
A mental health clinician embedded relational approaches within everyday community settings rather than positioned exclusively in clinics and short-term surge deployments. Care occurred in homes, schools, workplaces, recovery activities, and public spaces, allowing individuals to access support though trusted relationships and informal engagement pathways. This normalised help-seeking and reduced stigma. On the ground, this included informal check-ins during recovery activities, empathic conversations with locals in community settings such as the local motel restaurant, and outreach visits to isolated properties to assess how families were faring.
2. Advocacy for Workforce Continuity:
Immediate advocacy secured sustained mental health presence during and after the acute phase, preventing the common disruption caused by fly-in-fly-out surge withdrawal. Continuity enabled therapeutic relationships to develop across recovery stages. This was achieved through early escalation of workforce risk to health service managers and formal letters of support for contract extensions.
3. Collaborative Recovery Mapping:
Mental health recovery pathways were co-designed by SWHHS with EQ, RFDS, NGOs, and community leaders. Road to Recovery mapping initiatives identified psychosocial risk clusters, service gaps, and community strengths, creating integrated referral pathways rather than siloed services.
4. Targeting Screening and Monitoring:
Psychometric screening and RHealth utilisation data informed triage, prioritisation, and ongoing monitoring of mental health needs. This supported early identification of emerging risk and continuity of care into the chronic recovery phase.
5. Integration with Broader Disaster Response:
The model complemented NGO and RFDS supports whilst addressing known limitations of telehealth-only and fly-in-fly-out delivery. Telehealth was retained as a secondary modality, ensuring that care journeys remained flexible, person-centred, and contextually responsive.
6. Targeted Youth Supports:
In collaboration with Education Queensland, targeted psychosocial supports were implemented for school-aged children. This included distribution of Birdie's Tree resources to all families, delivery of the Journey of Hope program (with permission from Save the Children) within an Apex Leadership Camp, and ongoing monitoring by the school guidance officer. At approximately six months post-flood, psychometric screening identified students requiring additional support, enabling timely referral to Education Queensland wellbeing counsellors and ensuring continuity of care.
Continuous quality improvement principles guided implementation. Feedback loops between clinicians, community members, and partner agencies informed iterative refinements to ensure cultural fit, accessibility, and sustainability.
Discussion
This project demonstrated that in remote disaster contexts, effectiveness depends less of what care is delivered and more how it is dispensed. The prescription 'evidence-based disaster mental health care' remained unchanged. The dispensing shifted toward relational, embedded, community-integrated practice that enabled seamless journeys from crisis response through to sustainable recovery.
Key enablers of success included sustained clinician presence, community trust and endorsement, cross-sector collaboration, flexible delivery environments, and early advocacy to maintain workforce continuity. The relational model reduced stigma and increased engagement among individuals unlikely to access formal clinic-based services. In very small communities, where dual relationships are inevitable and visibility is high, mental health care must be integrated into daily life rather than positioned as a separate, clinical event.
Importantly, the model strengthened continuity across disaster phases. Individuals who first engaged during informal early recovery interactions transitioned seamlessly into structured therapeutic interventions when needed, without requiring re-entry through unfamiliar systems or repeating their stories to new providers. This continuity reduced service drop-off following surge withdrawal and supported early identification of escalating distress.
Lessons learning included the importance of early relational investment, workforce stability, and collaborative pathway design. Limitations include workforce sustainability risks, reliance on clinician continuity, and challenges creating large-scale quantitative datasets in small populations. However, qualitative indicators of trust, engagement, and continuity - alongside emerging utilisation trends - indicate meaningful system and community impact.
This model is highly transferable across rural and remote Queensland settings, particularly disaster-affected communities facing workforce shortages, stigma toward mental health care, and service fragmentation. It aligns closely with Queensland Health priorities around integrated care, place-based service design, and seamless recovery pathways.
Next steps include formalising the framework into a Remote Disaster Mental Health Dispensing Model, embedding it within disaster preparedness planning, developing workforce training resources, and strengthening longitudinal evaluation metrics.
In remote Queensland, the prescription works. The dispensing must fit the place and the journey.
References
Australian Institute of Disaster Resilience (AIDR). (2018). Community Recovery Handbook.
Australian Red Cross & Australian Psychological Society. (2013). Psychological First Aid: An Australian Guide to Supporting People Affected by Disaster.
Farmer, J., et al. (2012). Developing and implementing rural health workforce strategies: A place-based approach. Health Policy. 105(2-3), 221-228.
King, J., Longman, J., Matthews, V., Bennett-Levy, J. Bailie, R.S., Carrigg, S., & Passey, M. (2020). Disruptions and mental health outcomes following Cyclone Debbie. Australian Journal of Emergency Management, 35(3). 62-70
Hobfoll, S. E., et al. (2007). Five essential elements of immediate and mid-term mass trauma interventions. Psychiatry, 70(4), 283-315.
Poulin, M. J., & Silver, R. C. (2019). Near-miss experiences and post-traumatic stress symptoms. Journal of Traumatic Stress, 32(1), 12-21.
Key contact
Byron Richardson
Director of Nursing / Facility Manager
Thargomindah Community Clinic
South West Hospital and Health Service