Fighting the good fight

What you get is what you see with RAW CEO Liz Little.
She has been in the job since July 2016 and since then she has formed very strong opinions about her organisation, its importance, and where it fits into the fabric of Tasmanian rural communities.
“It was quite obvious to me from the start that there was something about RAW that made it very important. The term I like to use is ‘much loved’ by many people in the community,” she said proudly.
There was no “soft lead in” for Liz. Within weeks of starting she was on the flood frontline in the northwest of the state with her staff, who were the first port of call for many rural communities in the wake of the natural disaster.
“That is just one of the many things that we are here to do for rural and regional Tasmanians. It also gave me a valuable chance to witness first-hand how Tasmanians feel about our organisation.”
She is clearly very proud of the service that RAW provides, and of her front-line staff members.
“My initial description of the RAW outreach workers was, my collection of John Wayne’s – and I’ve said this to them,” Liz said smiling.
“My outreach workers are extraordinary people. They are rugged individuals – they go out and spend an enormous amount of time in isolation. They do not know what they are going to find when they get there. In 2015 our outreach workers walked in on 32 actual suicides occurring.
“They often have quite traumatic experiences. Often when they walk in they do not know what they are going to find, so they are extraordinarily self-contained people. They are people of inevitable and incorrigible good humour because they have to be. They are incredibly busy people and very, very diverse. We have people from ex-forestry drivers, through to social workers and mothers. They are the people that they serve."
This view is one that Liz believes has been echoed by community members who come into contact with RAW.
“There are a couple of key messages that I have received about RAW. That ‘they are where we need them to be and when we need them to be there’; and that ‘the way the people who work for RAW talk to us is about meeting who we really are and responding to us in a way that is respectful’.”
High praise for an organisation that deals extensively with the very sensitive and critical issues of mental health and suicide prevention.
“One of the things that we often hear is that when people have issues, say with mental health or wellness or suicide, depression, anxiety, any of these things, with many of the services that they talk to they get a feeling that they get a response that only tells them of what the service does not do. So, many people are getting a sense of not being listened to, not being heard,” Liz said.
“So, I guess that is the first thing that I have learnt about RAW. When you go up to someone and say: ‘I am an outreach worker from RAW, how are you going?’ then they can talk about the weather, talk about the price of dairy products, or they can talk about the fact that you have a kid that is maybe dabbling in ice. You can talk about all of those things, and all of those things are included in how RAW responds.
“I think that is the big difference with us. Metropolitan- based services tend to be focused on very narrow areas: ‘we do this, but we don’t do this whole pile of other things and know that we will talk to you about mental health, but we don’t want to talk to you about your housing or your income security’.
Whereas, I think that people really value the extent of the problem that they feel RAW is prepared to deal with.”
As a service specifically run by, designed by and for rural people, Liz is also very much about pinpointing where exactly RAW fits in the terms of the wellbeing of rural communities of Tasmania.
‘This is part of a bigger conversation on where exactly rural Tasmania fits into the wellbeing of Tasmania as a whole. It doesn’t stand by itself,” she said.
“There is a heap of other things I have learned that I have been quite shocked about I have been a senior bureaucratic in my past, but I am still pretty horrified about the lack of understanding in some parts of Government about rural people and the way that they need to be able to receive service. There is still a perception that if a service has three regional locations, one in the south, one in the north and one in the north-west then they are a state-wide service. That just means they are servicing regional centres.
“The other issue that comes into play there is that there are specific parts of the rural lifestyle that I just don’t think people associated with the design of metropolitan based services even consider.
“One of those would be that many people in rural communities live and work 24/7 in the same place. They work with their families, they don’t have another place to go to so they live 24/7 with a whole lot of the same problems and the same benefits. There are good things, and there are bad things, but it’s a completely different lifestyle. When families are in that situation they just don’t feel okay to take time out They’re up there working whether they are sick or healthy, convalescing, or 100%. As a result the rehabilitation and recovery profile for people going back into rural settings is much tougher.”
Liz believes that political parties in Tasmania, no matter what their colour, should start to actively factor the unique communities into their future plans.
“Health and well-being is not a bubble inside an individual’s head. Yes, sure it is primarily about how an individual is feeling, but it also about the support networks they have around them in terms of family and community. It’s how they feel about belonging and how they feel about the future,” she said.
“Agricultural industries in Tasmania are now the state’s primary income source. If we are talking about sustainable agricultural industries contributing to the economy of this State, then we have to start talking about how we contribute to the well-being of the communities that are producing

“It needs a sense of family, even though some people may leave and come back. That you can have a lifestyle there that you find enjoyable and enriching. That it will allow you to do your work, but also play It has to have all of those things.”
At the moment RAW has ten outreach workers on the ground in Tasmania, but the list of “what could be done” is even longer.
“To do what we need to do now we really need 12, and we would happily have 14–16. We had to withdraw live-on services on King Island on 31 December last year. But we do fly in and fly out along with Flinders Island as well,” Liz said.
“At the moment RAW is keeping its key focus on the mental health and suicide prevention issues. But the list goes on. We would really like to be able to do more in the area of alcohol and substance abuse. We also know that more focus is needed on young people and children living in rural communities, also on families who have hit rough times and are unable to cope.
‘’I’m terribly worried about what’s going to be happening with older people, that’s a growing issue. We know that the fastest growing proportion of our population committing suicide are older people.”
Just to amplify the logistical problem, funding, or a lack of it, is now a very real issue for RAW.
“We have always received a proportion of our funding from the Federal Government, but that money has been transferred from the Department of Health and Ageing into Primary Health Tasmania. Primary Health Tasmania does, what is called, commissioning. This means that they go around to services, not people, and ask what is needed in those communities. They don’t speak to the farmers or people in the rural communities.
“Pretty much every big service in this state is telling Primary Health Tasmania what they need. We are the only voice I am hearing that is in there talking about the needs of rural people.
“I take my hat off and I respect all those other organisations, and I think they deliver really good services, but the reality is that they are not delivering many of the people that we get to see. Yes, it is hard but we are just a single voice in a massive process. It’s a real problem”.
Liz said that what RAW really needs is for people to speak up and tell governments the value of what RAW is doing in their communities.
“Speak up, tell governments and tell a politician what it is that we have done for you. I would also like to see the Tasmanian Government committing to developing a 2020 strategy about sustainable, liveable, rural communities,” she said.
“We are interested in health and wellbeing, but we also want communities that people feel good about living in. Communities where they know that, if they have troubles and bad times, there is help there and they can get help in a way that is relevant and accessible. People of all ages, the earlier we can start work with people the better.
“That is what sustainable rural communities are. It is about having adequate employment opportunities, it’s about having sustainable agricultural industries, about people being able to be trained and able to live in them, it’s about a lifestyle that people can see that it is a really good place to live and bring up a family in.
“When you talk about RAW you shouldn’t just talk about us being a health service, we should be a part of a whole government strategy. We are talking to Government about getting funding from DPIPWE. We should also be talking about where we fit within the Department of State Growth and the Premier’s Development Commission.
“I have sympathy for Minister Ferguson, as the dollars in the health budget are amongst the most contested dollars of all. But, why would you put the whole of rural Tasmania’s wellbeing into a department that is trying to support multiple regional hospitals? So, part of the conversation between RAW and governments is that they need to have a much more strategic vision.”
In five years Liz would like to see RA W’s outreach program adequately staffed and covering all of rural regional and remote Tasmania.
“I would like to see organisations with specialist services using RAW almost as their vehicle into where the people are. We don’t need to be the service that delivers everything, but we can be the service that people trust and that they will go to and that they will welcome into their homes. So, we can hopefully have a delivery system that can take the right services to them,” she said.
“We will never get a whole range of clinical services or expensive services located in rural communities, but if we can identify the people who need those services and help those services go out to where those people are. Then we could have a high-quality service delivery system and allow people to get over the blockages of access that they have now.”
And it’s not necessarily about throwing the proverbial “bucket of money” at it either.
“The reality is that we are in a resource scarce environment so there is not going to be a whole pile of resources thrown at this,” Liz said.
“We could achieve a great deal by working very differently. It is actually about building our services around people and going where people are. It is not about every town having a hospital, but if we know about people that are at risk, it’s about having services to help them not get sicker, or to cope with a crisis better. We can all do this together by working together and differently.”

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RAW CEO Liz Little