title: Mental health support in northern communities: reviewing issues on isolated practice and secondary trauma.
abstract: BACKGROUND
  Communities in northern Canada face many mental health concerns related to isolation, historical and intergenerational trauma effects, and economic issues. Access to mental health services is problematic due to geographic, cultural and economic issues. Reduced mental health services have resulted in more responsibility and stress for the remaining formal mental health practitioners (including counsellors, psychologists, social workers and nurses) and on informal mental health support, such as lay counsellors, Elders, family members, and community-identified helpers.
  
  
  OBJECTIVE
  This review explores the unique conditions found in northern-based mental health support in on-going efforts to develop a practice model for mental health support in the North and to better understand the connection between isolated practice and secondary trauma. Practitioners who work in isolated settings are often removed from other professionals, training opportunities, clinical supervision, and family support, with this seclusion contributing to feelings of professional and personal isolation. Aspects of isolation as well as the requirements of empathic engagement with clients leave practitioners vulnerable to various constructs of secondary trauma. The unique challenges of northern practice may contribute to added risk of secondary trauma for formal and informal mental health practitioners. Secondary trauma is defined under the constructs of burn-out, compassion fatigue, secondary traumatic stress, and vicarious trauma. Although research on the contribution of secondary trauma to the high-turnover rate of professionals in the North is scarce, informal reports suggest that northern practice may be detrimental to longevity in the field for mental health practitioners, especially those who come from outside northern communities.
  
  
  CONCLUSIONS
  The reviewed literature presents the unique challenges of formal (professional) and informal (para-professional and other) mental health practice in northern communities including: isolation related to the principle of confidentiality, geography, and lack of supervision; high visibility and lack of anonymity; and the struggle of negotiating membership in a community with professional and para-professional practice. The literature indicates that practitioners are challenged and effected by the work they do, including both negative and positive aspects. Professional and physical isolation are key areas to consider in the development of a practice model for northern mental health providers and in gaining a better understanding of the impact of isolation on the phenomenon of secondary trauma. Differing views and definitions on the phenomenon of secondary trauma continue to be espoused. The specific context of northern mental health support needs to be considered when practitioners use various construct labels to describe what is happening to them. As suggested by the literature, an understanding of northern cultures is essential for competent practice in such settings. This understanding includes the diversity of culture and also work and economic factors influence on the social psychology of communities and the resulting impact on mental health supporters. It is proposed that a conceptual and practice model be developed specifically for isolated mental health support in the North, and broadened to include informal mental health providers as well as formal practitioners.
authors.affiliation: University of Northern BC, Prince George, British Columbia, Canada. loneill@unbc.ca
authors.forename: Linda K
authors.initials: LK
authors.lastname: O'Neill
mesh_terms: D002170:Canada; D006282:Health Personnel / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D008605:Mental Health Services / Q000600:supply & distribution*; D015873:Northwest Territories; D011365:Professional Practice Location; D000078329:Workforce; D014947:Wounds and Injuries / Q000523:psychology*