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Rural youth suicide: convention, context and cure: Chris Sidoti (1999)

Rights Rights and Freedoms

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

  • 'there has been
    no increase in mental health beds in local hospitals in spite of the
    increased population in recent years'
  • the one adolescent
    mental health worker is 'not enough to meet the needs of young people
    with mental health problems'
  • there is no psychiatric
    registrar at the hospital and
  • 'the area has
    never been able to meet the needs of after hours crisis'.

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.
16Young People Living in Rural Australia in the 1990s,
1998, page 10.
17Bush 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

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