Male suicide is two and a half times more likely in remote Queensland than in our cities. Last week Mental Health Minister Mark Butler released the Suicide in Rural and Remote Areas of Australia report, which studies suicide in detail but offers precious few solutions.

Illustration: Sturt Krygsman

It is yet another document launch from a federal government with a patchy record in both rural health and mental health policy.
Mental heath is the challenge of our generation. It costs Australia around $6 billion annually, with the bush bearing more than its fair share. The Government doesn’t even have a regional health portfolio. That leaves the Coalition to doggedly pursue Labor to maintain any focus on mental or rural health.

Those living with mental health issues deserve all the support we can provide. So it is disappointing that a breakthrough drug now funded in a number of countries overseas has been refused funding approval here for the third time. The manufacturer has now given up, meaning the drug is only available to the rich on a private prescription.

Agomelatine targets completely different receptors in depression, making it a promising option for those suffering side-effects like sleep interruption. Just ask my Parliamentary colleague, Andrew Robb, who wrote of having to swap between different antidepressants in his book Black Dog Daze (2011). Sleep interruption can turn a productive life into misery.

The rejection was based on comparing the new drug to existing PBS antidepressants. The problem in mental health is that new treatments are so uncommon, the comparators are decades-old post-patent products whose prices are just a fraction of the cost of bringing cutting-edge alternatives to market. The older and cheaper existing drugs are, the harder it is to prove cost-effectiveness.

In cancer for instance, less cost-effective drugs than agomelatine are routinely approved because they compare well against expensive recently released alternatives.

By simply watching on and doing nothing, this government is presiding over an emerging two-tier system in our beloved PBS. On the one hand, our pharmaceutical system pays high prices for new drugs simply because they are replacing other high price drugs. On the other, patients in ‘old drug’ categories like depression either pay out of their own pocket or make do with last generation alternatives.

Knocking back breakthrough mental health treatments hits hardest in the bush. That is because rural incomes are lower and out-of-pockets costs higher. Access to mental health expertise is limited, particularly for those battling side-effects which this treatment avoids.

Labor made matters worse when it won office in 2007 and failed to continue the successful Howard era Mental Health Services in Rural and Remote Australia program. It phased this program out in order to expand the Coalition’s flagship Better Access initiative, which while not ideally suited to rural circumstances was better than nothing. Fast forward to 2011, and Labor gave Better Access the chop as well, in favour of city-centric early intervention centres.

This week’s report contains many other insights into the unique aspects of mental health in rural communities. There are a range of cultural, social and economic risk factors, particularly associated with male identity and masculinity, which result in higher suicide rates in the bush.

Macho attitudes, dangerous alcohol consumption, risky patterns of behaviour and tendencies towards violence often mask depression within rural communities that are in constant flux. The last decade alone has seen record-breaking droughts, floods, bushfires on top of exchange rate and industry deregulation pressures. 

The current federal government is banking enormous savings from massive PBS price cuts. So it shouldn’t force around 10,000 Australians to stump up the cash for world-class mental health care which is funded in Germany, Ireland, Spain and France.

As it stands, Labor risks taking mental health patients back to the pre-PBS era, a time when the rich got the best and the rest made do.

If you need to talk to someone call Lifeline on 13 11 14.

Comments on this post will close at 8pm AEDST.

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    • acotrel says:

      05:07am | 26/11/12

      How many graduate clinical psychlogists have been produced by our Australian educational institutions and medical profession in the last ten years ? Drugs give a reprieve, however are not a complete answer to underlying problems.

    • YaThink says:

      05:40am | 26/11/12

      It is not just the bush.  Cooroy is only 20mins from Noosa, but you can only access Nambour Hospital which is 40 mins away and has limited services.

      A good example is someone we know, she is in her late 20’s has bi-polar but it is taking years, yes years, to get her medication right.  She will get an appointment with the mental health there, they try something, then they set an appointment for 8 to 10 weeks later (when the drugs they are trialling on her only last 2 weeks).  Next, she loses it, as has happened a few times and gets arrested by the police.  Last year was very scary, she was arrested due to walking up the middle of the road with a very large kitchen knife in her hand.  The police then send her to Nambour, where she is treated in a different area, given a stop gap, and then the whole process starts all over again.

      Her mother is too old to look after her, there are no proper mental health facilities, nowhere to go, not to mention the waste in police resources being called out to people like her.  That is just one case in a regional area.

      With unemployment being 2nd highest in Queensland in our region, this type of situation is only going to get worse.  Now the Newman Government has cut back the health facilities even further, but as it is only 1 or 2 staff, no-one is jumping up & down about it.  BUT, 1 or 2 staff when you only had 3 or 4 to start with and they could not help the population already, well, you do the maths?

    • Achmed says:

      07:59am | 26/11/12

      In Karratha we rely on using videolink facilities to speak with a psych.

      The question that needs to asked is - How many psych’s are there and are there enough to provide all these wanted/needed services?  How many of them want to work in the regions?

      How much of an impact was there when Abbott reduced training positions and handed $1 billion from the health budget to Howard to add to a phony surplus?  That act showed the true Liberal care for Aussie health and now it appears the Liberals in QLD are showing the same low level of care.

      I can go onto the Jobs WA website and the vacanices for the Pilbara and Kimberley are dominated by health services seeking more staff, or to just fill what they have.

    • Andrew J says:

      08:18am | 26/11/12

      Andrew, you need to make it clear that the rejection of agomelatine was by the Pharmaceutical Benefits Advisory Committee, NOT the government itself. Your omission of this fact is clever politics, but inaccurate. PBAC is an independent body that advises the Government on PBS listing
      Now,you can level legitimate criticism if the government second-guesses PBAC (which it did last year on a number of issues), but not for accepting its conclusions.
      Basically it found that there was no new evidence, and no convincing proof of superior safety and efficacy. Anyone who wants to plough through the reasoning can do so here:

      That said, you raise an important question. Not sure how the actions of your mate Newman is going to help here. Perhaps you could clearly articulate what you and the Coalition propose to do in the event of you winning the election.

    • In The Tunnel says:

      09:00am | 26/11/12

      Money that could be used to directly support people with depression is being leached away by Beyond Blue.
      It is a quango that does nothing for us with depression but lavishes government funds on self promotion and a useless web site that could have been made by a 12 year old.

    • ByStealth says:

      11:05am | 26/11/12

      It would be good to see more funding for mental health services in this country. After seeing a friend slip through the cracks, I’d like to spare people the devastation these illnesses can cause.

    • Philosopher says:

      11:10am | 26/11/12

      Under a Abbott-led coalition government, mental health would improve nationally through the following initiatives:
      - increased spending on mental health and health funding generally
      - a more flexible and compassionate unemployment/welfare system
      - greater resources for non-profit government services, including regional areas
      - improved conditions for employees across private and public workplaces

      Abbott and his team are looking forward to implementing many initiatives to improve the mental and financial well-being of all Australians, regardless of where they live or how much they earn, or whether they earn at all. It’s a central tenet of Liberal values, after all. Thank you Andrew Laming for reminding us of this, I wait with baited breath for how mental health will improve under your system.

    • True Blue Ozzie says:

      11:49am | 26/11/12

      Web sites Like Beyond Blue, Life Line etc in no way help many so depressed that suicide is the only option. When a person is so depressed and in the suicideal state only a real person trained in this feid can assit the person. Web sites like the above only assit those who realise they have depression, it in no way helps those in the suicideal state, only trained people on the ground can help these people. How do I know,well my only daughter hung her self at age 21 after 7 years of mental health issues,7 years of countless suicide attemps my daughters death was totaly preventable,  it’s the Health System and lack of funding on the ground that cost my daughters life, and left our shattered lifes forever dependit on a failing health system. It’s long over due Mental Health should be on an equal footing with heart, cancer, kidney, liver problems just to name a few. How many more Australians must die at their hands and lives destroyed before Governments do something serious about this very real Illness? Roxan spent billions fighting big tobaco, smokers only kill them selves, this money would have been far better spent onthe Mental Health system on the ground with real people, a suicide death has far more reaching permeant health destruction on families left behind.

    • Swamp Thing says:

      01:49pm | 26/11/12

      @True Blue. Very well said mate, lots of nice words on offer to them in strife but dosen’t really help one bit.  Practical assistance is rare & that needs to change - urgently.
      Sorry for your loss.

    • Greg says:

      03:23pm | 26/11/12

      The victims are overwhelmingly white men, who are not allowed to have any lobby groups, because it would be racist and sexist if they did.

      So it is not a political problem, and it gets little attention, especially when the victims get blamed for having “male identity and masculinity”, “macho attitudes, dangerous alcohol consumption, risky patterns of behaviour and tendencies towards violence”.

      White men cannot ever be victims of anything, they must be blamed for everything, including their own suicides.

    • JB says:

      06:05pm | 26/11/12

      @True Blue When I hear of stories like your daughter’s I weep inwardly. The pain can be overwhelming.

      I have suffered since I was 8,  I am now over 50. Every day can be a battle. Beyond Blue may be a lobbying group to harvest research funding, but I believe Lifeline has trained councilors. I have not used it though. The reason is, I am not sure what their reporting and confidentiality is like when you go where depression can ultimately take you.

      It is a illness no talks to me about it even though it is so obvious that I am overwhelmed by it. If one was suffering from an illness with a potentially fatal outcome friends would be all over me like a rash

      There are no easy black and white cures in some cases. Councillors can be too professional and be just parroting and propagating what ever doctrine they have been taught and they are hugely expensive.

      Sometime I just long to talk to a fellow human who simply understands where you are coming from. Perhaps funding the guidance of lay volunteers (including our family or friends). Just having one who is knowledgeable in talking and listening to a fellow human when they are down
      (I admit it is a difficult skill) could be a valuable tool
      to manage our companion:- depression.


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