LIFE News issue 9: rural and remote

Comment: Suicide prevention in rural and remote communities - an ongoing challenge

Thirty-thousand feet above the fertile valleys etching Australia’s eastern coast the overseas tourist sitting in front of me, who seemed hypnotised by the view from the window, turned to her fellow traveller and commented on the ‘vastness’ and ‘emptiness’ of the land below. Of course, it all depends on one’s perspective and while it is clearly vast it is far from empty. For Australia this is dense rural settlement. However, even if we were flying west rather than north, across savannah, spinifex and desert, below us there would be stations, mines, roadhouses and communities – all the way to the Indian Ocean. Invariably one wonders who lives there, what they do, and how they ‘cope’.

Such musings are prejudiced by the projections of metropolitan experiences and expectations; size is not the only difference - the small populations in most of these remote settings are not microcosms of the wider Australian society and need to be taken and understood on their own terms. The circumstances, opportunities and challenges of the environments in which they are located have resulted in populations quite different from the national demographic. New mining towns of bubbling 4X4 affluence, largely male, young and impermanent; drought savaged marginal rural and pastoral communities where those too old, exhausted or poor to leave are in the majority; and oases of workshops, dongas, yards and a shop to service passers by who may never return. There are towns that come to life for a few months a year when a dozen languages are heard as the picking proceeds or the harvest is brought in. And there are the discrete Indigenous communities of remote Australia, from the islands of the Torres Strait and the Arafura Sea to The Centre. These are but some of the many colours of ‘remoteness’.

Then there is isolation – which is not the same. Even the most remote settings are not isolated in the sense that they were just three decades ago. Transport and, in particular, telecommunications, have changed that, and isolation can be as potent in the metropolis. Disability, mental illness, poverty, substance dependence, prejudice… all can be more effective agents of isolation than geography. However, all of these conditions also exist in remote Australia and those so afflicted are truly remote and isolated. They are doubly disadvantaged, their vulnerability generally compounded by the absence or inadequacy of services.

Remote Australia presents major challenges for suicide prevention. Reducing risk and promoting resilience in these settings necessarily demands approaches as varied as the demographics and circumstances of the communities and towns involved. While there are obvious commonalities (enhancing social connectedness, improving service access, reducing risk behaviours etc.) there will clearly be major differences in approaches between, for instance, reaching out to unemployed or struggling farmers after years of drought (such as the Rural Alive and Well project) versus trying to engage ghettoised Aboriginal youth for whom marginalisation has been a lifetime experience (such as the Yiriman Project).

It is now sadly apparent that Indigenous Australia has had staggering increases in suicide over the last three decades with communities in the Kimberley, the Northern Territory and north Queensland repeatedly identified in the national press. Over that period the patterns have changed with increasing numbers of children now adding to the statistics. While there has been much speculating and theorising about why Indigenous Australians are so vulnerable, it certainly relates to their social and economic disadvantage by comparison to the wider society, which includes benefiting less from advances in information technology and telecommunications – most remain on the other side of a digital divide.

Bridging that divide is one way of moving forward in suicide prevention. Anyone with experience in remote Indigenous communities will quickly discover that there is enormous enthusiasm for digital devices and the creativity of those who do have access is obvious. So, given the extent that health promotion and suicide prevention rely on these approaches there is an obvious challenge: How do we take advantage of technical opportunities and local energy to improve the reach and effectiveness of suicide prevention in remote Indigenous Australia?

As one example, HITnet is a Cairns-based ICT4D (Information and communication technologies for development) venture with a national network of touchscreen kiosks located in Indigenous communities, on which are deployed narrative and interactive content across a range of health and social arenas, most of which is produced in remote settings and also made available in iDVD (interactive DVD) format for mediated group use. As a partner within an NSPS funded project – Building Bridges: Learning from the Experts – which sought to reduce risk and improve resilience by sharing experiences across rural and remote Indigenous communities in Queensland – HITnet undertook two tasks.

First, a specific module was developed drawing on the experiences of one community that has suffered and moved on from a spate of suicides in the late 1980s and early 1990s. Buluru Yealamucka – Healing Spirit was shot in Yarrabah and includes fourteen narratives in three broad areas – personal recovery, community leading the way, and community recovery. HITnet also drew on a knowledge sharing meeting within the project to create another resource as part of a wider initiative – Frame of Mind – in which participants in community workshops focusing on local social and mental health issues cooperate in creating a performance based on their work which is filmed and edited (this one at an NSPS site, Dalby, but others have including Hopevale, Napranum and Aurukun). Both these modules have been deployed across the national kiosk network.

There are other, older forms of technology that prove just as valuable in reaching out to rural populations, such as community radio. The Community Broadcasting Association of Australia, which produces short radio segments addressing mental health and suicide prevention, broadcast to a large national audience of rural listeners who may not have access to other technology. 

And nothing of course will ever replace the value of face-to-face interactions. Home and farm visits, counselling and education and training programs and workshops will always have a pivotal role in creating and sharing mental health and suicide prevention awareness.

LIFE Fact Sheet 18: suicide in rural and remote communities provides a sobering overview of the problems we face in striving to reduce the number of people in rural locations who take their own lives. As with most of our efforts in this difficult area, the gains are likely to remain modest and the task ahead substantial. In remote Australia that task will require innovative technological solutions to overcoming distance and isolation but, more importantly, it will demand creativity – applying creativity in our work and enabling the creative potential of those for whom we work.

Ernest Hunter is the Principal Investigator of the Health Interactive Technology Network (HITnet) and author of Aboriginal Health and History: Power and Prejudice in Remote Australia (CUP 1993).

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Above: two participants in the Yiriman Project.

By LIFE Communications

The Yiriman Project is a culturally based youth diversionary project operating throughout the south west Kimberley region in Western Australia. Run by the Kimberley Aboriginal Law and Cultural Centre (KALACC), the project is designed and governed by Aboriginal Elders from the Karajarri, Nyikina, Mangala and Walmajarri language groups. Yiriman targets at risk youth, including those who come into contact with the justice system and those disconnected from their culture and heritage.

‘So many Aboriginal young people today are disconnected from their elders, disconnected from their country and disconnected from their culture and language,’ says KALACC coordinator Wes Morris. ‘Yiriman seeks to reverse these historical processes.’

One of the major ways through which Yiriman achieves this is its implementation of a set of ‘back to country’ programs that engage participants in a range of activities including hunting, walking trails, mapping country and observing cultural landmarks. The bush trips comprise around 30-100 participants and typically last between one to three weeks. The project offers a range of other initiatives including digital media workshops, leadership activities and a diverse array of dance and cultural programs.

Dance is particularly important in Aboriginal culture, and in the lead-up to music and cultural festivals Yiriman educates young Aboriginal people on the subject.

‘A lot of young people around the demographic of 15 or 16-year-olds, due to various historical factors, don’t know the dances, don’t know the songs, don’t know the movements, don’t know how to paint up and don’t know any of the cultural underpinnings,’ says Morris.

‘So before we take them to a big festival we work with these young people to help them learn their culture, feel strong about themselves and then perform in public in front of their peers and in front of their families.’
Yiriman experiences a plethora of ongoing challenges related to working in an area as large and remote as the Kimberley.

‘We live, work and operate in a remote area with huge distances, a lot of transport and logistical problems and a huge level of social need,’ says Morris. ‘A lot of people are unemployed. A lot of people live in houses with 15 or 20 other people. There is a huge level of social need right across the board.’

• For more information about The Yiriman project, visit their website or the Yiriman LIFE project profile.
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Did you know?

• For more information about Farm Link read LIFE’s project profile. 
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Above: Vyv Alomes (right) and participants in a Rural Alive and Well high school mentoring program

By LIFE Communications

By The Community Broadcasting Association of Australia

People in rural and remote areas can face a lot of stressful situations, with issues such as isolation, the impacts of drought and lack of access to services and support making life on the land extremely difficult.

To provide people in these communities with information on mental health and suicide prevention, the Community Broadcasting Association of Australia (CBAA) is broadcasting a series of short audio segments on community radio stations in rural and remote areas of the country.

These radio segments have a strong focus on the issues faced by people living outside of our major cities and towns and are designed to promote help-seeking behaviour and positive lifestyle choices.

The project, developed with the support of the Australian Government Department of Health and Ageing, has profiled a range of suicide prevention projects underway in rural and remote communities.

A great example is the Rural Alive and Well program, which operates through the Southern Midlands and Central Highlands areas of Tasmania and is also featured in this edition of LIFE News.

This important local project seeks to help build the resilience and capacity of men, their families and the community to react to challenging life experiences, with a specific focus on suicide.

Project coordinator Vyv Alomes provided this advice for men in rural and remote communities who are going through tough times in their lives: ‘I would encourage men primarily to talk to their mates,’ he said, ‘and to engage other males in their area to form supportive networks and groups.

‘An example is a group of farmers in the Colebrook area of Tasmania who meet monthly for a hot pot night at each other’s places. They talk about what’s happening, and as they say ‘shoot a few crows’. So I’d ask men to engage each other, having regular social contact with other men, plus in the community generally.’

Another person interviewed by the CBAA suicide prevention project is Stuart Gordon, the CEO of the New South Wales Outback Division of General Practice.

He told our national audience about the importance of people living in rural areas being aware of the impacts of stress caused by drought on their health and wellbeing.

‘Droughts come and go, there’s always tough times for communities,’ he said.

But just like other chronic illnesses and other lifestyle risk factors, there are things that we can do to ensure that we stay healthy during these times.’

• For more information on this project, and to obtain copies of the monthly newsletter and audio CD, please contact the Community Broadcasting Association of Australia on (02) 9310 2999, or email Project Coordinator Ian Watson. Alternatively you can visit the CBAA website or read the LIFE’s project profile.
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Above: participants in the Toowoomba Older Men's Network (TOMNET).

By TOMNET

A special interest of Toowoomba’s Older Men’s Network Inc. (TOMNET) is the wellbeing of older men in rural and remote areas of South West Queensland. This includes men who are doing it tough and their peers who can offer appropriate support.

We know about high suicide rates for rural and remote men. This represents ongoing challenges for TOMnet, which operates in concert with local community organisations to prevent suicide. By constantly dealing with suicide-related issues we remain committed to increasing our knowledge and skills in the interest of suicide prevention.

Recently our suicide prevention, intervention and postvention activities have been enhanced by two related sources: a book by Thomas Joiner, Why People Die by Suicide (2005, Harvard University Press) and an article by Thomas Joiner and colleagues, Establishing standards for the assessment of suicide risk among callers to the National Suicide Prevention Lifeline in Suicide and Life-Threatening Behaviour (June 2007; American Association of Suicidology).

Joiner’s book has particular relevance to the men of interest to TOMNET. Two concepts discussed in the book are especially important: perceived burdensomeness and thwarted belongingness.

Perceived burdensomeness is closely associated with feelings of ineffectiveness. It is painful enough when one perceives oneself to be ineffective. That this ineffectiveness should result in loved ones being threatened or burdened is even worse. As Joiner says: ’Those who view themselves as a burden on others have a negative self-image, feel out of control of their lives and possess a range of negative emotions stemming from a sense that their incapacity spills over to affect others besides themselves.(p 47).’

It is emphasised that, not infrequently, the person contemplating suicide perceives themselves as a burden and the state they are in as permanent, with death the only solution. This may often occur where successful independence and self-reliance are highly valued but not realised.

Thwarted connectedness refers to a sense that one does not belong. Where the need to belong is satisfied, even where perceived burdensomeness exists, connectedness may be powerful enough to prevent suicide. But where such a need to belong is thwarted, risk of suicide increases. Not being connected can be much more than the feeling of loneliness. It is a sense that sustaining connections are obliterated and that relationships are unfulfilling, meaningless or without proximity. Hence, social withdrawal and refusing help from others results in thwarted belongingness - not least, self-imposed isolation. It is no surprise that psychological pain or “psychache” can become overwhelming and lead to suicidal behaviour where un-connectedness prevails.

The article by Joiner and colleagues has sharpened our observation and increased our ability to more systematically assess the men served by TOMNET. We have added to our Needs Identification and Psychosocial Assessments a more suicide specific assessment tool entitled Psychosocial Outcome Rating Scale (PORS), which reflects core principles and subcomponents suggested by the article.

Essentially PORS takes into account schemes to identify three broad levels of behaviour: suicidal desire, suicidal capacity and suicidal intent. Within each scheme are indicators that allow for convenient classification of suicide risk levels. As a consequence, appropriate responses can be undertaken.

Buffers against suicide are also identified. These buffers help to counteract suicide ideation and behaviour, the most important of which is connectedness of one kind or another. Such buffers also contribute to a form of counter-culture. Here connectedness becomes a preferred imperative against self-imposed isolation, the latter being outmoded and a thing of the past.

TOMnet continues to openly and honestly address suicide issues in its overall concern for the well-being of older men in rural and remote regions. By constantly improving our vigilance, knowledge and skills our commitment to supporting and serving these men remains a high priority in the work we do.

• For more information about TOMnet, visit their website.
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By HITnet

By NALAG

 

NALAG is an independent not-for profit organisation established in response to the 1977 Granville train disaster. Since its formation over 30 years ago NALAG (NSW) Inc’s primary objective has been to encourage and promote professional and community education and support in loss, grief, bereavement and trauma throughout New South Wales.  A large part of NALAG’s scope includes working with rural and remote communities throughout central west NSW.

NALAG contributes significantly to the area of loss and grief by providing individual and group counselling, education and support. NALAG has 6 Centres and Branches across NSW with its State Office located at the NALAG Centre for Loss and Grief Dubbo. In 2009, Trudy Hanson (NALAG Centre for Loss & Grief Dubbo Manager, Grief Counsellor and Educator), Ann-Maree Hartley and (Psychologist,

Educator and Suicide Prevention Specialist) formed the NALAG Suicide Network (NSN) to address the significant needs identified in Dubbo and surrounding central west communities. NSN’s established goals are to provide awareness, education, support and advocacy to community members, and most specifically to those bereaved by suicide.

Since its inception, the NSN has provided free training to many professionals in the helping industry, tertiary students and community members in an effort to raise awareness and reduce stigma pertaining to suicide.  Through this training the NSN has attempted to advocate for the collaboration of services to individuals experiencing suicidal ideation or those who have survived suicide locally.

The “Bereavement Buddy” Grief Support Program recently developed by the NALAG Centre Dubbo will be trialled and evaluated in 2010. This program is designed to help people who have experienced the loss of a loved one and involves education and group support components. Specific topics include the experience of grief, feelings and beliefs, self-care and health behaviours, stress management, problem solving and cognitive behavioural therapy. The NALAG Suicide Network are currently piloting this Program specifically for those bereaved by suicide. Participants who have completed the Program are able to access a free community driven support network that is supported by NALAG staff and volunteers.

The NSN is also establishing a series of relevant community resources for persons bereaved by suicide and those who support them. These resources will be available for free via the internet, local community groups and agencies.

• For more information please contact the NALAG Suicide Network on 02 6882 9222 or visit their website. 
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Improving mental health and wellbeing in rural and remote communities - The Centre for Rural and Remote Mental Health Queensland (CRRMHQ)

Above: destocked grazing land south west of Longreach.

By The Centre for Rural and Remote Mental Health Queensland

Based in Cairns in far north Queensland, the Centre for Rural and Remote Mental Health Queensland (the Centre) was established in 2006 and aims to improve mental health and wellbeing in rural and remote communities by leading and supporting innovative projects and interventions using a partnership approach.

Rural and remote communities in Australia face a range of socio-economic and environmental stresses and over the last three years the Centre’s projects have focused on positively influencing protective factors for suicide, especially individual and community resilience. Through projects like Building Bridges, Me and My Community and Pathways to Resilience the Centre’s staff and project teams have been able to successfully engage with communities across rural and remote Queensland and work collaboratively to develop initiatives based on locally identified priorities. Here is a short profile of the three aforementioned projects.

Building Bridges: learning from the Experts (funded by the Department of Health and Ageing National Suicide Prevention Strategy)

This project was funded by the Commonwealth Department of Health and Ageing and drew upon Indigenous knowledge sharing between men’s groups across four sites: Hope Vale, Kowanyama, Dalby and Yarrabah. Building Bridges took a multi-faceted approach with the aim of strengthening community skills and knowledge about suicide. The project focused on community-driven processes using the Family Well Being empowerment framework, though expanded this to enable knowledge sharing across communities regarding risk-reducing and resilience-enhancing strategies. A series of knowledge sharing events was held across far north and south west Queensland. The value of these events was enhanced through a series of in-depth interviews which canvassed community members’ perspectives on suicide.

The above strategies were complemented by an innovative Information Technology/Multimedia program (HITnet), which provided both a record of community experience and informed community understandings of suicide and recovery. Following completion of Building Bridges, the Centre was successful in securing funding for Building Bridges Phase 2. The objective of Building Bridges Phase 2 is to develop a framework to strengthen the capacity of organisations in the Dalby/St George area to address identified gaps in suicide prevention related service provision.

Pathways to Resilience (P2R): Rural, Remote and Indigenous Communities Suicide Prevention (funded by Queensland Government Department of Communities)

Phase One of the P2R project commenced in October 2008 and involved consultations in the communities and townships of St George, Cunnamulla, Doomadgee, Mornington Island, Mt Isa and Aurukun with the aim of implementing activities which would complement existing community programs or address identified gaps in responses to suicide. When it came to identifying activities which would assist in informing people about suicide each community or township identified different issues and priorities. Following this, Phase 2 focused on planning and implementing activities identified in phase 1. The Aboriginal and Torres Strait Islander Mental Health First Aid [AMHFA] Training instructors’ course was conducted in Cairns with participants from Cunnamulla, St George, Mt Isa and Doomadgee. St George established a Pathways to Resilience group. The group has developed and launched a community brochure which provides information on Social and Emotional Well-Being and where to  get help locally. Mt Isa developed a health service directory which lists the services available, referral mechanisms and links to relevant websites. The Mt Isa directory is  supported by a website. Mt Isa also considered the feasibility of setting up cultural camps for young people. Cunnamulla hosted a range of P2R activities which centred on NAIDOC week celebrations and included DJ music workshops, community days, discos and a comedy performance.

Me and My Community (funded by the Department of Agriculture, Fisheries and Forestry under its Australia’s Farming Future Initiative)

The aim of the Me and My Community project is to develop leadership and life-skills among young people and women working in the farming industry in various rural and remote locations in Queensland through the delivery of training workshops. Me and My Community training draws on the Building Rural Leaders program and mental health literacy   training and is delivered in three one-day units. Each day has a different focus. Day one focuses on the individual: how we respond to change (both chosen and unchosen), problem solving skills and developing networks. Day two focuses on family: how to identify individual talents and strengths and how individuals influence others. The focus of day three is on the role that individuals and families have as the building blocks of their communities and how individuals can have a positive influence on the broader community. To this end, day three is based on mental health literacy and provides participants with the skills they need to take an active role in mental health promotion, prevention and early intervention strategies. Take home activities extend and reinforce the knowledge and behaviours explored in the face-to-face sessions. The Centre is now in the process of delivering Me and My Country to groups in Mt Isa, Longreach, Roma and Kingaroy. Me and My Community will culminate in a national workshop  to be held in Cairns on the 24 September, following directly on from the Creating Futures 2010 conference on 20-23 September.

• Further information on the Centre’s current and past projects is available on the Centre for Rural and Remote Mental Health Queensland website.  
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By LIFE Communications

Next edition of LIFE News

The next edition of LIFE News will focus on suicide prevention in culturally and linguistically diverse (CALD) communities

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