In the last couple of days I have heard numbers of reports of the drought starting to impact the mental health of farming people… the tough times have commenced… and some have already taken their own life…. time for rural mental health workers to ready themselves to help…… here is a resource that is useful aimed at supporting rural men with their mental health – pass it around…. share. I will continue to load more info as I locate it for circulation to promote rural mental health in drought times…..
Received an advance copy of my new book today – smells new, looks shiny….. so pleased with the result and very chuffed to have worked with other mental health experts on this book – Nicholas Proctor, Helen Hamer, Denise McGarry, (Me), and Terry Froggatt. Available to the Public from January 2014. Link for more details direct from publishers – Cambridge University Press.
Depression, drought & mental health help. Bush Remedies – You and your mental health.
Here is the last in the Bush Remedies : You and Your Mental Health ABC New England North West Radio series for 2013. This year I have presented six mental health topics in Bush Remedies – all with a focus on rural people and place. This last one for the year features a discussion about drought and depression. I hope there are some useful tips as we approach summer in Australia for my fellow rural people.
Times are changing again in northern NSW with the shades of brown closing in on us and drought looming….
The health of the land and the climate has a big impact on the mental health of the people who live in rural drought zones. The changes in mental health can be slow and insidious. Mental health doesn’t usually just ‘snap’ or ‘break’ like a football broken leg injury, it happens slowly the same way that wrinkles and grey hair develop…. One day you notice that you have aged… but you don’t notice it every day. It is the accumulations of grey hairs over a long period of time…. And mental illness is a bit like that – especially depression. But in our rural case…. It is the slow shift from green pastures to brown bare ground that is reminiscent of depression. Mood, thoughts and senses all seem to slowly lose their flexibility and capacity for resilience.
It is not surprising that mental health is less robust in times of drought, and its impact is felt widely across the region. Drought is a chronic natural disaster… is slowly builds to a point where the impact is profound, and we know that people are vulnerable to those chronic changes – it is just plain human. Depression is not a weakness of character. Rather there are very clear explanations for why it should develop in the face of major decline of the health of the total environment, of which people are a part.
An interesting research study was done in Western Australia where there are some salinity problems. Salinity creeping to agricultural lands has devastating impacts for people, place and livelihoods, and it is very hard to turn back that clock… if at all. In this case, researchers compared maps of the land and salinity with population data and data about how many people in that region were discharged from hospital after treatment for depression. They found that there were significant increases in people requiring hospital treatment for depression who came from the salinity affected areas compared with the wider population. Drought might have similar impacts… those studies still need to be done, but there are lessons we can learn from the salinity impacts in Western Australia. (Here is the reference if you want to find out more – sorry there will be a pay wall for that one: Speldewinde, P. C., Cook, A., Davies, P., & Weinstein, P. (2009). A relationship between environmnetal degradation and mental health in rural Western Australia. Health & Place, 15, 880-887. )
So, Drought proofing our mental health…what can be done?
We can predict that depression will accompany drought – and will last slightly longer then the drought. Recovery takes time… for the land and for minds and emotions.
We know it is coming, so it makes good sense to make some plans to drought proof and depression proof at the same time. Perhaps we can’t take away all of the pain, but we might be able to minimize it, and reduce the impact by getting in early. Here are some tips:
- Mental health first aid – learn the basics about mental health and what to do if someone you know needs some mental health help in a crisis, and how to get them to expert help if and when it is needed.
- Consider doing a mental health first aid course – either you, or someone in your workplace or community…just the same way people do for physical first aid. Make sure there are enough people around in your rural community who have done mental health first aid so that someone knows how to get expert mental health help if and when it is needed.
- Look for opportunities to find the glass half full – not everything is bad all the time, but when your mood is low, it is harder to see the good, because the bad just seems to close in. Fight for that little glimmer of hope – don’t let go.
- Actively seek at least one thing that is deeply satisfying everyday-it can be something simple and that doesn’t cost money… there will be one thing! If you can’t find one thing every day – that is an urgent sign to see a health professional and get some help with your mental health. Don’t put off that appointment.
- Rural people sometimes equate being healthy with being able to work, so when they feel a bit low they counter that with trying to work harder (because if you can work hard, you prove to yourself that you are well). But it is a trap we rural people set up for ourselves…. If you struggle to be motivated, can’t remember the last time you felt happiness, not sleeping, and grumpy with the people you love the most…. Then working harder won’t fix it – BUT a visit with a mental health clinician might!
- Don’t work too hard. If you have put in a full day, then you have done your best. Be satisfied with your effort, rather than damming that you couldn’t do more. Drought is an endurance race…. The work that goes with it will be like a marathon – but tackle it one leg at a time. Don’t try to race to the finish line without stopping to catch your breath and recharge your emotional batteries. Take a day off – or a half day off if you need to. Look after your mind, so IT can look after you longer!
- Sleep – you need about eight hours a night…. Try and get yourself into a healthy sleeping routine. (See a blog or two ago for more about this!)
- Eat and drink well – that means not too much alcohol (it is a depressant drug itself – so don’t double dip into depression), plenty of water, fresh foods – not too much processed food. And, then eat slowly and mindfully – enjoy every mouthful, give it a moment longer in your mouth to relish flavor and be mentally and nutritionally satisfied.
- Talk… talk to others about how they are travelling… it might be that others are feeling the same way you are, ‘a problem shared is a problem halved….’ Bottling up emotions doesn’t work well – and eventually it explodes (like homemade gingerbeer… messy!).
- If you are not travelling too well – see a mental health worker sooner rather than later… there are no prizes for being stoic. It just doesn’t work!
If you do need some help – this is where to look:
- Local hospital (accident and emergency – if it is urgent), community health service or multipurpose health facility will know how to get you linked up with some help.
- Local GP – again, they will know where to point you in the right direction.
- NSW Health have a 24 hour Mental Health Line 1800001511 (free from landline – charges from a mobile). Call them anytime and speak with a mental health clinician. Calling this number it is the best way to access public free mental health care. You can call for yourself, to get information for a friend, or even ask them to do a welfare check if you are worried about someone else (eg you are worried about whether they might be thinking about suicide).
- There are a range of non government organizations – I have listed a few of them in previous blog posts…. Scroll back through some blogs.
- NSW Department of Primary Industries have The Rural Womens Network http://www.dpi.nsw.gov.au/rwn/support
- NSW Rural Assistance Authority have some practical supports that are worth checking out – some of which include rural financial counselors. Here are some handy links to them:
We can’t stop the drought – but we can take the steps needed early to make sure that the impact on our mental health is reduced. The more aware rural people are of the early warning signs the earlier mental health help can be started, the better. The sooner help starts the less the impact. If it is left a long time before getting help – the harder it is to shift; and the longer the recovery. Depression proof – get in early!
Some first signs that depression is developing:
- Talking about dying, wanting to die, or musing that it would be better off if you/they were dead
- Changes in eating- no appetite, or craving for processed and oil saturated foods
- Drinking more alcohol than usual; drinking to get to sleep at night
- Not sleeping restfully throughout the night; finding it hard to get up in the morning.
- Anxious- an little more on edge then usual.
- Finding it hard to concentrate.
- Can’t recall being happy in recent times.
- Low flat mood, without any modulations. Just low all the time, never seem to have moments of joy.
- Grumpy with others; angry, a short fuse.
Any, some, or all of these feelings (above) are worth further investigation. Make an appointment to see a health professional to get back on track with your mental health. A health professional will be able to make a plan with you for your recovery; it mightn’t be a big deal, it mightn’t take too much effort (especially if you get in early) and it might just be worth the awkward moments of reaching beyond any stigma or small town talk to get back to emotionally-normal-for-you as soon as you can. That way you will be better positioned to cope and you’ll be more resilience to the blows that accompany riding thorough drought times.
Out West for the weekend….. about 4 hours west of where I live in Northern NSW, Australia.
I have just completed some research in the same region about the emergent mental health problems of young rural people… I was looking forward to the drive, as an opportunity to reflect on the full cycle of the research project. I have been bunkered down in my office writing up the research report, so an opportunity to reconnect with the breath of the study region was especially appealing. But, what I saw, made me think more….. about how much mental health prevention, promotion and recovery supports are needed in drought affected rural communities.
It occurred to me that the colour of depression is brown…shades of brown. And the insidious slow slide from green to brown is exactly what happens to the collective mood as well. A heaviness sets in that is hard to shake off… perhaps the ‘black dog’ in the bush is actually a ‘brown cattle dog’…
In good times – things look good, and feel good and then slowly, very slowly the shades of brown start to set in, and the creep of the dry brown continues on the land, and in the mind.
Watching the stock trying to find a blade of grass, wandering in search of something to eat is a sad creeping feeling…. and that same creep surges into the small towns and villages on the farming fringes. The shades of brown; the moods of brown seep into the main streets, and downturns in the retail and hospitality sector appear obvious… the $2 shops thrive with mountains of plastic crates for sale,and the boutique stores fade away, some to empty shops and dilapidated signs. The bubbling social hubs of clubs and pubs where ‘everyone’ gathers starts to lose some pizzazz…. and the towns start to look sad…. it is hard, very hard.
I couldn’t help but notice in one town that the only thriving sector seemed to be the great big and polished-looking police station, with lots of police… and that made me think too…
I saw a proliferation of smashed windows, boarded up buildings, wire mesh over windows and doors, more prominent then before…. the broken window phenomenon escalating…. community hope and well-being in downward spiral… I suspect.
Drought has set in, a few rain showers here and there are just not enough….the landscape was looking dry, the only green was found in the prolific thorn bush… not good for anything. We spotted a paddock full of nothing but thistle…. the Plains were sparse; some of the stock thin, and plenty of road-kill kangaroo along the way.
A few reflections that put my research back in to perspective for me… the need to advocate for sufficient mental health care for rural people is crucial….
When the stock needs to be grazed in the ‘long paddock‘ and drovers watch and live with their stock on the roadsides to take advantage of the remnants of vegetation on the road side verges….it is a sign that times are tough. The difficulties seep through all layers of rural society. And when it does, that is when local communities need their local nurses…. to take the time to listen, to pay attention to the burdens of the shades of brown, to care… to monitor mental health of the local people, to intervene in time to make a difference…
I am cheering on the rural nurses from Out West… they are important social capital in rural communities…. they have a big job ahead I suspect…
Plain packets for fast food
What if we decided that fast food should be plain packaged with graphic health warnings like cigarette package now is in Australia? A Fast Food Plain Packaging Act?
Some of the reasons we now force the plain packaging of cigarettes:
- to make them less attractive to adults and children
- to ensure that advertising is not misleading and that there is no confusion about the health implications for consumers
- to provide health warning on the packaging
- to amplify the health warnings
Exactly the same messages could be echoed for fast food. I am thinking of especially the large companies who mass produce fast foods…. you know who they are…. they are dominated by bright attractive colours in their ‘restaurants’, and on their packaging…they include ‘nutritional facts’ on their labels (that you need a magnifying glass to read). They have cheap options to lure the cash poor….and they have meal deals and family meal deals which include fizzy sugary drinks to the mostly fried mix!
It is not rocket science – this stuff…hard to refer to it as food! This stuff is really, really bad for people to consume. It directly causes BAD health. There is a clear and obvious cause and effect….. if you eat a lot of fast food + sugary drinks you will get fat, have cardiac disease, diabetes, diminished mental health… the list goes on…. other blog posts of mine have discussed food security and the excess of poor quality food…
Fast food is addictive – our brains crave the saturated and transfats, and the more we have…the more we crave. It is fact.
Can we provide conditions that change the environment, help our brains and the brains of our children and young people to be less attracted to fast food? Would plain packaging and plain signage restrictions make a difference? I.m not sure that the evidence is out there to say it would help…. but in terms of health, I can’t see that it would do any harm to try!
Here is some more food for thought … a compilation of conversations that made me think more about this issue over the last few days…
Could this map explain in part world obesity….The global obesity crisis. A few big companies that produce of lot of processed foods high in fats and sugars? What would happen if we stopped buying this stuff? Would it matter to health? and how would that shape society? What items should/could be plain packaged? Are there incentives that could be in place to promote fun and enticing packaging of low processed foods?
I watched ABC TV show Four Corners … Supersizing India’s kids the other night…. As a health professional, I found it profoundly disturbing on so many levels…. watch for yourself! Kid’s obese… vulnerable…. surgery (and the health industry) exploiting them with expensive and invasive interventions (gastric bands and worse), without using other less invasive interventions first. Kid’s undergoing major gastric surgery… that can only end badly. Where are the nurses??? Why are they not taking some leadership in promoting health, reducing poor health….. ???? Why are they not advocating for safe health promotion and interventions for these kids…. ??? (AND – a big thumbs down to the surgeon who slapped the abdomen of a child while he was under anesthetic…. BIG thumbs down. Where was the nurse then????)
closer to home…
Kind of in my back yard…. a few blocks from where I live, an 18 year old young woman died from obesity in the last year. Devastating… so sad. So preventable… but help was needed. A few blocks from were I live major fast food ‘restaurants’ thrive… cars cue to ‘drive through’… so sad. The smell of the oils bubbling away saturate the air to those who walk by… enticing the brains of young people with their neurochemical lures… Here in rural Australia, where we grow fresh food, produce it for the nation and the world, where idyllically healthy living can be had in bucket loads…. we have our own fast food crisis. Where are the nurses? …advocating for health?
it all makes me think….
What can be done… to reduce the fast food led health demise in my town, in my country… in my world?
Perhaps every little bit might help and is worth trying…. why not plain packaging for fast food ? I am a nurse – it is in my professional DNA to advocate for health, especially for vulnerable people such as kids and young people, who sometimes can’t yet do that for themselves. I live in rural Australia…. it sharpens my mind to the needs of rural young people…. and to also advocate for their health.
We need fitter bodies and sharper minds in rural communities – we need less enticement to consume fast food which reduces physical and mental health. I say – Keep the packaging plain. Add health warnings to the packages, and include photos of horrendous consequences of prolonged consumption. Just like we do for cigarettes – see what happens…
Too controversial? or, on the money? Debate welcome!
The latest in my Bush Remedies ABC radio (ABC New England North West NSW, Australia) series about Rural Mental Health goes to air tomorrow morning on the Morning Show with presenter Kelly Fuller (about 0930 live on air) but- you can hear the podcast here sometime tomorrow afternoon…and listen at your leisure.
This time we are talking about how social media can support rural mental health, and in the spirit of rural innovation and modern social media, I thought I would integrate it all throughout a number of social media platforms to demonstrate how useful social media can be in the future as we work towards using e-mental health strategies more to positively promote mental health and well-being and encourage recovery… Below are some of the topics discussed in the radio podcast link above… As I hit the ‘publish’ button for this blog – it will also feed into my facebook page Rural Mental Health Nurse and to my Twitter feed – @RhondaWilsonMHN and also to my Linkedin social media newsfeed…. and travel well beyond my immediate small scope of ‘friends and followers’ towards a wider and unknown audience. In doing this – I am practicing what I preach…that is being a rural mental health nurse dedicated to promoting mental health well-being and recovery and building a community conversation about rural mental health…. hopefully my little bit contributes usefully to rural communities and rural people 🙂
I also encourage rural people to give social media a go and see if it is useful… it does reduce the travel miles when it comes to finding help, and there are some very good mental health resources on line.
So – here it is:
The iPhone has a lot to answer for – it has changed our world! And for the better when it comes to promoting mental health. Even it’s predecessors of regular old mobile phones have the capacity to do more for the health of the world than anything else ever has before! Bold claim… perhaps – but mobile phones and smart phones have the capacity to put a life saving mental health intervention in the pockets of most people in the world….The potential to save more lives than penicillin.
Mental health distress can be fatal – it is called suicide…. it is preventable. The burden of mental-ill health is fast looming as the next biggest cause of world-wide health burden. By 2020 health researchers predict depression will be the biggest health problem in the world. Depression is a risk factor for suicide. Suicide rates are higher in rural communities.
Mobile phones and smart phones may hold some hope in helping to reduce the impacts of mental-ill health & depression.
Why? How? Because they have the capacity to link people with other people to communicate anywhere, anytime – at the moment and instance of greatest risk, vulnerability and need. There is a hint of protection in that – and that level of protection can be worked in to safety plans for individuals….
Mental health services and clinicians can talk directly to clients; can set up scheduled messages or texts to promote mental health to vulnerable people. People can access facebook, twitter and other apps, and websites to enhance their mental health and even participate in therapy (eg Cognitive Behavioural Therapy) using app downloads. The convenience and privacy of social media and mobile phone mental health promotion is extremely appealing to many people, and it is located a time and place that suit the individual person. So much good is at hand!
What it isn’t.… social media and mobile/ smart phones are not a substitute for face to face mental health clinical help and services – but they are (increasingly) an adjunct to it.
Twitter, facebook and texting are fast becoming the ONLY way to communicate…. so it is important that mental health professionals keep up with the favoured communication pathways for people (and especially young people) and learn how to use social media to clinical effect – the world is changing! Our clients will expect us to change with it!
Twitter and Facebook are popular social media platforms – both have a great deal of positive mental health traffic – which rural people can tap into to build strength, resilience and protection in regard to being mentally healthy and encouraging others to do the same.
Social media and mental health
Nurses are already active in Twitter as mental health advocates for community mental health promotion, and as mental health communicators in both public and nursing conversations in the twitter environment. eg @jamieranse @meta4RN @ACMHN @Patbradley @hollynortham @thenursepath the list could go on and on… you can see many nurses who follow me – or I follow on my Twitter feed if you want to follow some! I am not promoting any particular nurse really – just the nursing conversation that is out there and happening in the public arena for anyone else to see and follow… (Obviously I follow a lot of nurses and vice verse – because I am pretty passionate about nursing generally – so my feeds are full of nursing talk!) The point is that nurses are some of the leaders in advocating for health and well-being across the social media platforms, and leading the way in many cases, a shift in health conversation and advocacy is in swing.
The use of mobile phones with the ability to connect to the internet (smart phones) is expanding rapidly – 75% of the developed world population has a smart phone.
We now use the internet across an increasing range of mobile devices including smart phones, tablets, and laptop computers we have the internet in own pockets, handbags, wherever we go…. On our lounge chairs when we watch TV, and on our bedside tables at night. Many people are never far away from the internet…. There are some down sides of this, but like all things it is a case of getting the balance right in life. There is a lot of good being spread in cyberspace as well – and especially in regard to promoting mental health.
In Australia there are about 12.2 million internet service provider subscriptions and half of those are wireless, while three quarters are household subscriptions (Australian Bureau of Statistics., 2013).
In Australia, there are 17.4 million smart phone subscriptions & a continuing rapid upward rise in this trend (Australian Bureau of Statistics., 2013). A specific shift in digital communication occurred around 2004 with the development of web 2.0, and a further shift towards social media utilisation with the advent of mobile web technology (such as the iPhone) in 2007!
Applications (apps) are readily available for all of these devices.
In Australia, Facebook is used for social networking with 11.5 million Australian users.
Half of Facebook users log on at least daily.
The flexibility of social media participation is entirely at the convenience and control of the user.
Four out of five professionals now use some form of social media and further adoption of this communication style is inevitable.
Social media represents the beginnings of a new era of communication and offers a platform from which health interventions and health communication can develop in the future
There are new potentials for e-health practice which have already commenced and will further develop in the future.
For example, the Suicide Call Back Service (@SuicideCallBack) is a free counseling service for people thinking about suicide or bereaved by suicide.
Many mental health organizations for people what mental health problems, people who care about someone else’s mental health, and have a facebook presence. I counted up how many I like ( I may be a biased example!!) = 23 +….. But once they are ‘liked’ you receive plenty of positive mental health updates in a newsfeed – every day. Sometimes I share them with my friends or various other facebook groups that I am part of…. It all builds the mental health conversation….. I would encourage everyone using facebook to ‘like’ at least one mental health promotion page…..
Here is some of my ‘like’ list:
· Walking feat – Sarah Mcfarlane-Eagle – advocate mental health awareness local champion. www.facebook.com/WalkingFeat
· Mental health council of Australia www.facebook.com/TheMHCA
· Suicide prevention Australia www.facebook.com/SuicidePreventionAustralia
· Mental Health Association NSW www.facebook.com/mentalhealthnsw
· RUOK day www.facebook.com/ruokday
· Children of Parents with Mental Illness www.facebook.com/COPMIorg
· Reachout.com Australia www.facebook.com/ReachOutAUS
· Mental Health Awareness Australia www.facebook.com/pages/Mental-Health-Awareness-Australia
· Single Mothers Who Have Children with Autism www.facebook.com/singlemotherswhohavechildrenwithautism
· Lifeline www.facebook.com/LifelineAustralia
· Anxiety on line www.facebook.com/AnxietyOnline
· Suicide call back service www.facebook.com/suicidecallbackservice (The Twitter presence of this service provides a convenient access to counseling and health promotion commencing in the social media environment as well).
· Carly Fleischmann www.facebook.com/carlysvoice
· Headspace www.facebook.com/headspaceAustralia
· E-hub self-help for mental health and well-being www.facebook.com/ehub.selfhelp
· Schizophrenia Fellowship of NSW www.facebook.com/SFNSW
· Rural Mental Health Australia www.facebook.com/RuralMH
And some more mental health professional pages that I ‘like’:
· International Journal of Mental Health Nursing www.facebook.com/pages/International-Journal-of-Mental-Health-Nursing
· Australian College of Mental Health Nurses www.facebook.com/AustCollMHNs
· National Drugs Sector Information Service www.facebook.com/NDSIS
· AFFIRM Australian Foundation for Mental Health Research www.facebook.com/pages/AFFIRM-The-Australian-Foundation-for-Mental-Health-Research
· Mental health foundation of Ghana www.facebook.com/MentalHealthFoundationGhana
· World Federation for Mental Health www.facebook.com/WFMH1
There is a robust facebook mental health promotion conversation to tap into where ever you live (as long as you have internet!)
Social media is here now; it will continue to evolve – need to make good use of this iteration of social media to positively influence the health and well-being of individuals and communities.
The general nature of social media has expanded to include professional conversations and while social media has a number of limitations, it also represents extraordinary capacity to do some good, especially in regard to the development of timely clinical conversations and the development of professional networks.
By using these #mentalhealth #rural –you will find there is a frequent stream of information – positive mental health conversations, links to information about specific issues, and some of the tweeters are mental health professionals.
Twitter is convenient because you can follow anyone you want to…. and the conversations are brief (just 140 characters) so you don’t get overwhelmed by long wordy blogs…. (like this!) Messages are straight to the point – nice and time efficient!. Tweeters tend to link to further information that is of interest – so if the tweet sparks your interest you can follow-up and go on to view any links.
Navigate Twitter by following people or organisations with a @ symbol, and by following # themes. Both ways will help you to build a community of interest about topics. I use #RuralMH #Rural #Mentalhealth #nurses #youngpeople #youth mostly in my tweets – because I Tweet mostly about those topics! I will be tweeting next week from the International National Conference for Australian College of Mental Health Nurses using #ACMHN2013 – you may want to follow on the hashtag and see what are the latest developments in mental health nursing…..!
Some Twitter mental health handles to follow:
E-self-help mental health
There have been significant developments in e-mental health, and especially with self-help e-mental health interventions such as cognitive behavioural therapy, many of which have been developed in Australia. Beacon at the Australian National University (ANU) host a controlled data base which contains about 62 web-based and 11 mobile applications for mental health and physical health self-help interventions listed on an open access website which addressed mood and anxiety disorders.
Most are designed for adults and were based on cognitive behavioural therapy principles. One third of the interventions have been evaluated by at least one randomised control trial, which shows some promise for the developing body of evidence emerging around the use of e-mental health in the future, however more research needs to be done in the future to understand the effectiveness and implications for e-mental health delivery to rural young people
Here are some examples of places to start to search for quality and reliable (evidence-based) mental health help and self-help therapy.
e-mental health will be here for the long haul…. It has the capacity to do a great deal of good. But it is not a substitute for local face to face mental health services or emergency service when they are needed. E-mental health is a companion to quality local mental health services, and in combination, there is promise for the mental health of rural communities.
Police and mental health clinicians co-located
This is such a good idea. Following my recent research about the emergent mental health problems of young rural people, and based on my finding too – I agree that this is an important way forward for rural communities.
Mental health nurses should be co located in police stations to improve the care of young rural people with acute mental health problems, and who as a result, become involved with the police.
Nurses are great at listening, caring and finding ways forward to improve the well-being of others – co-location with police who come into contact with young people with mental health problems is a far better way forward.
Congratulations to ACT police for piloting there program. Wishing them great success for the long haul!
Sending the challenge out to rural and regional police commands in all rural and regional centres to find a way to replicate the concept in their centres and stations!
This link takes you to a brief media review of the Canberra police program – watch it for inspiration!
Here are some facts about mental health and policing/justice….. (extracted from my almost completed PhD thesis…)
- The NSW Law Reform Commission undertook a general review of criminal law and procedures that are applied to people with cognitive and mental health impairment in NSW, and they reported that in NSW of all the young people (less than 18 years of age) detained in custody in NSW, 87% have at least one mental health problem and 73% have two or more mental health diagnoses (New South Wales Law Reform Commission., 2012).
- Young people with mental illness are over-represented in the criminal justice system compared with the wider population, where 22% of the general population have a diagnosable mental health problem and with the total prisoner population in NSW experiencing mental health problems at a rate triple that of the general population (New South Wales Law Reform Commission., 2012).
….The stated goals of policing and justice are diversionary wherever it is possible, however that requires sophisticated referral mechanisms between justice, social and health services, and these services are not always available or accessible, especially in rural regions, and so young people are not always able to engage with diversion options, and therefore are detained in custody, either because no other option is available to them, or because they have a history of offending (New South Wales Law Reform Commission., 2012).
- The average age for a young person with a mental health problem to be remanded in custody for the first time is 18 years of age and on average they will have had 15 police events recorded by that time, with a first police event occurring at an age of between 12-14 years likely; coincidentally an age where onset of mental illness is also noted (Kessler, et al., 2005; New South Wales Health., 2012; New South Wales Law Reform Commission., 2012).
It is difficult for non-mental health professionals to identify emerging mental health problems, and this is especially challenging in the context of the criminal justice system, however a mental health assessment service is available to some offenders who are fortunate enough to be dealt with by Statewide Community and Court Liaison Court Locations (CCCLS), however only 20 of these locations exist in NSW, with the service not available to the remaining 128 local court locations (New South Wales Law Reform Commission., 2012). The disparity of this service provision has been recognised by the Law Reform Commission and it has recommended an expansion of this program to all 148 local court locations (New South Wales Law Reform Commission., 2012).
- Police have powers to detain a person who they believe to be mentally ill or mentally disturbed, under the Mental Health Act 2007 (NSW), and police can formally request that the person be admitted to a involuntary mental health facility. This mode of request for admission makes up 23% of all police requests for admissions to mental health facilities, however 26% of police requests do not meet medical criteria for involuntary admission to a mental health unit (New South Wales Law Reform Commission., 2012).
- This leaves a substantial number of people who may have a mental health problem, but do not meet extreme criteria for involuntary treatment in a compromised position of not being able to access mental health help when it is needed, and at risk of reoffending and further complicating their offending track record (New South Wales Law Reform Commission., 2012).
- Collaboration between State governed Police, Health & Ambulance services in regard to supporting people with a mental health problem to access appropriate care is ideal and fits neatly with the ideals of ‘no wrong door’ to seek mental health help which are aspired to by State & National Mental Health Commissions.
- There are significant limitations within clinical decision making capabilities which need to be considered. In particular, no clinical risk assessment tools exist with adequate specificity, sensitivity and accuracy to predict harm to self or others (for example violence) by people affected by mental health disorder or illness (Ryan, Nielssen, Paton, & Large, 2010). It is not possible to accurately conclude that current clinical assessment of risk investigations will be sensitive enough to predict which clients will need higher levels of resource-heavy interventions and restrictive care, which people will require fewer and less expensive clinical resources and less restrictive care to achieve safety outcomes (Ryan, et al., 2010).
- Ryan et al (2010) reviewed the efficacy of the most commonly used risk assessment instrument, that is, the Macarthur Violence Risk Assessment, which is regarded widely as a valid for use in the prediction of violence amongst people who are acutely mentally ill (Monahan, Steadman, & Robbins, 2005). Ryan et al (2010) re-examined the data in the original study and found that the level of sensitively for accurate prediction was ambiguous and that it had very poor sensitivity in regard to accurately detecting risk related to future violence. In fact, the sensitivity of the instrument produced 9% incidence of false-negative cases, where people were categorised as being low-risk and went on to commit violent acts to themselves or others in the 20 weeks immediately following the assessment (Ryan, et al., 2010). Thus, 9% mentally ill people considered to be ‘low-risk for harm to self or others and in fact ‘high-risk’, and these people will slip through gaps in service streams of all types despite having been provided with a clinical mental health risk assessment, because to current instruments available are not sufficiently accurate to detect risk, yet they are in common use despite this paradox (Ryan, et al., 2010).
- Health services are adverse to risk events and wish to be seen to be doing everything popularly possible to reduce risk of harm to people. However Ryan et al (2010) have been able to demonstrate that based on the fidelity of the most common risk assessment tool, and the incidence of annual homicide rates by people with schizophrenia of 1 in 10,000, and if the risk assessment was conducted on every person with schizophrenia that annually 4117 people would be detained for up to a year in mental health bed-based facilities because they would achieve a ‘high-risk’ category, in order to prevent one person committing a homicide (Ryan, et al., 2010).
- However, of those people assessed as low-risk, 1 in every 22,421 people would in fact go on to commit homicide (Ryan, et al., 2010). The health resources and cost absorbed by keeping false-negative cases in hospital detract from the finance and recourse available to provide care to the low-risk cases, and some of the low-risk cases require high levels of care (Ryan, et al., 2010).
- The dispersal of health resources could be better allocated across a broader mental health agenda, and support the mental health of more people if the use of clinical risk assessment was abandoned as having any role in the clinical decision making process (Ryan, et al., 2010).
Given the frequency with which young people with mental illness are involved in justice and policing matters, and with a lack of accuracy and sensitivity in detecting risk related to acute mental ill-health, it is evident that the challenges in regard to helping young people with mental health problems and who are violent, and who do not wish to participate in mental health care, have little support available to them, and this circumstance perpetuates the problem of high number of young people with mental health problems in custody in Australia.
More research is needed to better understand how young people with emerging mental health problems can be helped earlier so that fewer young people are subject to custody arrangements related to their mental health state.
I am presenting this poster at the 39th International Conference of Australian Mental Health Nurses,
Pan Pacific Hotel, Perth, Australia
…you can follow along on Twitter at #ACMHN2013
A CONVERSATION TO BUILD MENTAL HEALTH RURAL RECOVERY IN A CHURCH SETTING: A STORY ABOUT A PATCHWORK QUILT, A YOUNG PERSON & A MENTAL HEALTH NURSE
Rhonda L. Wilson, RN BNSc MNurs(Hons) PhD candidate, School of Health, University of New England, Armidale NSW Australia
Introduction Mental health nurses in collaboration with churches can contribute positively to the mental health of communities.
This project shows how mental health nurses who already established in their dual roles as church member & mental health nurse, can contribute in a unique way to the mental health of individuals within their usual church setting. Social capital within churches can be harnessed to promote mental health helping within smaller groups & to reduce the stigma & isolation often experienced by people and families with mental health problems.
While a young woman was in hospital receiving acute mental health treatment over a period of weeks, a group of 16 church people produced a patch work quilt to give to the young member of their church who had experienced an acute episode of mental distress. The project was jointly led by a mental health nurse & an expert patchwork quilt maker. This collaboration capitalized on the skills within the small group, & combined them in such a way as to develop a unique avenue of support to the young woman quilt recipient. Church community members were enthusiastically engaged with the quilt making process because it offered them an opportunity to come together & learn more about mental illness while expressing their concern & care towards the young woman experiencing the episode of mental health distress. The quilt recipient was able to be engaged in the community without the adverse impacts of stigma or awkwardness. Together, this promoted acceptance in both directions and enhanced mental health recovery potential and shared community.
- Provide a safe recovery environment for the young woman & to prepare the church community as a safe, stigma-free & supportive place to assist recovery.
- Convey care, comfort & support
- Raise mental health awareness about mental ill-health amongst church community members.
Nursing Social Capital
- Nurses promote health, well-being & recovery.
- Nurses are health & well-being social capital in their professional & community roles.
An expression of health & well-being social capital occurs within a church community setting.
- Nurses are health capital in rural churches for people with mental health problem
- Prevalence of mental health problems is higher in rural communities
- Rural communities have fewer formal mental health services.
Two people, a mental health nurse & a quilt maker planned the project together.
- •Fabric resources were donated by interested people, & the project participants were invited by word-of-mouth to group sewing sessions.•A snowballing of interest ensued as more people (including non-sewers) became involved.•At the first session, the mental health nurse led a short discussion about mental health awareness & a guided group conversation about the topic followed.•The quilt maker led a short workshop about the techniques that would be used to develop the quilt.•An eight-week time frame to complete the project was selected.•A theme was chosen which would resonate with the recipient & reconnect her to some personal successes she had achieved in the recent past, volunteering in Africa & Greece.
Post Project Survey Results
Ethics was obtained & an evaluation survey of project participants (n15) conducted using an anonymous online survey tool (survey monkey) to understand if the project had met its original goals.
Selected participant comments which reflect their experiences & aspirations about the project:
- •a quilt is a physical reminder that she is loved & valued.
- •It allows the recipient to not have to deal with many well meaning (but awkward) visitors. It is a visual & tactile reminder at the lowest of times (yet) offers physical comfort, & these are important aspects of the gift. The sense of unity that the quilt displays (many people working on it, but all put together) may also offer some comfort and remind the recipient of the power of community and their position within that, no matter her mental health.
- •Inspiration to press on with her life dreams.
- •Whenever she has & holds on to the quilt that she will not feel alone.
- •Strong sense of working together. Sense that people were ‘doing something’ to contribute to a solution.
- •The opportunity to express love by doing something tangible. Plus I like quilting!
- •I wanted to help, but didn’t know how.
- •How helpless I felt & how little I really know about mental health even though my own brother suicided many years ago.
- •It is a medical condition no different to a broken bone-that it needs care & needs to repair with time.
- •We all have down times – they are a part of life.
- •That it is good to talk about it – not push it under the carpet like it doesn’t exist.
- •The sense of the shared ‘journey’, the collective expression of love and care.
- •A beautiful, beautiful idea 🙂 wonderful bonding…
Discussion. What was learnt about mental health and quilting:
Project members were able to come together in such a way as to generate a recovery environment & to promote a public conversation about mental health matters in a supportive environment. They were able to transfer their internal motivation of helping, towards active practical helping, & to participate in a public conversation about mental health. These aspects are very important in the reduction of stigma about mental health problems & to help in the development of resilience & recovery in community groups and amongst individuals.
The shared journey of learning about mental health, being prepared to talk about mental health, & of contributing to a quality activity together, helped group members in their personal spiritual & mental health development & awareness.
Initially there was a shared awkwardness about mental health but conversations about mental health issues became easier over time, setting the scene for a warm, welcoming recovery environment for the quilt recipient to return to. A group environment developed where members were sufficiently brave to step beyond their personal comfort zones & learn new skills, either about mental health conversation, or about quilting. Both were equally confronting for some members.
The quilt recipient was presented with the quilt in a usual church service & after the mental health nurse had assessed the emotional safety of doing so with the quilt recipient. The quilt recipient was extremely appreciative of this moment & it opened the conversation about mental health & recovery more widely amongst the broader church community who were then able to contribute to the overall safe, warm recovery space amongst people who cared for her.
A brief project was envisaged as a local response to a mental health crisis for a member of small rural church. The unique social capital within the church community was utilized to assist the recovery of one person following a mental health crisis, & to create a stronger public conversation about mental health issues thereby reducing stigma. The partnership of a mental health nurse & an expert quilter, & their leadership of a small group were key elements in developing the project.
The outcomes of the project have been extremely positive & have yielded a professionally constructed quilt as a tangible mental health recovery resource, & developed a stronger affinity for caring for people with mental health problems within a small group. The project had its origins as an act of kindness & compassion but, by utilizing the social capital strategically, developed into a positive experience for the quilt recipient, quilt group members, & the broader local church.
This project demonstrates how the quilt concept was developed, and what can be achieved by a small group of people who are prepared to harness their collective skills towards improving grass roots community mental health on a small scale.
Have you ever wondered how Australia’s health expenditure compares to the rest of the world? The answer is pretty well – Despite the gaps we see in health provision, and especially mental health provision, we have a strong health budget provision (almost US$6000/person). What we do need to think about is how we allocate that expenditure…. we need to make sure that the rural component is not too thin, and that we use what we have to better effect. I think rural nurses need to step up to the mark and step out in progressive specialist generalist care…. some research (including mine!) is showing that the listening, caring and referral we nurses provide is the most important aspect of early intervention they receive…and it keeps them engaged in recovery. Earlier helping often means less morbidity and speedier recovery – budget win:win! And health win:win….. Nurses are a critical factor in health budget planning. We need to perhaps be a bit more vocal to ensure that we advocate for health and well being for all….. Here are the global stats about health expenditure.