"Mate, how's your head?" – It could be the question that saves a life.
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Talking about suicide is hard. Meg Perceval, a PhD candidate with more than a decade's experience in suicide prevention in rural areas, can tell you that. It’s the conversation none of us want to have, but asking a mate how they’re going can make all the difference.
And after the Royal Flying Doctor Service (RFDS) released findings that country people were twice as likely to die by suicide but less likely to seek help than city residents, asking the question could be more important than ever.
Ms Perceval’s community support program CARE -- an acronym for connect, ask, refer, encourage -- starts with that: practicing the conversation.
"We might care but how do we go from caring about someone and noticing that they aren't doing so well, to being brave enough," she said.
Ms Perceval hosted a CARE workshop in Inverell this week.
"They become really nervous, and they find it really hard, even in that setting which is such a good learning environment.
"It is so hard for people to actually ask that, and evidence would tell us that the best thing to do is to ask directly."
Her program tries to bring down troubling suicide statistics by helping people in rural areas to get healthier overall.
"I think one of the saddest legacies of suicide is that people so often say we just didn't see it coming," Ms Perceval said.
"One of the goals I had when writing it was that the program would help people to be healthy. If we can help people get healthier, we will reduce suicide as a side-effect."
Suffering from mental illness was no more prevalent in rural areas than in the city, the RFDS report found, but accessing support services was more difficult and less likely for people living in the country.
Ms Perceval said access to support services was one of the greatest challenges for people living with mental illness in the country.
"That is definitely the case, and the more remote you go, that is certainly the case," she said.
"But also part of it is the utilisation of services. There seems to be more stigma, and a culture in rural communities, of not wanting to seek help for physical and mental health concerns."
Young men, farmers, the elderly and Aboriginal and Torres Strait Islander people were at the greatest risk of dying by suicide, Royal Flying Doctor Service research found.
"Sometimes it is that the services aren't there, but sometimes it is also that the people aren't using them," Ms Perceval said.
The RFDS report, Mental Health in Rural and Remote Communities, called for greater investment in "evidence-based, culturally appropriate" mental health services and suicide prevention and intervention activities for remote and rural Australians.
Ms Perceval said she had plans to host CARE workshops with local schools to help guide the conversation about mental health in rural areas.
The findings: Mental Health in Remote and Rural Communities
- Dying by suicide is twice as common in rural areas as in the city, but Australians living outside metropolitan areas have only around one-fifth the of the access to mental health support services as higher populated areas.
- Around one in five, or 96,000 people in remote areas of the country suffer from a mental illness, but suffering mental illness is no more prevalent in the country as in the city.
- Farmers, young men, older residents and Aboriginal and Torres Strait Islanders were at the greatest risk of dying by suicide.
- Research from the Royal Flying Doctor highlighted a reluctance to seek help, social stigma, distance and cost, and cultural barriers contributing to the unsettling statistics of sufferers in rural and remote areas.
- The report called for greater investment in evidence-based, culturally appropriate, mental health services and suicide prevention and intervention activities for remote and rural Australians
- The research studied a snapshot of 2,567 country Australians flown by air from different parts of country Australia for emergency mental health care by the RFDS from July 2013 to June 2016.
Why we should not use the ‘C word’
In 2013, the Australian Psychological Society published a glossary of terms to help guide sensitive conversation about suicide.
At the top of the list: we should not use words like “commit” anymore.
“Suicide is not a sin and is no longer a crime, so we should stop saying that people ‘commit’ suicide,” The APS wrote.
“We now live in a time when we seek to understand people who experience suicidal ideation, behaviours and attempts, and to treat them with compassion rather than condemn them. Part of this is to use appropriate, non-stigmatising terminology when referring to suicide.”
Support services
BeyondBlue
Mental health professionals are available at the beyondblue Support Service via phone 24/7 on 1300 22 4636 or via online chat (3pm-12am AEST) or email responses (within 24 hours).
Suicide Call Back Service
The Suicide Call Back Service is a 24-hour, nationwide service that provides telephone and online counselling to people 15 years and over who fit one of the following categories: People who are suicidal, people caring for someone who is suicidal, people bereaved by suicide, health professionals supporting people affected by suicide.
The Suicide Call Back Service is especially suited to people who are geographically or emotionally isolated. Contact the 24/7 Helpline on: 1300 659 467.
LifeLine
Lifeline is a national charity providing all Australians experiencing a personal crisis with access to 24 hour crisis support and suicide prevention services. Somewhere in Australia there is a new call to Lifeline every minute. People call Lifeline’s 24 hour crisis line 13 11 14.
Suicide Prevention Australia
Suicide Prevention Australia provides national leadership for the suicide prevention sector in Australia. SPA works collaboratively to develop a community that knows how to ask for help and how to give help.