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What travelling through country Australia taught me about mental health needs

Speeches in Parliament
Penny Wright 24 Mar 2014

Senator WRIGHT (South Australia) (22:10):  I rise tonight to report on the rural, regional and remote road trip I conducted during 2012-13 to learn about the mental health needs of people living in country Australia.

I set myself the task of gaining practical feedback from those working on the front line in rural, regional and remote mental health services. I wanted to understand the experience of those who live in the bush and are challenged at times by poor mental health. I also wanted to understand how it is for their carers and families. Rural communities are the backbone of our nation; they are not only important to our sense of who we are in Australia and our history, but they are integral to our economy and, ultimately, to our survival. They feed us, help clothe us and provide the food we need to sustain us.


In my home state of South Australia, it is often said that 'politicians think the state ends at Gepps Cross', which is a 20-minute drive north of the Adelaide CBD. But that is not true of me. As a Green, I am only too aware that it is our farmers who are the custodians of our food future. I am also very aware that it is the environment which sustains them and ultimately of course all of us.

Thirty per cent of Australians live in rural areas, but they do not receive their fair share of services and resources. This is particularly true, and particularly troubling, when it comes to health and mental health services and support for those living outside city limits.

The National Rural Health Alliance stated: 'There is a general downward gradient in health and health services from major cities to remote areas. The more remote the community, the poorer the health status of its people and the less access it has to health services and health promoting infrastructure.

Indeed people living in remote communities receive only eight per cent of the mental health services that their city and urban counterparts receive. Just like urban dwellers, country people experience challenges to their mental health. Some live with enduring mental illnesses, sometimes for large parts of their adult lives. But country people have unique pressures, experiences and factors affecting their mental health. They are often faced with the added pressure of stigma associated with mental ill-health because they do not have the anonymity that people living in urban and city areas might have. While people living in country Australia generally experience mental ill-health at levels equivalent to people in urban areas, they encounter higher risk factors for mental ill-health, including unemployment, lower socioeconomic status, poorer levels of education and reduced access to mental health services.

To get a better understanding of the issues facing country Australians and what they needed in the way of mental health services, I set out to visit people in the bush and to listen carefully. Too often we see policies cooked up in Canberra, or other urban centres, foisted on country people with the hope that they will have the desired effect. All too often, they are not relevant and they are not responsive and they are not ultimately owned by those people they are seeking to assist. But I was determined to listen carefully and then set out to develop well-informed, responsive and practical policy, grounded in the reality of the experience of those who live in the country.

So that is what we did. Over 18 months, I met with more than 185 people in 55 meetings across six states and 24 Australian towns. I met with service providers, carers, consumers and their families, and they all shared their stories generously with me.

While every person's experience is unique, there were also many common threads. I heard about, and experienced, the importance of community, and the importance of belonging. I believe every human being has a deep need to be acknowledged and validated, and my tour reinforced for me the importance of places in communities where people can go to feel connected.

So it was that I encountered community centres and neighbourhood houses. These were very, very important to the people who were lucky enough to have access to them, because they found them to be inclusive and safe places where often the focus was not solely on mental health but wellness more broadly, connectedness and social participation. I will share one story with you.       I was eating lunch at Port Lincoln Community House in South Australia-sitting with others who had shared a lunch that was prepared and served by other participants and people who use the neighbourhood house facility. For a modest amount-and this was a common theme at many of the neighbour centres and community houses that I visited-these people, many of whom are on low incomes, were guaranteed a healthy and sociable meal at least once a week and sometimes several times a week and they could come together and share their meal and participate.

One woman who served me my lunch told me her story. She had lost her home in the bushfires that went through the Port Lincoln area some years earlier. She had been seriously traumatised. Indeed, she had been found in a cupboard hiding away from people. She was ultimately coaxed out and she began seeing a psychiatrist on a very regular basis. Over time, she also made contact with the Port Lincoln community house and gradually became involved and felt validated, valued and needed by starting to participate in some basic cooking classes and then preparing meals for the shared meal and so on. After a period of some months, her psychiatrist told her that her healing was being more effectively dealt with by her participation in the community house and she had no need to see him anymore. She was incredibly grateful for the experience that she had had and she sat down and shared that story with me. By the time I met her she was attending regularly, she was confidently participating in the programs and activities and feeling valued and valuable.

On my travels I also learned about the importance of 'outreach'-actually meeting people where they are and reaching out to them, human to human. One organisation that I encountered that is doing great outreach work is Rural Alive and Well-with the acronym RAW-in the southern midlands of Tasmania. It is known affectionately by some of the people as 'Lifeline on wheels'. Basically, they would go out in their utes and their vans and reach out to people who might be at risk of suicide. This was often based on tip-offs that they had heard from other local people-maybe doctors or neighbours. They would also do 'cold calling'. Particularly for people living on isolated properties, they would drive down the long driveway to the house, knock on the door and have a chat and a cup of tea and offer a listening ear. The person I spoke to there said he had only been turned away once in all the years that he had been doing it.

I heard so many other stories about communities coming together to support their own in innovative, generous, caring ways. But of course I also heard alarmingly and constantly about a lack of services and gaps. I heard from parents who were desperate to get help for their kids and grandparents who were desperate to get help for their grandkids. I heard about reduced alcohol and drug services. I also heard about there not being enough support for people struggling to maintain their mental health, ultimately reaching crisis point and often having to be taken out of their communities to urban hospitals and crisis care, away from the relationships that help sustain them. I heard about the need for incentives for mental health professionals to work in country areas and I heard about great initiatives trying to overcome some of the tyranny of distance, such as travel subsidies, making transport free one day a week and coordinated underutilised transport with the help of volunteers.

After many months of listening, note taking and joining the dots, my team and I collated the information and feedback we had received on the tour and through an online consultation that we conducted. Together we developed a comprehensive report-'Voices and experiences: Improving mental health services in country Australia'-with recommendations that reflected what I had learnt on my travels. These recommendations formed the basis of our 2013 federal election policy initiatives, which were fully costed by the Parliamentary Budget Office-coming in at $1.1 billion as a commitment to improving Australia's mental health system.

But this commitment is far more than what can be measured in monetary terms. I often say that, once you have heard a story you know something and you cannot 'un-know' it. This has been an experience that I will never forget and something that will continue to shape my priorities and perspectives both when it comes to the work I do within the parliament and in the community. To put it simply: I believe in an Australia where all people have the chance to live full, productive and connected lives-no matter who they are or where they live. I would like to place on the record my thanks to all those people across this country who trusted me with their time, their ideas and their often very personal experiences.



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