When you have a mental health issue, one expression you come across is, “Get a grip”. In regional and rural areas, mental health issues are more prevalent than in cities, but services are inadequate and youth in particular are missing out. Claire Fenwicke explores possible solutions.
The statistics are grim: suicide is the number one cause of death of Australians aged 15-24, and it’s worse in non-urban areas. According to News Corp, in 2010, 5.9 per 100,000 15-19 year-olds died by suicide in capital cities compared to 10.3 per 100,000 outside capitals. Analysing 20-24 year-olds in the same year, the suicide rate was 9.0 per 100,000 in capital cities compared to 16.5 for young people in regional and rural areas. The suicide rate of youths in country areas is almost double that of their city counterparts; but are youth suicide rates in regional and rural areas preventable?
For Jannelle Brandley, who works in a non-clinical role for mental health in Armidale, the numbers did not resonate until her seventeen-year-old son, Jarrod, took his life in May 2014. “It wasn’t until our boy died that the statistics [became] prevalent for us. When you’re talking 200 attempts a day that are reported, they’re huge numbers, and they’re just the people we hear about.”
It’s hard to pinpoint a solid reason why suicide rates are higher in country areas. Trevor Hazell, an executive manager for the Centre for Rural and Remote Mental Health, believes the actual incidence of mental health issues is probably no different outside cities. “But the one big difference between you having a mental health problem in a rural and remote area compared to an urban area is the services that are available to you.”
Trevor says that mental health programs implemented in schools in the last 10 years, and the creation of numerous online and telephone services have provided resources. But face-to-face services are in short supply, and online services need to be promoted. “[It’s] one thing knowing what online services there are, and also if they have the Internet to access them.”
Many help-seeking programs encourage early intervention. But people can be adept at hiding their condition. Jannelle says that there were days when it seemed like Jarrod was back to his own self.
“Now that I think about it, sleep was his only rest from the depression. When he could sleep, and if we happened to wake him in the morning, you could just tell that he was so deflated by the fact that he’d woken up, and he’d go days and days like that. And then you’d have two or three days where he’d engage with you, and you’d think ‘oh, my boy’s back’… Then a week later he’d be back down again. And for us, where was the line with that in terms of depression as opposed to just a teenager wanting to sleep a lot? He was very good at hiding it.”
Jannelle is frustrated with the lack of access she had to Jarrod’s care before he died. As Jarrod was seventeen, she could not find out information from his GP, such as if he had been prescribed medication. Jarrod had also been using cannabis, which brought him into contact with the justice system.
“There just seemed to be barriers everywhere I turned in terms of being able to connect him to the right kind of care. He wasn’t ‘mental health’; he was assessed as ‘low risk drug user’. So I thought to myself, ‘Am I making a bigger deal of this than I need to? Is it just a little bit of teenage cannabis use that he needs to get over?’ Because he still talked about TAFE and he still talked about work, and he still engaged in social activities with his friends, up until about the last four or five months before he died.”
Jannelle says that youth-friendly mental health services are missing from regional and rural areas. In Armidale a young person in crisis might be admitted to the children’s ward – if there are enough beds and if the staff are willing to take on a psychiatric patient – otherwise they can voluntarily be sent to Clark Centre, which has only eight beds. As a last resort, the young person may have to be admitted involuntarily to a centre in Tamworth or further away.
“If that’s your first connection – as it is for some young people that I’ve worked with – to mental health care and admitting you’re not feeling great, chances are you’re not going to tell anyone again.”
By contrast, cities such as Sydney have youth-oriented options – something now being advocated for the bush. Dominic Greenwood is the rural outreach coordinator for the mental health education organisation Batyr, which connects with high school and university students through the sharing of mental health stories. A pilot of their ‘Being Herd’ program is being trialled in Cobar.
Dominic says that youth engage well with Batyr’s storytellers because “it’s someone on their level. You’re not seeing an advertisement on TV, you’re not having a teacher just telling you about it, you’re actually hearing first hand what it’s like to experience it and what it’s like to come out the other side, and what it’s like to keep on managing mental health.”
Statistically, in an average Australian classroom of 30 people, seven will experience difficulty with mental health. Of those seven, two will seek help, leaving five people who will suffer in silence. “There’s no blanket solution to [prevent] the levels of suicide or help-seeking because it’s such a complicated topic,” says Dominic. “Some people need counsellors or psychologists or medication or a combination, there’s no one-size-fits-all.”
Dominic says telling someone with a mental health issue to ‘just get over it’ is the same as telling someone with no hands to get a grip, yet this is a common response. Through ‘Being Herd’, he wants people to realise ‘it’s ok not to be ok’.
“It’s very lonely, mental health, when you have no one to talk to … [and] mental health is the most normal thing. Almost 50% of Australians experience it at some point in their life. It really makes me, not upset, but frustrated that so many people out there don’t feel normal, because they are experiencing something that is very common.”
Dominic says the youth he has been talking to want to create a positive change, and there is a movement of young people wanting to start conversations about mental health. “We know it’s a challenge, but you’ve gotta start somewhere.”
Trevor believes the new youth-orientated Headspace program is beginning to make an impact, but it needs to be rolled out in smaller rural communities too.
“In the Headspace centre, they have funding to employ clinically trained people specifically to deliver treatments for mental illness, whereas in smaller towns you may have a youth worker, but that youth worker might not have clinical training or knowledge of the psychological treatments for mental illness.”
While youth suicide statistics are still shockingly high, youth-oriented services such as Headspace may make a difference. Tamworth’s new Headspace centre has come too late for Jarrod. His mother, Jannelle, has one final plea. “If I could ask for anything out of the whole process for us, it would be an improved process for families to access care.”
If you need help or someone to talk to, call Kids Helpline on 1800 55 1800 or the Suicide Call Back Service on 1300 659 467.
Young Men taking their lives at twice the rate in bush mental health crisis, by Sue Dunlevy, National Health Reporter, News Corp Australia Network, published 31 August 2014