General Rural Stigma Reduction — 13 March 2019
Antidepressant medication
Photo: Buying medication to treat mental illness can carry a sense of shame for some regional Australians. (ABC News: Nic MacBean)

A new awareness of the impacts of ‘pill shaming’, which can prevent people from purchasing medication to help treat their mental illness, has emerged in online forums.

The movement has been shared across various social media and blogging sites, with individuals using #PillShaming to open up about their own experiences, or to encourage others to drop the stigma around mental illness and taking medication.

Confidentiality concerns
Photo: Some patients feel uncomfortable purchasing medications that treat mental illnesses. (Reuters: Darren Staples)

The campaign has been discussed internationally, with one blogging site’s video attracting around 15 million views.

In 2017, The National Rural Health Alliance (NRHA) identified that around 20 per cent of people Australia-wide experience mental illness.

However, rates of suicide and self-harm increased for people living more remotely.

Royal Australian and New Zealand College of Psychiatrists (RANZCP) president Kym Jenkins said that anecdotally the amount of medication being prescribed to regional Australians to help treat or manage an individual’s mental illness had increased.

Despite this, some professionals working in the mental health space have said a negative stigma in regional Australia had caused people to feel embarrassed about accessing medication.

Dr Jenkins said continued efforts to reduce negative perceptions of mental illness must be made and if more locals were to share their personal stories, the stigma could be reduced.

“We don’t have much in the way of role models or stories coming out from people who are living rurally and remotely,” she said.

“[People opening up and] saying, ‘I’ve had this mental illness, I got it treated, I feel better now and feel that I’m a contributing member of society again’ [would be positive].

“We don’t have many … people modelling how to get treatment for mental illness and how effective that treatment can be.”

Fear of knowing chemist staff

South Australian psychiatrist Ken Fielke, who specialises in rural patient care, said a significant number of people were not taking the medication that had been recommended, as patients felt uncomfortable about purchasing medication from their local pharmacy.

“I go to a range of different towns across the state — they are fish bowls — and people are really concerned about their privacy and confidentiality,” Dr Fielke said.

“In some respects, it’s great to be in a rural community where you’ve got networks and people that support you, but in [others], you also want confidentiality and privacy and with mental health issues that is often the case.

“[This is something] we wouldn’t think about with some other conditions that you go the pharmacy and get your script filled for.”

Dr Kym Jenkins said anecdotal evidence suggested that this issue was not limited to just regional SA and was an experience noted in many other regional areas nationwide.

Taking medication ‘somehow’ viewed as a weakness

Melbourne woman and ‘A Path To Follow’ founder, Kirstie Edwards, has lived with mental illness for most of her life, starting treatment about 15 years ago.

woman sitting in front of green bushes
Photo: Mental health advocate Kirstie Edwards has overcome mental illness and is sharing her experiences to help others. (Supplied: Kirstie Edwards)

Ms Edwards grew up in a country community in Victoria and moved to the city in her late teenage years.

The mother of three said it was unsurprising that people felt embarrassed or uncomfortable about accessing medication, as the negative stigma still surrounded mental illness in rural areas.

“More people may be taking medication than what they previously were, but they are not open about it,” she said.

“There is still this overriding sense — more so in the country — that society tells us we should be able to cope with this on our own, and if we’re not then somehow that’s a weakness.

“My family in the country knew I was sick, but they certainly didn’t know the details.

“I am still much more open about my mental health journey with my family and community in Melbourne than I am with those people from the country.”

Rural GP shortage a barrier

Dr Parisa Pour Ali takes a patient's blood pressure
Photo:Dr Parisa Pour Ali in a consultation in the far-south coastal town of Merimbula, NSW. (Alice Matthews: ABC South East NSW)

According to Dr Fielke and the NRHA, a key to successfully supporting a person’s mental illness treatment is a strong connection with their general practitioner.

Dr Fielke said this was difficult for people living in regional areas that did not have ongoing GP services or communities that had a high turnover of GPs working in the community.

He said this caused people to be less trusting of diagnosis and treatment, including medication.

“General practice is changing and a GP that [would have treated you from] cradle to grave … is becoming less and less common,” he said.

“If you can’t see a regular GP, or you’re seeing a locum, then you’re seeing someone who doesn’t know you so well and that does make it more difficult to get the mental health care that you might require.”

NRHA chief executive Mark Diamond said the impact of rural GP shortages on patient care was a major concern.

“The research that we have done in relation to access to health care indicates that around 20 per cent of a person’s health outcome is impacted by a timely, appropriate and affordable access to care,” he said.

“The health outcomes that country people experience are poorer than their metropolitan counterparts and most of that is attributable to this issue of access to timely, appropriate and affordable care.”

Can pill frustration and pill shame be beaten?

Treating mental illness with medication is not the first preference for many and is often an emotionally and physically draining journey.

Ms Edwards, who had strong support from her family during treatment, said she had to persevere and continue to follow up with medical professionals and encouraged others to do the same.

Mental health advocate Kirstie Edwards is pictured with her partner and three sons.
Photo: Mental health advocate Kirstie Edwards has been able to overcome mental illness with great support from her husband and three sons. (Supplied: Kirstie Edwards)

“I can see why people give up on medication because it can be a really hard journey to have to go back and say, ‘This isn’t working’, or ‘I actually feel worse’,” she said.

“Even in the city we had to work really hard to try and find somebody who I could connect with on an ongoing basis.

“After a period I got better, but that was after quite a lot of experimentation to get the right medication and then the right level.”

This piece by Laura Collins was originally published on ‘ABC News‘ 4 February 2019.


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