Australians living in rural areas are no more prone to mental health problems than anyone else – but there are markedly different concerns. Annette Basile looks at those issues and discovers help is at hand.
From droughts to deluges to bushfires, the Australian continent is one of extremes. While Australians living in rural and regional areas are no more likely to experience mental health issues than those in the major centres, the problems Australians in non-metropolitan areas face are markedly different. The catastrophic and ongoing drought has had an enormous impact on rural Aussies, affecting not only family finances but their very way of life. Floods and bushfires have also taken an inestimable toll, and some psychologists even predict it may take years to recover.
Australians outside metropolitan areas may also have limited access to mental health services, plus higher rates of unemployment – particularly in satellite cities like Newcastle and Wollongong and their surrounding regions, where unemployment rates have climbed uncomfortably above than the national average.
A report by the National Rural Health Alliance concluded that as "rural Australians face greater challenges in accessing services to obtain timely help … the burden of associated disease is proportionately higher".
The family doctor – taking a lead role in rural mental health
"What we know is that in both urban and rural areas, depression and anxiety is pretty consistent in terms of its prevalence, but there's an increased suicide rate, particularly in males, in rural settings," says Dr Kellie Marshall, a clinical psychologist and the Deputy CEO of the Illawarra Division of General Practice, a non-profit organisation that supports general practice to address community needs.
"What we know is that in both urban and rural areas, depression and anxiety is pretty consistent in terms of its prevalence, but there's an increased suicide rate, particularly in males, in rural settings," says Dr Kellie Marshall, a clinical psychologist and the Deputy CEO of the Illawarra Division of General Practice, a non-profit organisation that supports general practice to address community needs.
"The rural community faces much more distress and trauma, with natural disasters such as drought, that impacts on the whole community," Dr Marshall continues. "Rates of suicide increase in communities with populations of less than 4,000."
Niall Mulligan, the Counselling Centre Manager at Lifeline Northern Rivers in Lismore, has seen the drought impact on the calls the Lifeline receives. "I think that sense of anxiety and a lack of control of the future is what often drives people to call," he says. "Distress and strains caused by draught are certainly a factor in calls we get from regional areas."
While this picture may sound grim, there are people and organisations that can assist. "I think general practice is the place to start for someone to seek help," says Dr Marshall. "A lot of GPs are well trained in the area of mental health."
In distress? Call 13 11 14
For those who don’t want to talk to a health professional face-to-face, or for Australians in remote areas where the local doctor is many, many kilometres away, there's the 24/7 free telephone counselling service Lifeline.
For those who don’t want to talk to a health professional face-to-face, or for Australians in remote areas where the local doctor is many, many kilometres away, there's the 24/7 free telephone counselling service Lifeline.
In 1963, the late Reverend Dr Sir Alan Walker received a call from a man in distress. Tragically, the man took his own life three days later, sparking Reverend Walker to found Lifeline. Within days of its birth, Lifeline had received more than 100 calls. Today, the service receives an average of one call a minute, taking some 450,000 calls each year. While Lifeline proudly acknowledges its Christian heritage, it regards itself as "a secular organisation", but one that's "informed by Christian values to a large degree", Lifeline's Niall Mulligan explains. The telephone counsellors come from all walks of life and are as "diverse as the Australian community".
Lifeline, a highly regarded and respected non-profit organisation, works on the principle of "self-empowerment". They don’t dish out platitudes or clichéd advice. Instead, Lifeline works with the caller to help them find solutions. "If we start giving advice to people we just make them more dependent on another person, then put the phone down and abandon them," says Rob, a Lifeline counsellor and trainer. "That's actually harmful. What we do in our time with people is to try to work with them so they can discover and reconnect with their own skills and resilience, so that they're empowered in the situation. That may also include giving them referrals.
"Even with a person who is very depressed and very suicidal, you can still work on empowering that person to take responsibility and to take action to make themselves safe."
"A lot of the time we refer people to other agencies," adds Niall. "We have a national database that we maintain. If a counsellor in Tasmania gets a called from Lismore, and that caller, for example, is experiencing domestic violence, the counsellor can look up a women's refuge in Lismore, or a domestic violence support group – whatever they feel the person might want will be on that database.
"There is evidence, mainly from the United States, about the effectiveness that telephone crisis counselling can actually play," Niall says later. "We do acknowledge that we're operating within certain limitations. Our counsellors don't talk to the same person over a period of time. They're one-off, self-contained calls, so what we can do in that time is limited. So to be useful, the idea is that we connect with the person, perhaps work out what the issues and the problems are that are confronting them, and then look to give them some strategies and help in dealing with those issues.
"Our callers are anonymous. The whole counselling environment is completely anonymous."
Staying in shape – mentally
Most of us are aware of the need to maintain our physical health, but sometimes mental health gets forgotten. Clinical psychologist Dr Kellie Marshall offers guidelines about how we can all stay mentally healthy:
• Keep physically active
• Maintain social contact
• Reduce stress and anxiety
• Get enough sleep
• Reduce/eliminate alcohol and other drugs
Most of us are aware of the need to maintain our physical health, but sometimes mental health gets forgotten. Clinical psychologist Dr Kellie Marshall offers guidelines about how we can all stay mentally healthy:
• Keep physically active
• Maintain social contact
• Reduce stress and anxiety
• Get enough sleep
• Reduce/eliminate alcohol and other drugs
Those first two points, Dr Marshall says, are the "really critical areas of maintaining mental wellbeing".
Mental health is a serious issue for all Australians, and depression and anxiety are named as the most common mental health problems we face. As we become increasingly aware of the issues, the stigma is starting to lift. And the message is becoming clearer – mental health concerns are common and not a sign of weakness. If you're experiencing difficulties, seek help.
Recognising depression –
in yourself and your loved ones
in yourself and your loved ones
Clinical psychologist Dr Kellie Marshall explains what to do if you – or someone close to you – is experiencing depression.
Depression can be deadly. And it affects as many as one in five Australians. Depression is a persistent sense of sadness, hopelessness and helplessness that goes beyond the kinds of downs that are part of everyday life. Sometimes depression is related to external factors, like relationship breakdowns, illness, grief or financial pressures. But depression can also appear when there are no external triggers.
Depression can be deadly. And it affects as many as one in five Australians. Depression is a persistent sense of sadness, hopelessness and helplessness that goes beyond the kinds of downs that are part of everyday life. Sometimes depression is related to external factors, like relationship breakdowns, illness, grief or financial pressures. But depression can also appear when there are no external triggers.
There is, says clinical psychologist and Illawarra Division of General Practice's Deputy CEO, Dr Kellie Marshall, "a strong correlation" between depression and thoughts of taking one's own life. But not all people that attempt or carry out suicide are depressed or have a mental health concern," she adds.
Dr Marshall outlines the signs of depression, which are consistent across all demographics:
• A low mood, which is often out-of-character
• Social withdrawal
• Losing interest in pleasurable activities (including sex and social activities)
• Loss of sleep
• Changes in appetite
• Increased drug and alcohol use
• Staying home from school or work
• Social withdrawal
• Losing interest in pleasurable activities (including sex and social activities)
• Loss of sleep
• Changes in appetite
• Increased drug and alcohol use
• Staying home from school or work
"There's not one thing that stands out to say 'this is a problem'," says Dr Marshall, "but a combination of those things suggests that someone might want to talk to a health professional about what's going on – particularly a GP."
If you’re suffering from depression, the main message from the experts is simple: talk to someone. "Most people having talked for some time about their issues do feel better," observes Rob, a Lifeline counsellor and trainer. "They do get some relief, even if they have a jolly good cry."
Problems can build up out of proportion when they're left inside the four walls of your head. "They just rattle around in a big empty space and the echoes get louder and louder," says Rob. "That's what Lifeline is there for. We can be a fantastic circuit-breaker. People can get things off their chest."
"When people call Lifeline, they can expect the phone to be answered by somebody trained in counselling, who's going to be non-judgmental, and who's going to be willing to listen and help them work through their issues," adds Niall Mulligan, Counselling Centre Manager at Lifeline Northern Rivers in Lismore.
Ideally, people trying to cope with depression should seek assistance as soon as possible – before things reach crisis point. And the family doctor is the person to talk to. There is an increased awareness about mental health in the community and GPs are at the frontlines. "What their GP will do is help navigate the next step for them," says Dr Marshall. "It not always medication. The GP may help them access the appropriate health professional – whether it's counselling or a psychologist."
Helping a family member or friend
There are persistent beliefs in society that people who talk about suicide aren't really serious about it, or that they're just trying to 'get attention'. Many also think that someone who's tried to take their own life but survived, won’t try again. These are myths. If someone talks about it, take it seriously. It's also important to understand that people considering suicide won't necessarily discuss it – there's no hard and fast rule.
There are persistent beliefs in society that people who talk about suicide aren't really serious about it, or that they're just trying to 'get attention'. Many also think that someone who's tried to take their own life but survived, won’t try again. These are myths. If someone talks about it, take it seriously. It's also important to understand that people considering suicide won't necessarily discuss it – there's no hard and fast rule.
If you see the signs of depression in someone close to you, Dr Marshall advises to try to open up a dialogue with the person about how they're feeling, and encourage them to see their family doctor. "Talking raises the issue for them, and lets them know it's okay to talk about it. We know – particularly with a lot of men – that they struggle to talk about the issue, and if someone else is initiating it, it can often make it easier for them.
"Really listening to what the other person has to say is important."
A word to the blokes
Men traditionally find it more difficult to talk about their problems than women. We ask why.
Approximately 2000 Australians take their own lives every year. Of those, roughly three-quarters are men, with suicide being the leading cause of death for men aged 44 and under.
A word to the blokes
Men traditionally find it more difficult to talk about their problems than women. We ask why.
Approximately 2000 Australians take their own lives every year. Of those, roughly three-quarters are men, with suicide being the leading cause of death for men aged 44 and under.
"Men tend to keep quiet about their health," observes Dr Kellie Marshall, a clinical psychologist and the Illawarra Division of General Practice's Deputy CEO. "They conceal their vulnerability – they want to appear independent. There's also a lack of knowledge and information about services, and men actually seem not to acquire that knowledge, particularly about counselling. Men have also been shown to be less aware about how counselling can help. There are also system barriers that are separate to gender – such as cost, access and waiting times – that impact on men seeking help.
"Women are more able to identify mental health problems," Dr Marshall continues, because they're more likely to talk about what's going on for them. They're more likely to seek help than a male because women's social groups trend to support that."
The statistics from Lifeline back-up the idea that women are more likely to seek assistance than men – there are two women to every man who calls the national counselling telephone service.
"Australian men certainly have a tendency to need to appear strong and in control," says Niall Mulligan, a Lifeline centre manager. "The definition of the male role is of somebody who's in control, so maybe reaching out for help and acknowledging that you really aren’t coping that well is a difficult thing to do. Women appear to have that ability to share and talk about problems."
"Australian men certainly have a tendency to need to appear strong and in control," says Niall Mulligan, a Lifeline centre manager. "The definition of the male role is of somebody who's in control, so maybe reaching out for help and acknowledging that you really aren’t coping that well is a difficult thing to do. Women appear to have that ability to share and talk about problems."
Seeking assistance is not 'unmanly', nor is it something to feel ashamed about. In their Toolkit for Men Experiencing Difficult Times, Lifeline recognises that reaching out can be especially tough for men in rural areas "as they often feel that everyone around them relies on them and expects them to cope in the face of hardship". But while "asking for help can be difficult…it doesn’t make you less of a man".
Men who are going through difficulties are encouraged to talk about their problems, and qualified help is close as their local GP. The family doctor will be able to listen, provide support and refer patients to the relevant mental health professional if needed.
For men unwilling to speak to a doctor, Lifeline is an excellent – and anonymous – option. "Picking up the phone is a lot easier than a lot of the other strategies that you could adopt," says Niall. "That's what we're really about, the idea of being accessible and 24/7.
"A lot of the time, picking up the phone and calling Lifeline is the start of a journey."
The original articles were published with an extensive list of links and mental health resources. More in this series is available on request. Originally published on prime7.com.au