Rural Kiwis deserve equal access to mental health care

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One issue that keeps popping up on my radar again and again during the election campaign, from farming friends and in this weeks NZHerald  is the strain on mental health faced by our farming communities – and I really want to see our government do something about it.

The suicide rate in farming communities is alarming. 4 suicides confirmed by the coroner in December alone, and at least 14 in the 6 months to date. Plus an unknown amount of struggling farmers who have attempted suicide and/or have had to receive support for depression & other mental health issues. Federated Farmers put out a press release back in October 2014 highlighting the fact that our suicide rates are significantly higher than workplace accidents causing death in the rural sector. And they raise a very good point – much effort and money has been put into health & safety in the workplace by the government, while the state of rural health care continues to fall apart.

Otago and Southland residents (I live in Southland – local perspective) fall under the umbrella of the Southern District Health Board. This area is massive, and predominantly rural. Under population-based funding, we suffer the most, and from recent reports it looks like we will be struggling even more in years to come. Meanwhile, a continuing decline in rural GPs despite efforts to recruit keeps worsening and rural town medical centres continue to be closed down – or communities are being ordered to find their own funding if they want local healthcare – due to two words I really loathe – ‘centralisation’ and ‘efficiencies’.

While some commit suicide without warning, many do show prior signs of needing support, and unfortunately in Otago & Southland at least, news of helpful emergency intervention isn’t rosy. Due to population funding, there is only one SDHB emergency mental health team available to be called out to crises on the weekend – for an enormous area of countryside including Queenstown, Te Anau, Stewart Island, Clinton, Gore, Invercargill, Riverton and more. And if they can’t get to you fast enough, they will advise you to ring the police if you are concerned about someone’s safety or your own. This puts family & friends in a quandary, particularly in rural areas. Nobody wants to call the police on their loved one, especially when news gets around quickly & reputations are vital.

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If farming – particularly dairy farming is the ‘backbone’ of our ‘rock star economy’ – then why is our government not putting more funding and concerted effort into ensuring equal access to health care in rural areas?

Suicides and mental health struggles aren’t limited to the male head of the farm. Rural women and farm workers also suffer, and our stats on rural youth aren’t great either. Isolation isn’t just a feeling when you live rural, it’s also a practical everyday reality.

Recently I spoke with a University of Auckland psychology research fellow who was involved in setting up SPARX – an online CBT (cognitive behavioural therapy) program for youth. They were driven to develop this program due to the lack of accessibility to mental health care for youth, including rural youth, who often face long waits to access treatment – if they disclose or get any help at all. Robust studies have shown an improvement in youth engaging with this program both short & long term, but is our government prepared to commit to researching & implementing programs like this on a long term basis? Right now, funding for research remains a year by year lolly scramble. It takes time for change, and often programs are shut down before they have been given a chance to show meaningful results.

SPARX is a great concept, and I think it’s fantastic, and very much needed. But isn’t it a huge shame on our nation that compared to a young person in a city’s comparatively easy access to assessment and therapy, for many rural youth, their best option is an online faceless app? Yes – of course I realise that there isn’t an endless stream of money, but when you compare the lives of humans who are contributing a lot of that money to the country to the likes of the America’s Cup, golf games with Obama, Sky City, Tiwai smelter ($30million profit in a bailout year??!!) and other chunks of taxpayer funding that are handed out to a few elite humans & businesses who mostly have tonnes of moolah anyway, my mind boggles at the unfairness of it all.

The ‘positivity brigade’, as a friend calls it, particularly the banking industry, have relentlessly maintained that dairy is a sure win. Any feeling of bleakness is unnecessary and temporary and it’ll be fine next year, and some will have been convinced some to get themselves into financial difficulty. I can only imagine, but it must be terrifying to play the tightrope of assets & debt that farmers do. And when the payouts drop as far as they have this year, anxiety must be through the roof. Combine that with isolation, the ‘tough bloke’ image where men must hide any feelings of worry & weakness, and the unavailability of psychiatric assistance, it should not come as a surprise to anyone that farmers are actually doing it bloody tough.

Imagine if we treated mental health exactly the same as physical health. Because it is – our brains are, after all part of our body – and chemicals do go haywire. That’s a medical issue. And if we did, would we be ok with having one ambulance on the weekends from Queenstown southwards? Would we be ok with the nearest district nurse or paramedic being 3-4 hours away like psych teams can be, for a substantial population? I doubt it.

There are two main ways to prevent mental illness from a health perspective that have already been attacked by government and still face a total gutting – preventative health care and local primary access to health professionals. They are always the first up for the chop in ‘finding efficiencies’ yet analysis has shown that both of these factors actually will reduce costs quite substantially. Ambulance at the bottom of the cliff when it’s gone completely out of control stuff is expensive, and relying on that model to be good enough is clearly deadly.

Projects like Resilient Farmers show potential as far as peer & community support go, but health & social services must also be available for professional support. These frontline staff are vital to ensuring any issues get picked up and treated early.

Possible solutions include having nurse practitioners in rural areas, who can do some of the diagnosis, assessment and treatment GP’s normally do. With it seemingly impossible to get GP’s into rural areas, this is a promising alternative, although rural residents will still need to travel some distance to get further specialist treatment. But at least there would be local health professionals who can pick up on issues early, and also be a contact person for concerned loved ones. Another strategy would be DHB’s investing in more mobile health staff, who travel to the patient to do assessments and provide ongoing support, rather than farmers taking a day off to head to the city to meet with strangers in hospitals.

There’s no one fix solution in a country of very different local communities, but there is a lot of research out there on what works overseas, and what our communities believe would be helpful to them. It would be great to see many of these ideas implemented, because our rural suicide rate is truly tragic, and we desperately need to do whatever we can to provide every New Zealander with mental health support when they need it, no matter where they live.

15 COMMENTS

  1. Very good post thank you Rachael.

    I moved to a isolated rural area 10yrs ago 80 kms from the nearest City.

    I am 70 yrs old and settled here fine, as our memories keep us sane.

    I can see the lonely isolation may drive some batty but we keep ourselves busy with social issues, Save the rail, and other environmental issues so we are somewhat detached from being lonely but if I was on my own I may go batty if the sheep wouldn’t talk to me every day.

    This Government does nothing to make life in the rural sector more liveable, as they wont extend any health services to our nearest outpost village of less than 100 18 kms away, nor will it even tar seal our dirt roads which choke us all every day the trucks rumble down our roads.

    National is all about pork barrel policy and considers us sparse communities as irrelevant to their chances of winning an election so we have to accept the case that without a population we stand to be let without any Government support.

      • @ Rachel Goldsmith ; Like Arnold Schwarzenegger … I’m back .
        Please bear with me . I can’t think of a simpler way of putting this without writing a book .

        @ Mick . What Rachel Goldsmith has written is correct .

        Now , to answer your question and equally , what I’m about to write … is correct .

        ” Why do farmers , in the main, vote National ? ”

        Because National are by definition liars . They’re liars , manipulators , swindlers and crooks . Hagers book ‘ Dirty Politics ‘ only just scratched the surface of the cadre of swindlers and thieves that infest NZ’s socio-economic environment .
        Most Farmers vote National because National say they must .
        National has perfected the dark arts of logical fallacies to enamour Farmers with promises and pretty things , wealth generally and on-going security. Farmers , by majority , believe such lies and bullshit because they have no choice . Therefore , when a National Party Voting Farmer votes National they take a huge leap of faith . And those leaps of faith have always ended in disaster for Farmers, as is happening again as I write .
        Perhaps a more interesting question might be ; why does National court the Farmer ? Like you @ Mick, most people ask why do NZ Farmers vote National . The question is never “ Why does National lay claim to the agrarian economy ? The Farmer .

        So , why do you think National spends so much time painting rural NZ so Blue ?

        It can’t be for the voting numbers because according to the New Zealand Department of Statistics there are only fifty three thousand people deriving their income solely from agrarian enterprises . Hardly a powerful pool of votes . You’d think It’d be wiser for National to court the urban lower and middle classes to ensure dominance in Parliament via the democratic processes of those with the most votes win ? But no .

        Again, why does National fawn and wheedle around the Farmer like Gollum around The Ring ?

        Well , the answer is obvious . Ask any Bank-ster . The answer is money .
        From the NZ hinterlands , literally from the blood, sweat, tears and deaths of fellow humans who happen to have chosen farming as a way of life and a source of income are literally dying of exhaustion from working tirelessly to keep ahead of Nationals carefully laid plans of dominance , control and the exploitation of NZ’s Primary Industry that is our Farmers .

        With the help of a cadre of liars and well educated manipulators they’ve managed to pull off that swindle for years and years . And by the looks of things , they’re coming unstuck if there is a God .

        @ Rachel Goldsmith . You ask “ If farming – particularly dairy farming is the ‘backbone’ of our ‘rock star economy’ – then why is our government not putting more funding and concerted effort into ensuring equal access to health care in rural areas? –

        The answer to that question might be because the government doesn’t care to . The last thing The Government wants is for Farming to realise it’s true potential from a healthy and clear thinking rural population . Farming might then start asking uncomfortable questions of the Government. Like , how come our product attracts the highest post – production mark-ups of any manufactured good in NZ and yet Farmer lives are fraught with constant economic uncertainty ? How come the wool board hoards wool to manipulate the prices it gets and gambles on the exchange rates and the farmer sees nothing of those proceeds ? How come our once reliable USA/European customers suddenly gave up on us , forcing us to try and sell our Farmer products to our most deadly competitors , the Australians . ( Hence, a flood of crap Australian cars and cheap Asian shit in exchange for the worlds finest agricultural products )

        From the end of WW 2 our agricultural sector has been in steep societal decline and interstellar debt burdens .

        There’s another question for you @ Mick . Why would a healthy and well intended Government deliver such poisons to it’s most vital foreign income earning sector ? And by that I mean of debt , financial schizophrenia and encouraging the media carte blanche and unchallenged scope to demonise and vilify those same farmers who did nothing much else other than work their tits off for fuck all ? To essentially de-sex our rural infrastructure and proceed to hoard our best young minds and bodies in an average city untidily arranged at the far tip of the North Island as far from those areas that actually earn our foreign exchange as possible ? Can one assume it was to further isolate the Farmer from his / her money ?

        Sure , there were exceptions, like those Good Ol Boy Farmers who realised there was an easier way of earning money from farming than farming itself . All you had to have was have a gift of the gab then all you had to do was reach into those other farmers pockets and help yourselves AFTER you became a politician and learn to launder your swindles politely .

        It’s been my uncomfortable discovery that 99.999% of Urban NZ has no idea about farming , farmers or the vital role Farming plays in the lives of all of us .
        I also discovered the same to be true of Farmers . 99.999% of farmers have no idea how vital they are either .

        Back in 1967/8 my farming father started a direct action farmers union movement with a focus on the relationships between politicians and large urban business . His agenda was to lead a strike . Take all farmers out on a stop work strike . All farmers would have been forced to with hold their labour , stock pile their products as necessary and force the hands of the politicians to come clean and purge Farming of the infestations of vermin like the banks , co-ops and producer boards who were nothing more than mobsters with lawyers and acts of parliament to metaphorically gun down those few dissenters who dared to challenge that culture of greed that has evolved into The National Government .

        And now as you very ably and poignantly point out, suicide is the vile bi-product of those deviant machinations . As is the case in the cities with poverty and a lack of hope . But at least City people have each other and the semblance of culture and connectedness .

        You say there is no one-fix solution .

        Unless Farming unites with its city cousins in the work force there are no solutions and we’re doomed to continue along this dire path .

        I actually see a Farming dystopia of corporate factory farming , of thousands starving and billions being made .
        Oh , wait . That’s now ! That’s Fonterra and West Auckland with the gentle sounds of Bentlys purring softly within the leafy suburbs of Epsom

        The Great New Zealand Institutionalised Lie .

  2. @ Rachel Goldsmith . Ooo . You be careful . You may be picking at the very stitches that hold the fraying sack of lies together that is the parasitic relationship that National has with Farmers . When NZ Farmers come together to protect themselves and realise just how exploited and swindled they are , and have been ? There will be carnage . Both literal and metaphorical .
    I have to be truthful and say that I have yet to read your Post but I’m hugely excited that you seem to care and have broached the subject of Farmer mental health .
    I can’t wait to have the time to read and duly comment . x

  3. It is understandable – the drive to produce more to meet high mortgage payments in the face of increasing extreme weather events. Less intensive farming does not mean a drop in net returns but makes for less stress, improved health of the farmer, his family and the environment.

  4. Thanks for putting the reality of the isolated rural life out there Rachael.
    Fact is you can’t get the level 4 mental health cert training needed to to enter this area of employment in Northland. I know I have tried even when I lived in Whangarei it wasn’t offered by Northtec. We are very lucky in the Far North to have the standard of services offered in Kaitaia. All this due to lobbying by Grey Power , the District Council, the medical personnel already employed up here and Maori health organizations as well as the Ruananga. Lange’s government were going to close everything down up here. We are 165kms from Whangarei.! FFS! The population continues to grow and is scattered over a huge area as well as many being inaccessible areas due to flooding. The chopper services are always working up here. We are lucky to have the power of a slightly larger population base than rural Southland and Otago. I do not envy you.

  5. While I like the idea of improved mental health services I would avoid stating that mental health is synonymous with physical health. Such a view point is often based on unproven theories that are often used to promote medications and coerce patients in to unhelpful treatment. I’ve seen many people forced into taking dangerous medications based on some vague idea of a neurotransmitter imbalance

    • I agree the ‘chemicals go haywire’ notion is simplistic and ignores familial, cultural, social factors. But it pretty much defines the health system’s biochemical approach to mental health. And there is a valid argument that resourcing should thus match that of physical health.
      It’s a tricky one because it’s also important not to silo physical and mental health, and that’s what Western medicine has done. The physical health problems of people with mental illness have been neglected.
      And then there’s my condition, which requires physical and psychological treatment delivered in a coordinated pathway, and the only place that is available is Auckland, as far as I know.
      We have a long way to go.

  6. One final thing …

    My farming father came unstuck with his Farmers Union movement because he was targeted by government spooks who buried him under a mountain of MSM generated logical fallacies . Sound familiar ?

  7. The positivity brigade creeps me out too and its the usual suspects, Chief Bank Economists, doing National a favour with a payback if you like. Their cheerleading belies the reality for most that things aren’t as good as the claim although the banks and their shareholders are creaming it deluxe, thanks to National and all the record amounts debt they are encouraging. Moreover these “economists” are destroying their credibility and that of their positions with such questionable propaganda and that massive conflict of interest they and their banks have.

    There is something very wrong that in this “Rockstar” economy of “Boom times” and “Pure economic growth” that there are people killing themselves or in such despair in farming.

    The bullshit piles high under this government but the cold reality is sometimes hard to contain.

  8. So FF want the same standard of mental health services as the rest of the country do they? In other words they want the same substandard underfunded service as the rest of us. I thought they would have wanted better than that for their members. Do they have any idea of how bad mental health services are in this country?

  9. It’s not only mental health issues either. When my 10 year old needed an ambulance it took over 45 minutes to get here, to travel just 18km. The austerity measures you hear about in Europe and America are in place here, our government is just covert about their spending cuts and doesn’t have the decency to announce it to us.

  10. There’s nothing new in farmers ‘going to the wall’ – yet, can’t we do better this century? It’s too late when the red ink is dripping from the bank statements. Put in the safety nets before the high-wire acts begin.

    Federated Farmers providing a lot more financial and social support. And taking on the heartless might of the banking regime. Protecting its members. Being able to get funding as a collective at better rates than for an individual, thus reducing the threat and pressure. Spread the risk wider.

    Perhaps, farm advisers who have some sort of ‘social training’ to guide small groups to open up and work through issues. Getting people to develop local practical options for following up.

    Hold meetings at the local school or high school, after work. Not the pub. Not with all those expectations of ‘staunch’ and ‘tough it out’ and other BS.

    Training in the local high schools – about business and foresight and community and altruism. For college-age kids – and night classes for the older people. It just might help the kids on the sidelines, too.

    Developing off farm opportunities for additional income streams. Dealing with the urban-based ‘health and safety’ by laws that stifle more than they protect. Developing strong and effective advocacy skills and knowhow.

    Some of these measures may already be in place in some form but clearly much more is needed. It shouldn’t matter a jot if ‘these blokes are rolling in it’; they’re workers in about the same grim conditions as a care-provider and ‘we just come to work here; we don’t come to die’ applies to them, too.

    Might be worth a lot of chats with the local women – including teachers. Plus tapping in to the intra-net system to tune in and then influence with integrity.

    Go for it.

    Structural changes and attitudinal changes are required now for the greater good of all in the rural sectors.

  11. People living outside the main centres miss out on lots of assistance with chronic health problems. This became obvious when my husband was diagnosed with Parkinsons. Medical services are very good in Fiordland and emergencies are dealt with very well but assistance with ongoing everyday problems in living with a handicap such as this, is not available. I refer to things like personal care assistance, physiotherapy help for the sufferer etc. Many services which can be accessed at a base hospital must be paid for or while you can access the hospital based services you have a hefty fuel bill to get there.

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