5 Realities of Rural Mental Health Care

When I first starting needing mental health treatment I lived in a small rural town.  The nearest major town was 5 hours away, at the time it was mostly a dirt road.  I don’t think that people realise the realities of living in a rural town when it comes to health care.  These are my own experiences.rural mental health

1. You can’t beat the queue in public health by seeing a private practitioner, unless you want to travel.

The first psychiatrist that I saw when I was 14 was actually from the adult team.  I saw her because she visited more often than the child psychiatrist.  When I say ‘more often’ it was every 6 weeks instead of every 12.  If there was a crisis in between appointments it was dealt with over the phone, or with a GP.

2.  Forget having privacy.

This is not generally down to the staff, and it’s not the nitty gritty details that will get out, but don’t expect to be able to be admitted to hospital without the town knowing.  Someone will see you, who tells someone else, who tells someone else and on it goes, all complete with parts that didn’t actually happen.

3.  Inpatient treatment is often hours and hours away.

When I was a teenager, the closest inpatient unit was 16 hours away.  As an adult, before I moved to the town that I live in now the closest public unit was over 7 hours away.  I was lucky that either one or both of my parents were able to stay close to the hospital when I was admitted.  Not everyone is that lucky.  An admission to an inpatient unit, especially for the first time, can be daunting enough without having to do it without support of loved ones.

4.  Sometimes a town doesn’t have a GP, hospital or a chemist.

The town that I grew up in went through stages where we had our own GP or we relied on a visiting one.  The hospital has now also closed down and is only a primary health centre.  This means that they do have an RN, but they are not on site at all times and they can only deal with minor injuries and illnesses.  There is also no chemist and the closest one is 68km away, with no public transport.  Prescriptions were taken over by the local transport company in a sealed bag, so any medication needs had to be dealt with in advance.

5.  Stigma among health professionals is more noticeable, and there often isn’t an alternative professional.

The town where I got most of my treatment had two GPs.  One of them didn’t believe in mental health.  Hell I don’t think he believed in a lot of health conditions.  Sometimes when I presented to the hospital he was the Dr on call.  This never went well.  The Dr was also the senior GP, so any decisions he made were final.

It’s unacceptable that in a developed nation there are people going without much needed mental health treatment because of where they live.  The most vulnerable in our society are being swept under the rug, even though many of the farmers are the backbone of our economy.  It’s a sad state of affairs when cost comes before health.

Have you experienced mental health treatment in a rural town?

Dear first time Mum

Dear first time Mum, apologising to my baby

Your bundle of joy is here.  The hormones are rushing and it dawns on you that a little person is now relying on your for their everything.  It’s OK Mama, you’ve got this.  Hold him close, take in his milky goodness.

Accept those offers of help Mama, but don’t be afraid to put up boundaries.  Don’t let anyone else cloud your time with their demands.  It’s OK to say no.  You aren’t being unreasonable, being a Mama is exhausting.

It’s true, the housework can wait but sometimes it’s soothing to wake up to a clean house and to nap without worrying about the things you need to do.  Don’t be afraid to leave the house Mama, it will be your saving grace.  It’s OK to window shop just to get out of the house.

The instincts you feel are fierce Mama, if you let them.  Your mind can play tricks on you, telling you that you don’t have the answers.  When it’s 2am and no one has slept, it’s easy to feel like you are the worst mother on the planet.  Be assured in the knowledge that everyone has felt that gripping fear and loneliness.  You’ve got this Mama.

Throw out those damn books.  Trust yourself.  Learn to cherry pick the advice, for there will be gems among the stones.  It’s OK to say thanks but no thanks to the well meaning advice, even if that advice is given forcefully.

Find your tribe Mama.  It may take a few tries but that tribe is so important.  They are your sounding board and your safe place.  Being a parent can be isolating, especially if you are the first in your friendship group to have a child.  Don’t let the loneliness breed.

Don’t be a martyr, your baby won’t thank you for it.  It’s OK to admit that you aren’t finding things are going smoothly.  It’s OK to admit that you need help.  Your baby needs a mentally healthy Mama just as much as he needs anything else.

Take time out.  Don’t become one dimensional, it’s OK to like spending time on your own, away from your baby.  It’s OK to have interests that are just for you.  You don’t cease to exist as a person when you have a baby.  You aren’t a bad mother for desiring time out.

Most of all Mama, take it a day at a time.  Take it a minute at a time if you have to.

Much love,

A Mama who has been there.

Self harm images

*The following post discusses self harm.  Please ensure that you are in a safe place mentally before reading.  If you are feeling unsafe please ask for help. Lifeline 13 11 14, a friend, your GP.*

People with struggle with self harm urges often use various distraction techniques to help ward off the distressing thoughts.  Sometimes it is about getting through the next minute, then the next.  One of those techniques is often social media.  However social media, and the internet in general can also hinder efforts to distract yourself.

When I was actively self harming, I didn’t really care too much about triggering images.  I wasn’t always actively trying to stop, so I didn’t see the point in protecting myself from self harm images.  I even contributed to those images a few times, something that I am not proud of.  I was a regular use of pro self harm websites, I was destroying myself and sought out those who understood that desire.

However now that I am focusing on not engaging in self harm, I have experienced first hand the impact that those images and descriptions have on other people.  I know what it’s like to be scrolling through my social media and be confronted with images of the very thing that I am trying to avoid.

Sometimes though, these images are shared with the intention of raising awareness and that is where I have the biggest problem.  These images aren’t created by people who are hell bent on destroying themselves, people who don’t know better.  They are shared by people who think that they are doing the right thing.  They are shared to shock people into realising the impact that their self harming has on others.

Not all of these images are shared by those who don’t know better though.  I have noticed an increase of Mental Health Awareness social media accounts sharing articles with these images.  The articles are shared without disclaimers, there is no warning that the article contains images which may be distressing.  In some cases these images are even posted as the preview image, meaning there is no barrier.  It’s confronting to scroll through your social media and see an image of a razor held against someones skin.

These social media accounts have a duty of care to their followers, and in reality one would think they would know first hand the impact these kinds of images have on people struggling with self harm.  Surely they can’t be so short-sighted?

To be completely honest, I’m not really sure that these images are necessary.  I think that the images take away from the message that the article or personal story is trying to share with others.  I also wonder how many of these articles use these images to shock and repulse rather than create a place of understanding.  I wonder too if someone sharing their personal story would receive less negative feedback without the image?  A picture might be worth a thousand words but at what cost?

Have you noticed an increase in self harm images?

Do you think these images help or hinder the stigma?


I’ve already got plans

*The following post discusses self harm.  If you are feeling unsafe please let someone know.  If you are in immediate danger please go to your nearest Emergency Department.*

Over the last 13 years I have struggled on and off with thoughts of self harm of varying degrees.  These thoughts have ranged from fleeting images to seemingly relentless onslaughts.  For a lot of years I separated those thoughts from my body, choosing to see them as an entity I was too weak to resist.

I have tried different distraction techniques over the years, all with their own rate of success.  I have posted before about living in a triggering world, and the steps that I take to protect myself from it.  These steps help immensely in the long term, however I still struggle with the day to day impulsive triggers.

Since Mr 6 came along I have used him as a reason for refraining from self harm.  I told myself that I couldn’t afford to self harm while being a parent and I used that guilt against myself.  It hasn’t always helped, and I feel weak for being unable to resist.

I have however built on that technique, using it in a more positive way, a way that relies less on other people and more on myself.  I know that it is unfair to subconsciously rely on a child to keep myself safe and it is one of the reasons that I am reluctant to talk about the catalyst for change.  I don’t want Mr 6 to feel that weight, I don’t want him to feel that my happiness rests on his little shoulders.

So I began the delay technique.  For anything else, delay and procrastination would be a disaster but for my self harm thoughts it has been a saviour.  It does sound a little daft, but it works.  I simply tell myself that I am too busy for self harm right now.  I list in my head the things that I have to do that day.  I capitalise on my fear of failure being strong enough to override my self harm thoughts.

Telling myself that I am too busy right now for self harm thoughts helps to stop them in their tracks.  I cut them off before they begin to take hold and I don’t give them  they power that I have in the past.  Using my wise mind, I create logical reasons that I cannot give in to my self harm thoughts.

Like mindfulness this is a technique that I didn’t realise I was doing until I analysed my behaviour more closely.  Once again, I didn’t give myself credit for being able to take back control of my thoughts.  I let my mind talk me into being a failure when the it couldn’t be further from the truth.  Who knew that procrastination could serve such a useful purpose!?

Have you used delaying tactics to stop yourself engaging in negative behaviour?


Warning: Graphic Content

The media has a strict set of guidelines for the reporting of content that viewers/readers may find distressing.  A warning is given before the story, informing consumers that the following content is graphic in nature.  These warnings are used for articles about suicide, mental illness, drug abuse and violence.  Numbers for helplines are posted at the end of the stories, urging those who have been affected by the proceeding story to seek help.  However no such warning is in place for fictional stories, either in print or film.

If I am reading an autobiography of a recovering drug addict or the memoir of a person with a mental illness then I am expecting the content to be distressing at times.  I can make an informed decision about whether I am in a safe place mentally to read the book.  However if I am reading a suspense thriller then I am not expecting to come across a graphic description of the main character harming themselves.

A few years ago I made a complaint to the ABC about an episode of Degrassi The Next Generation.  I don’t make a habit of writing emails to television studios about the shows they air because I feel that it is often easier to change the channel.  However this episode showed a teenager engaging in self harm behaviours.  This episode was aired at midday on a weekday so the target audience would have been at school.  While the show did come with a generic ‘this show deals with topics not suitable for a younger audience’ it did not have a warning about self harm content.

The response that I received from this email was that the generic warning was enough as it fit in with current guidelines.  So as long as they weren’t breaking rules, it was OK, regardless of the impact that it could have on viewers.  I wasn’t distressed about the content being talked about, but I was distressed that someone struggling with self harm thoughts would be taken off guard by this episode.

Content and trigger warnings do need to be specific.  I am in a number of mental health support groups on Facebook and only a few have rules about trigger warnings.  These are the groups that I feel most safe in because they have strict rules about specific trigger warnings.  I know that a post is talking about suicide or self harm because a warning is written before the post.

I don’t think that fiction writers need to stop writing about sensitive topics that could distress their readers but I do think that they need to specific with graphic content warnings.  These specific content warnings allows readers/viewers to make informed decisions about what they are mentally comfortable with.  It’s not about censoring, it’s about protecting vulnerable people who are possibly using reading or television as a distraction technique.

Do you think fictional stories should have content warnings?