SEEDS OF HOPE
Widespread drought often directs the spotlight on mental health issues in rural and remote Australia. Yet the challenges and difficulties exist come rain, hail or shine.
Widespread drought is shining a light on mental health issues in regional Australia.
It’s an iconic line from one of comedian Dave Allen’s famous skits – “Teeth will be provided”. The witty punchline makes Mark Davis chuckle every time he hears it. But for Davis, the joke isn’t just funny. It also saved his life.
It was the early 1980s, and Davis planned to make his suicide look like an accident. He was home alone, but the TV was on in the adjacent room, and Davis’s ears pricked up as Allen’s Irish accent delivered the famous gag.
“I would have sworn black and blue that I wasn’t capable of a chuckle,” says Davis. “I was so divorced from myself at that stage that I didn’t think I was capable of love. I didn’t think I was capable of a great long list of things, and the fact that I’d chuckled came as an absolute surprise.
“What it did on that occasion was let me know, ‘Hang on there, there’s more to things than I know about’.”
Davis lives in Westbury, a small town in central-northern Tasmania, 30km west of Launceston. His address may not seem that important, but this simple matter actually puts him at a higher risk of suicide and self-harm than his city counterparts.
The prevalence of people experiencing some form of mental illness is consistent around Australia – according to Beyondblue, about 20 per cent of Australians experience a mental health condition in any given year. However, rates of suicide and
self-harm across the country increase significantly with remoteness. In 2016, the number of suicides per 100,000 people was 50 per cent higher in rural and remote Australia than in the cities, according to a research paper by the Centre for Rural and Remote Mental Health (CRRMH).
Moreover, data collected between 2012 and 2016 and published by the Australian Bureau of Statistics shows that the rate of suicide is rising more rapidly outside capital cities (in those years there was a 9.2 per cent increase in suicide rates outside the capitals, compared to just 2 per cent within).
The discrepancy is blinding and there are a number of factors at play, but much can be attributed to access. It is simply harder to reach necessary health services the further away from urban centres you live. According to a 2015 report published by the Centre for International Economics in Canberra, residents of rural Australia are only able to access mental health services at a fifth of the rate of city dwellers.
Mercifully, this hasn’t been a problem for Davis. The 70-year- old has lived with post-traumatic stress disorder for decades – a result of his time working as an Australian Federal Police officer, and he has been suicidal “multiple times”. He still battles his condition, but he has also benefited from Commonwealth-funded medical support since he was retired unfit from the force in the mid-1980s.
“Because the Commonwealth has paid for me to see a psychiatrist whenever necessary, I have not had the same troubles in a rural area as most people do,” says Davis.
But for many other Australians living in rural areas, the tyranny of distance creates a dearth of services and health resources. According to the not-for-profit National Rural Health Alliance, in Australia’s very remote areas, there are just 18 psychologists for every 100,000 people, compared to 73 in metropolitan areas.
For Brisbane psychologist Selena Gomersall, the true magnitude of this situation hit home in 2011, when she was invited to offer her expertise to a group of women and children from cattle properties in the Etheridge Shire in Far North Queensland. Not only did she find significant evidence of moderate to severe mental health concerns, but she also found a dogged community of people committed to just getting on with the job.
“They’re remarkably capable and resourceful people, there’s no doubt about that,” says Gomersall of rural Queenslanders. “People in the bush expect and require a lot less.”
Gomersall says that issues such as long-term isolation, decades of inaccessibility and traumas in a small community are often not dealt with properly, which means they compound on one another. “People’s margins are very small and you throw in something like a drought – which goes on and on for years – and you just remove those margins very quickly,” she says.
Gomersall’s experience led to the 2013 launch of Outback Futures – a not-for-profit organisation delivering mobile mental and allied health services throughout remote centralwest Queensland. Gomersall is the organisation’s CEO, and she visits outback Queensland regularly.
The drought has hit this part of the country hard. Almost 60 per cent of Queensland is in drought, as is much of eastern Australia, and such conditions undoubtedly impact mental health trends. Yet Gomersall explains that the portrayal of the desperate Aussie farmer, so often splashed across the popular media at times like these, is doing more harm to rural communities than good.
“[Farmers] want to be recognised as the innovative and solid business operators that most of them are … when you haven’t had an income for six years because of natural disaster, that would cripple anybody.”
Steve Chase, a cattle farmer who lives between Tottenham and Trangie in central-west NSW, typifies Gomersall’s point. The father of four says his depression, diagnosed a decade ago, is exacerbated by the drought, but not caused by it. “I don’t think many people who have got depression have got depression because of the drought, [but] it’s made it worse,” he says. “We are going to have a million dollars extra worth of debt because of [the drought], but we choose to do what we do. Yes, it is tough out here at the moment, but we’ll come out of it.”
The renowned culture of selfreliance – prevalent in rural and remote areas – can make it difficult for people to seek help. However, this wasn’t the case for Chase. The fourthgeneration farmer has a family history of mental illness, and his experience with his father’s depression allowed him to recognise and accept his own symptoms more quickly.
In his father Geoff’s case, on the other hand, symptoms lingered for years before a close call shocked him into action. Geoff recalls: “I was driving to a meeting … and I thought, ‘Do I take the S-bend or just go the short cut straight into the tree?’ That was the catalyst that made me wake up. You think you’re bulletproof until something like that happens.”
Both Steve and Geoff were diagnosed with depression by a GP in Tottenham – about 25km from their Trangie property. Not a great distance by outback standards, but not without its problems. Rural communities often struggle to attract and retain doctors, and this challenge only increases when applied to allied health providers such as psychologists. That is why programs like Outback Futures work. As a fly-in, fly-out service, staff turnover is greatly reduced – and this helps to strengthen connections with clients.
“To tell your story out there once is a big deal. To have to tell it again and again is a deal-breaker,” says Gomersall. “We’re regularly in the towns, building relationships, developing trust and connection. We connect with them wherever it suits and then we fly out again, which means they’re not going to run into us at every social function – they’re not going to see us in the pub [or] the [supermarket] when they’re in town.”
In NSW, the Rural Adversity Mental Health Program (RAMHP) is delivering a similar service in a different way. A major program of the CRRMH – which is an initiative of the University of Newcastle in partnership with the NSW Ministry of Health – RAMHP helps to connect people in rural areas to appropriate mental health support. It was first established in 2007, in the midst of the ‘Millennium drought’, which devastated communities in southern Australia. But while drought has been a theme across the program’s 11 years, it is not the focus by design.
“[We’ve been] helping communities through various forms of adversity, not just drought, because usually drought is followed by flood – and then there’s bushfires and then just the everyday challenge of living in a rural area where there aren’t as many opportunities,” says program manager Tessa Caton. “It’s a constant, but the purpose of our program is to make sure people are linked into care.”
With 14 coordinators across the state, and five more being recruited, RAMHP has every rural area in NSW covered. But some coordinators are required to cover vast distances. The far-west region, for example, is about twice the size of Tasmania.
“We do a lot of kilometres in cars to get around to those communities to put a face to the service, because that’s one thing rural people need and don’t often have … a face-to-face conversation with people,” says Caton.
As well as the on-the-ground staff, RAMHP provides ‘gatekeeper training’ too – a form of community education.
“[Rural people] will not talk unless they trust the person, so we train vets, we train stock and station agents, we train all different types of agriculturefocused professions – professions that might have good relationships with people that might be vulnerable,” Caton says. “From our perspective we want to get as many eyes and ears out there looking out for people as we can, so communities support each other.”
Advancements in technology have also helped to close the gap between vulnerable communities and mental health support. For example, in South Australia, the government’s Digital Telehealth Network (DTN) helps patients connect remotely with clinicians, including mental health specialists, via video conferencing. Part of the Rural and Remote Mental Health Service (RRMHS), operational since 1994, the network allows care to be delivered from a centralised service in Adelaide. This program is supported by 13 community mental health teams located across country South Australia.
Aussie Helpers, an Australian charity dedicated to helping droughtaffected farmers, offers a similar service in partnership with Virtual Psychologist, where round-the-clock counselling can be accessed via SMS, chat, email or phone.
Other online interventions include, but are certainly not limited to: Beyondblue, providing online chat and forum services; MindSpot Clinic, which offers assessment and treatment for anxiety and depression; and the Black Dog Institute’s myCompass tool, a free, interactive, evidencebased self-help program.
Driven by his own journey, Mark Davis has volunteered his time to a number of services, both online and off, that use lived experience to support people struggling with mental illness or suicidal ideation. Whether he’s delivering a speech or providing anonymous remote support, Davis’s message is one of hope. “Even if the overwhelming circumstances of one’s life are pretty horrible, it only takes a small change in how one thinks about them to make an enormous difference,” he says.
“There is help there. It is terribly important not to be in isolation – to open up to a medical professional or someone you trust in your own life and get help. Things do get better. I am talking in relation to my own experience. [Mine is] a message of encouraging people to seek information, seek help. There’s an awful lot of hope.”
“When you haven’t had an income for years, that would cripple anybody.” SELENA GOMERSALL