It's hard being a city slicker forced to live in the country. I walk and talk too quickly, complain about the lack of good Asian food and I don't smile enough. Instead of sitting in Sydney traffic for hours, I drive on highways for hours, just to get groceries. I have long conversations with strangers when I dial the wrong number.
As a mental health worker, it is an area of great need. Rural men in their teens and 20s are the most vulnerable group in our society. They have shown the biggest increase in suicide in the past two decades, the rate almost trebling since the 1960s. Their methods - guns and hanging - are also the most violent. They have the least understanding of mental health issues and the worst access to appropriate services.
Rural areas here are different from those in much of the world. Our bounty is capital intensive and less dependent on labour. Mining, wool and agriculture have never required large numbers of people. In an unforgiving, harsh land that can alternate between drought and bushfires, isolation is an added burden.
Australia has long been one of the most urbanised countries, fifth within the OECD, behind the Netherlands, Japan, Belgium and Britain. About 68 per cent of our population live in cities, according to 2006 census figures. But the world is catching up.
Since 2005, says the United Nations, for the first time, the urban population has outnumbered the rural. Millions in the developing world are travelling to cities, searching for work, hoping to taste a piece of the globalisation cake.
It is also a time when rural suicide has increased dramatically, as those left behind face greater pressure and isolation. Although exact figures are unreliable, the World Health Organisation estimates that suicide rates in rural China and India have tripled in the past two decades, just as their countries enjoy among the highest economic growth rates in the world.
Australia has also urbanised further in recent decades, although not comparable to the breakneck changes within developing countries. The economic crisis is only likely to make things worse locally. Added to the problems of drought are the crash in commodity prices and the value of the Australian dollar. Farmers are getting much less for their wares on the world market, just as demand is set to fall.
Socioeconomic factors have been shown to be a greater factor in men committing suicide than women. In studies since the early 1900s, male suicide rates showed greater increases during the Depression and the world wars. A likely explanation is that high unemployment in the Depression affected men and women differently. For men, their customary role as provider is eroded whereas for women, the traditional roles of mother and homemaker assume an even greater importance.
While gender roles have changed considerably, the male ego remains more dependent upon occupation. This is surely more pronounced in country areas, where the metrosexual is unseen. People who see themselves as rugged frontiersmen are reluctant to reach out for help. And suicide risk factors such as depression, economic worries and alcohol use are heightened in rural areas by social isolation, lack of mental health care and the easy availability of guns.
The atomisation so often described in the urban metropolis is also becoming apparent in once idyllic, tight-knit rural communities. Women are working more often, and usually not on the land, rural collectives have given way to corporations, and the tyranny of distance, especially in the vast expanses of arid countryside, have loosened social ties.
But there are signs of recovery. A host of men's health forums organised by Beyond Blue in towns such as Gundagai and Gunning are attracting hundreds, young and old. Pru Goward, the local state MP, said one such meeting in Goulburn was the biggest gathering of males she had seen. A local mental health worker relates a particularly effective event where a shearer spoke of his troubles with depression and suicide.
There is also the realisation that physical problems are a much easier entry into afflictions of the soul. For older men going to the GP, the prostate has been the door to the psyche.
A pilot program in South Australia where financial counsellors were given mental health training and closely tied to services has shown promise. There are moves to replicate the strategy throughout rural Australia. Ultimately, country living will continue to have its charms interlaced with considerable struggle. Given it continues to represent our breadbasket, rural problems are a concern for city dwellers, too.
Tanveer Ahmed is a psychiatry registrar.
This article was first published in The Sydney Morning Herald
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