You can’t simply plonk mental health services into rural areas and hope that people will come. The best chance of making a difference is working from the ground up, writes Alison Fairleigh.
This is one of a series of articles looking at issues relating to care in our communities in the lead up to the 2013 federal election. More coverage can be found at the ABC’s election website Australia Votes.
Recently, I popped down the street of my small rural town in north Queensland to pick up a couple of things at the shops. As I was jumping back in my car, I heard a loud “Oi” from across the street.
I looked up to see the welcome and familiar face of a local male farm worker running across the road to say g’day. Max* is in his fifties, married with grown up kids, and has worked on farms his entire life.
We took up the characteristic conversation pose for rural people of leaning on the bonnet of my car (I don’t have a ute, otherwise it would have been on the tray-back) where we stayed talking for more than an hour.
Max is a former colleague and we share a very special bond. You see, almost five years ago one of our male co-workers, John*, took his own life onsite and Max was one of two people to find him.
Typical of rural areas, Max and John had gone to school together, grown up together, worked together and had more than their fair share of drinks together. It was a devastating blow to Max, and he explained to me over the bonnet of my car how, to this day, he is still deeply affected with flashbacks and the futility of John’s decision.
It is a scenario that plays out over and over again throughout our farming communities. Evidence indicates that the suicide rate among Queensland’s agricultural workers – including farmers, farm managers, farm hands and shearers – is over twice the rate of those in other occupations.
While suicide is devastating wherever it occurs, the impact is particularly harsh on rural communities where everyone knows someone who has been there.
Much has been written about the complex factors influencing the high rate of suicide within rural communities, including, but not limited to, climate, declining profitability, bureaucracy and government regulations, isolation, stigma, lack of mental health education and services, and masculinity.
But we also have a considerable body of evidence telling us which programs and approaches do work in rural communities, and it is from this evidence that our policy makers under the new government must take heed.
First and foremost, ‘top-down’ approaches do not work in rural communities. ‘Ground-up’ is the most successful model of building capacity in rural and remote communities to manage their health and mental health. This can be achieved by empowering individuals and groups within local communities to work with existing models to strengthen collaboration and leadership.
Even where formal mental health services do exist in rural and remote communities, farmers and fishers in particular are not likely to utilise these services. Nor do they tend to make use of telephone help lines, telehealth or online services.
GPs are still the preferred health information source for farmers and fishers, who will travel considerable distances to ensure continuity of care through a trusted rural GP. It is therefore essential that considerable investment is maintained in the delivery and support of doctors to rural and remote Australia who have sufficient mental health training.
However, farmers also respond well to receiving health and mental health information through trusted sources such as recognised community groups (e.g. service clubs) or industry groups (e.g. state farming organisations), and in group settings (e.g. industry forums).
Therefore, the delivery of services to rural and remote communities can be better achieved through a “community health development approach”, in which industry, government, health services and community work together.
Such an approach will utilise “soft entry points” – i.e. industry field days and community events – to promote the effective use of available services, and will identify within communities credible individuals who can act as “boundary crossers”, having the trust of farmers, industry and health services alike.
Agricultural production and services to farming form the socioeconomic base for most rural communities. With the health and mental health of our farmers being one of the greatest challenges facing the future of Australia’s primary industries and rural communities, there is no room for delay.
Get it right now, and we get it right for the future – ensuring healthy, sustainable and thriving rural communities. And with that, I hope, there will be fewer people like Max, left struggling to cope with the loss of a mate.
*Names have been changed to protect privacy
Alison Fairleigh is the 2013 RIRDC QLD Rural Woman of the Year and Queensland manager of ‘Living Proof’ & Rural Services at the Mental Illness Fellowship of NQ Inc. Follow her on Twitter@AlisonFairleigh.
As first appeared on The Drum, ABC News.