Rural communities: challenging the stigma of mental illness

Imagine your whole town called you a 'monster', forcing you into a lonely life ostracised from the community. Imagine it was because of an illness you couldn’t control. La Trobe’s Professor Amanda Kenny researched rural mental health services and came across heartbreaking tales like this. Now she’s helping deliver better service design.

Living with a serious and enduring mental illness

Around 600,000 Australians live with serious mental illness, including bipolar, schizophrenia and borderline personality disorders.

For Professor Kenny, while awareness has risen about anxiety and depression, our understanding of those living with chronic mental illnesses has slipped through the cracks.

‘Most people would know that statistics around suicide and depression are really bad,’ she says. ‘But we might not think about the 60-year-old man who lives by himself in an isolated community and has suffered from a mental illness since he was 16.’

Ideally, people with a mental illness would live in metropolitan areas or regional centres, close to the services they need. However, many in need of these services move to rural communities.

Often people who have serious and enduring mental illness have trouble with employment. They often live in poverty.

According to Professor Kenny, there’s been a significant change in rural demographics. ‘Traditionally, in rural areas there was a small community that was very supportive,’ she says. ‘People that were a bit ”unusual” would have been looked after. But now lots of people can no longer afford to live in the city. Often, people with serious and enduring mental illness have trouble with employment. They often live in poverty.’

As a result, they move further away from expensive housing surrounding the city. But often, she explains, the rural communities they move don’t have mental health nurses, but rely on practitioners without training in psychiatry or mental illness.

‘These health professionals are fantastic and work so hard,’ she points out, ‘but don’t necessarily have the knowledge and skills to work with these people. Many small communities don’t have mental health nurses, so you’ve got generalist staff who don’t always feel equipped.’

Tackling stigma through education

The entrenched stigma of mental illness can create barriers to support. People with mental illness can be isolated, as Professor Kenny explains.

‘In our interviews people spoke about being called a “monster” or having teenagers throw stones at their house. They’re picked on at the supermarket because they wander around talking to themselves.’

People caring for family members with mental illness also felt disconnected.

‘I’ll never forget the woman who told us: “If my daughter had cancer, the whole community would be around with casseroles. They would bring flowers and support. But because she’s got a serious mental illness, people don’t know what to say. They don’t know what to do, so they stay away.”'

Professor Kenny believes it’s a lack of understanding that creates stigma.

‘People don’t mean to be cruel or horrible. In many ways, I think it’s about the fear we have around any group that’s different. You can understand why some people might be terrified.’

Through her research, she saw how stigma can be shifted by exposing people to real-life experiences. One registered nurse said she was scared of working with people with serious mental illnesses, but by working with Professor Kenny’s group, her attitude began to change.

‘She developed this amazing warmth and friendship with a couple of people in the group and said to me, “They are just people like me, aren’t they?” When you get to know someone, you do realise people with a mental illness are just like everyone else.’

Creating opportunities for these kinds of connections is a primary focus of Professor Kenny’s work.

Creating a sense of community

As a result of the project, participants are now breaking down stigma by sharing their stories with community groups. They’re hosting meetings and helping to train junior doctors and medical professionals.

‘A medical degree gives someone a certain type of expertise, but that’s no more valuable than someone who has had a serious mental illness for 40 years and has had enormous experiences with the healthcare system.’

Through Professor Kenny’s work, not only are people with mental illness opening up about their personal expertise to inform how services should be improved, they're also developing their skills and feeling better for it.

For Professor Kenny, recognising everyone has complexity in their lives will improve the lives of everyone involved.

‘A major finding was that people involved with our work said their own mental health improved because they felt valued. They had a role to play.’

For Professor Kenny, recognising everyone has complexity in their lives will improve the lives of everyone involved.

‘Whether it’s diabetes or enduring mental illness, they’re both chronic conditions and it’s all about developing understanding.’

Professor Kenny is convinced that creating that understanding will build stronger communities. ‘We’re trying to improve the lives of people with serious mental illness, but ultimately also improve the lives of the whole community because each one of us is different and unique.’

That’s where her passion comes from: getting to the root of a problem and building connections in a community, so that people can look out for one another.

Professor Amanda Kenny is located at La Trobe University's Bendigo campus. She is Professor of Rural and Regional Nursing in the La Trobe Rural Health School, Department of Rural Nursing and Midwifery.

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