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Rural youth suicide: convention, context and cure

Speech by Chris Sidoti, Human Rights Commissioner to the Australian College of Health Service Executives (SA) Seminar, Adelaide, 14 October 1999

Every suicide of a young person is not an isolated, individualised event. Certainly it robs the young person of his or her promised future. But it also traumatises the family, the friends, the school or workmates and, especially in a rural or remote community, the entire community. Every suicide of a young person speaks volumes of weeks, months, even years of confusion, alienation, hopelessness and despair leading up to the final and fatal event.

In some towns I have been told - and it is indeed common knowledge - of multiple suicides within days or weeks. These strike rural and remote communities as silent, devastating, plagues bringing trauma, fear and a sense of impotence to all.

As you know, suicide rates seem to be especially high for young rural males. For 15 to 24 year old rural males, the suicide rate is more than double that of their metropolitan counterparts.1 And it has increased by around 350 per cent over the past 30 years. The problem is especially serious among gay and lesbian young people. An excellent national study indicates that their suicide attempt rate is four times that of heterosexual young people and occurs at a much earlier age - 15 years is the average age.2

I think my most useful contribution as Human Rights Commissioner to this forum of experts is to elaborate quite briefly on three topics among the many related topics for discussion today. They are

  1. the human rights context of rural youth suicide
  2. the information I have gleaned over the past 18 months of consultations in rural and remote Australia and
  3. some projects and programs established to address this issue.

1. Human rights context

Recognising rural youth suicide as a human rights issue in all its dimensions gives us an additional framework for understanding it as a phenomenon and for building strategies to reduce and eliminate it. There is more to the issue than the right to life alone, fundamental as that is, because children's rights encompass all areas of their lives and well-being.

The UN Convention on the Rights of the Child sets out in the clearest terms what every child needs to survive and thrive, to develop to the fullest his or her personality, talents and abilities3 and to prepare him or her for 'responsible life in a free society'.4 Thus every child has the right to 'the highest attainable standard of health'5 without discrimination of any kind.6 This requires positive action on the part of governments. Every child has the right to be protected from physical and mental violence, injury or abuse, neglect and negligent treatment, maltreatment and exploitation7 and, once again, this requires positive measures to be taken.

A strong theme in the Convention is the centrality of the family in the child's life and for the child's well-being. This theme is summed up in the Preamble's statement that 'the child, for the full and harmonious development of his or her personality, should grow up in a family environment, in an atmosphere of happiness, love and understanding'. That is not always possible, of course. Where a child must be removed from the family for his or her own protection, the state bears the ultimate obligation of care as the parens patriae, the parent of the nation. In most cases, however, the child will remain in the family and the state's obligation is to support and assist the family to provide the best possible care and guidance to each child. Australia, like the other countries which have ratified the Convention, has undertaken to 'respect the responsibilities, rights and duties of parents [and others as provided by local custom] to provide ... appropriate direction and guidance in the exercise by the child of [his or her rights]'.8 The family is not to be separated against the will of its members unless, as stated, that becomes necessary in the child's best interests.9 But the government must 'render appropriate assistance to parents ... in the performance of their child-rearing responsibilities'10 and 'ensure the child such protection and care as is necessary for his or her well-being'.11

In summary there are three principles of relevance to our discussion:

  1. the principle of the individual child's well-being and best interests
  2. the principle of the importance of the family and
  3. the principle of the child's participation in decisions and activities that affect him or her.

The Convention requires positive government action and interventions on all counts. One anticipated outcome of effective and conscientious implementation of these undertakings will be, of course, thriving and surviving young people who never seriously contemplate suicide.

2. Bush Talks findings

What I heard most clearly during my 18 months of Bush Talks consultations is that Australian governments - federal, state and territory - have a long way to go in the effective implementation of their Convention obligations. Direct preventive services are simply not there; rural decline, if I can be forgiven a shorthand term for a complex phenomenon, is directly undermining the capacity of rural families to protect, support and assist their children and young people and the capacity of communities to secure the future for themselves and their youth. And the abject neglect of remote communities systematically undermines every good intention of family and community leaders.

Health services

Almost everywhere Bush Talks visited, lack of services for mental health was raised as a pressing issue - counselling, psychiatric, hostel, in-patient, especially services suitable for young people, and especially suicide prevention programs.

From North Queensland I was told

Mental health services are abysmal in the bush, almost non-existent, as is detox for alcoholism which is rife, marriage counselling, respite, palliative care, legal services, etc. These are of course all related.12

In Geraldton WA there was no specialist in child and adolescent mental health. In Central West Queensland 'there is no-one to provide counselling services and a lot of young people are struggling with mental health problems'. In Rockhampton there is no permanent child psychiatrist. In nearby Biloela a psychiatrist, a psychiatric nurse and a social worker visit once each month but 'this is not enough for people who are in a critical condition' and 'people always see a different person and waste time telling their history over again'. Even in Wagga Wagga NSW, that State's largest inland city, there is no resident psychiatrist. Psychiatrists have to be flown in on circuit to see patients by appointment.

In Port Macquarie NSW I was told

Participants in Burnie in Tasmania blamed 'short-term government grants' and the 'privatisation of health services'. Participants in Port Augusta SA concurred, stating that '[mental health] services are only given short-term funding but it takes time to get established, become known and earn the confidence and trust of locals'. A rural health researcher blames

a paucity of research into rural mental health issues which creates a vicious cycle - lack of research leads to lack of information which inevitably leads to lack of funding and lack of services. The overall result is that rural mental health services and research are a neglected issue.13

A public health worker in Geraldton WA made a similar point at a Bush Talks meeting.

When you're working in remote areas you are working at the frontier of health. Because of the low population density, however, our services are not funded to collect the data we need to inform about the needs of our community, the causes of health problems and gaps in services. We are continually compromised in the health care we can provide. We don't have access to facilities to empower people to improve their standard of health.

While mental health services are cut or even non-existent, stress related problems are on the increase in the bush. According to the Australian Catholic Social Welfare Commission

rural health workers [have] reported increased substance abuse, low morale and depression; and long hours of work that lead to greater risk of accidents and withdrawal from community activities and involvement. With the closure of support services and the difficulty of accessing medical services, families have less access to help.14

Of course, the problems were very different across the country. Some towns have plenty of access to GPs but no services for the mentally ill. Others have a doctor but no hospital. There are also differences in the state of rural health depending on whether you live in a remote area or in a rural town, what the economic situation is like in that area, whether or not you are Indigenous. As you all know, the 'bush' is by no means homogenous. However, overall, the range of problems and shortages in rural health is somewhat overwhelming.

Rural decline

The broader context of the lack of preventive health services is the decline of rural infrastructure more generally. In its 1998 report Valuing rural communities the Australian Catholic Social Welfare Commission noted

Government reports have shown that, in relation to access to social services, people living in communities of between 5,000 and 10,000 face what they describe as 'considerable' disadvantage, while those living in communities of below 5,000 people face 'extreme' disadvantage. Those living in isolated areas are especially affected. They face a 'lack of information' about what is available; the absence or inaccessibility of many services; poorer quality services; higher costs associated with accessing services; inappropriate urban service and funding models and poorly motivated staff.

In Geraldton WA Bush Talks was told

The basic ingredients of a country town are being eroded - that sense of belonging is diminishing.

In a 1995 report on youth homeless, the House of Representatives Standing Committee on Community Affairs concluded

Many rural and remote communities lack the essential service infrastructure required to support young people and their families. If family support services are thin on the ground in major centres, they may be practically non-existent in rural parts of Australia. While local community support networks still exist in rural and remote communities, the changing social and economic circumstances in these communities no longer provides the safety net it once did for people when they are in crisis.15

One participant in Albany WA explicitly linked suicide to the declining economic situation in some rural communities.

Economic downturn with the resulting sense of hopelessness and despair is a major factor contributing to the high rate of rural suicides. A lot of people who get put on the economic scrapheap through no fault of their own feel an enormous sense of worthlessness.

Something as simple as the paucity of public transport provision can have dramatic impacts on the lives of young people in particular. As the Youth Research Centre has recently pointed out

Lack of transport limits the access young people have to health services, to education and to employment, all of which have an adverse effect on their health. For people under the age of 18, the lack of public transport means that they are reliant on others for transport.16

The overall attitude to young people in Australian political rhetoric was also identified as problematic by many Bush Talks participants.

Young people are happy to contribute to society but political rhetoric scapegoats them. The community sees children as problems to be endured, not our future to be nurtured.17

3. Rural initiatives

Rural communities frequently overcome the debilitating sense of hopelessness and despair caused by youth suicides. They evaluate their situation and create initiatives to address underlying causes. I will mention some of the initiatives I have been told about and finish with a first list of success factors I have identified in them.

Projects

One of the most important means of encouraging young people's commitment to life, rather than death, is having a sense of 'agency' - the ability to act for oneself and to have an impact on others. A purely 'medical model' of health care for young people can only provide a limited understanding of young people's health needs. I have been told about two South Australian projects which try to take a broader perspective.

The Community Health Adolescent Murraylands Peer Support project (CHAMPS) in South Australia is run by young people with adults taking up positions as supporters. CHAMPS enables young people to take action that promotes their mental health on their own terms and according to their own priorities through the establishment of regular CHAMPS forums. The forums provide an opportunity for young people to work in partnership with health professionals to find ways to create conditions within which young people have good mental health. For example, CHAMPS conducted a River Project where young people designed a Youth Recreation Area in Murray Bridge.

The second South Australian initiative is 'Bridging the Gap' which focuses on the mental health of Aboriginal children and adolescents in the Far North Region communities of Copley, Maree and Oodnadatta. Because of a number of concerns about the impact of trauma arising from deaths, suicide and at-risk behaviour of young Aboriginal people, this project aims to identify the needs of young people and promote the social and mental health of communities to develop their resourcefulness and resilience in dealing with social distress. Approaches of this kind are clearly encouraged by the National Youth Suicide Prevention Strategy which is 'based on the belief that youth suicide is a highly complex phenomenon which is caused by a number of interacting factors, both social and individual'.18 The Strategy therefore adopts a 'Public Health' approach to its preventive goal by targeting whole populations and not just individuals at risk, involving consumers and the community, being sensitive to the social and cultural context and prioritising intersectoral collaboration.19

Three other initiatives should be described briefly. The first is a national youth suicide prevention project utilising the internet. 'Reach Out!' offers a directory of local services and has three sub-sites

  1. 'Chill Out!' is a chat line for young people to let them have their say and explore issues
  2. 'Family and Friends' offers support and information to people affected by youth suicide and
  3. The 'Professional Forum' is a discussion and information site through which Australian professional dealing with youth suicide - eg as counsellors or doctors - can find support and share ideas and emerging knowledge.

'Desert Acrobats' in the Kimberley region of WA aims to prevent health problems by adopting the philosophy of Aboriginal Health, which is 'The enhancement of the emotional, social, spiritual wellbeing of an individual and the community in which they live'. The Desert Acrobats teaching team travels out to remote Kimberley communities every two to three weeks running workshops for children and young people in theatre, dance, gymnastics and music. The team is based in Broome and targets young people in the area from Broome to Kununurra, reaching about 800 each year.20

Finally I will mention 'Outlink' which is a Commission initiative supported by the Australian Youth Foundation. Lesbian, gay and bisexual young people in rural areas are severely disadvantaged. They experience the stigma associated with homosexuality, the disempowerment common among young people and the difficulties of contemporary rural life. Research also shows that in the face of these difficulties they often receive less than adequate support from families, schools, youth services and the broader community. For example, in Peterborough SA Bush Talks was told

Gay and lesbian people get a hard time. One couple was hounded out of town. Another couple was harassed with eggs thrown at the house and their rubbish bins overturned.

These factors combine to place lesbian, gay and bisexual rural young people at high risk of drug and alcohol abuse, conflict with family and peers, early school leaving, homelessness and suicide.

Lesbian, gay and bisexual young people in rural areas often experience a high level of isolation, as do individuals and organisations working to assist and support them. Outlink is a project to build a national network for mutual support, to share knowledge, skills and resources, and to have a united voice on issues such as community education, service provision, funding and government policy. At least one-half of the network's management committee must be young rural gay and lesbian people.

Common success factors

In conclusion I pose the question, what features need to be built into preventive programs to address rural youth suicide so as to ensure their effectiveness? This is a first list for your consideration and discussion. There are, I think, three critical features.

First, local community participation or control is necessary to ensure that the service or project is directly responsive to the local situation and 'speaks the language' of that particular community. In a 1997 report the National Farmers' Federation made this point.

Rural populations have specific and different needs for health care within and across regions and relative to urban populations, and the need for service models which are different to urban models.21

Second, the young person's survival and well-being need to be seen and addressed in the totality of the individual, family and social context. The so-called 'medical model' in which the young person is reduced to a set of physiological features is inadequate. Health does not depend on health service provision alone. Education, employment prospects, community attitudes, family relations - all these and more play a critical role.

Third, programs must be founded on respect for young people's rights as well as on an ethic of care and concern. This will require young people's active participation as service planners and service-deliverers as well as clients. The Convention on the Rights of the Child counsels that young people have the right to participate in decisions which affect them22 and this means that they are to have a say in defining their own best interests, in articulating their needs and in designing their own solutions.

Endnotes

1 National Rural Public Health Forum Conference, 12-15 October 1997.
2 Jonathon Nicholas and John Howard, 'Better dead than gay?', Youth Studies Australia, Vol.17, No.4, December 1998.
3 Article 29(1)(a).
4 Article 29(1)(d).
5 Article 24(1).
6 Article 2.
7 Article 19.
8 Article 5.
9 Article 9(1).
10 Article 18(2).
11 Article 3.
12 Submission from E Stafford, Kuranda Qld.
13 Guy Cumes, 'Rural mental health: Policy, practice and law', in Centre for Rural Social Research, Charles Sturt University, Quality of Life in Rural Australia, 1998, page 42.
14 Australian Catholic Social Welfare Commission, Valuing Rural Communities, 1998, pages 11 and 12.
15 House of Representatives Standing Committee on Community Affairs, A Report on Aspects of Youth Homelessness, 1995, page 329.
16 Young People Living in Rural Australia in the 1990s, 1998, page 10.
17 Bush Talks, Port Augusta SA, June 1998.
18 Penny Mitchell, 'National Youth Suicide Prevention Strategy' in Australian Institute of Family Studies, Youth Suicide Prevention Bulletin No. 1 page 3.
19 Id, page 4.
20 Desert Acrobats is a project of the Kimberley Aboriginal Medical Services Council Health Promotion Unit HEATworks and is solely grant run.
21 NFF Discussion Paper, Trends in the Delivery of Rural Health, Education and Banking Services, February 1997, page 8.
22 Article 12

Last updated 1 December 2001