Mal Coutts helps to connect people struggling with mental health issues with the support they need. (ABC Wimmera: Danielle Grindlay)
Mal Coutts scrolls through an old flip-top mobile phone, tallying up 47 calls, incoming and outgoing, from one day.
- An ABC crowdsourcing project identifies widespread issues with access to mental health support in regional and rural areas
- One woman says she tried nine times to find a GP to provide ongoing support for her son
- A mental health outreach worker says there needs to be a shift away from looking at numbers and towards people’s lived experiences
“The need is just huge, especially now with this COVID-19.”
Mr Coutts is a mental health outreach worker in western Victoria, a role he describes as a “gap-filler”.
He is not a doctor, nor a psychologist or social worker, but operates like a well-connected parent who can line up appointments and navigate people through a “completely disjointed” system.
“We can keep them level, I suppose, until they can get the help.”
There is no clinical referral to Mr Coutts nor his two counterparts in a free program based on a simple catchcry: “It costs nothing to talk.”
In an ideal world, Mr Coutts said his job would not exist.
“We need those workers because people fall through the cracks.”
He is talking about people in rural and regional Australia.
In regional and rural Victoria, the suicide rate is 40 per cent higher than that of metropolitan areas, despite a similar prevalence of mental health issues.
National mental health reforms and state-level strategies have failed to create noticeable change, with the suicide rate, especially outside of the cities, climbing.
In 2014, 40.8 per cent of Australia’s 2,922 suicides were recorded outside of metropolitan areas; in 2018, there were 3,046 suicides and 41 per cent were outside of the cities.
For every death by suicide, as many as 30 other people attempt to end their lives.
Mr Coutts said he was not that interested in the statistics, but rather the stories and lives of the people behind them.
“It nearly makes my hair curl, some of the stuff you hear,” he said.
‘Profits over people’
When COVID-19 made its mark, Mildura resident Chris* lost control of his mental health along with his job.
“I’m one to be working 60 to 70 hours a week, so going from that to being stuck at home full time with minimal money, it put a lot of strain on the family,” he said.
Chris phoned Beyond Blue and was urged to see a GP to develop a mental health plan. He made the call and told the receptionist why he needed an appointment.
When he got into the doctor’s waiting room, he took a breath and shared his story for the third time.
“The doctor just went, ‘Oh, I can’t do this, you need to make a double appointment’,” Chris said.
“I wasn’t asked whether I was suicidal, nothing at all.”
Before sending him out the door the GP gave Chris a flu shot, which he hadn’t requested.
“I was already feeling down when I was walking in there; I walked out of there just extremely down.
“I didn’t really know what to do.”
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Chris’s impression was that of a healthcare system that valued “profit over people”.
“They’re in it for a quick-fix solution, so they’d rather just put a band-aid on everything or push you out the door with a flu shot,” he said.
Mr Coutts said it was a common story and often turned people off reaching out for help again.
“It takes a lot for someone to talk, so it’s a really frustrating part of it,” he said.
“Straight away they go ‘whack’ into a brick wall and all of a sudden the anxiety is up again.
“That’s where we ring back and ask, ‘How’d you go?’, and we will book that double appointment in to make sure they stick with it.”
An ABC survey shows regional Australians are struggling to find support for mental health issues. (ABC Wimmera: Danielle Grinday)
Courage to speak out
Sarah* said she had no idea her 19-year-old son was suicidal.
“He’s always been confident and happy and the life of the party,” she said.
Behind the scenes, he was dealing with serious mental health issues, and not even the people he lived with knew what he was going though.
“He had the courage to speak out,” Sarah said.
“He admitted to suicidal thoughts and he had been self-harming as well in a number of different ways.
“To hear that your child is struggling so much and to have not known, [you] just want to be able to help them.”
But Sarah said she had no idea how hard it would be to find ongoing GP care in the regional town of Horsham.
“It took us nine attempts, over a 10-day period, to get an appointment [with a GP],” she said.
“The majority of the doctors that we spoke to simply just said, ‘Sorry, we’re not taking new patients’.
“For me it was incredibly frustrating that we just needed help and we couldn’t get it; but for him, it was like he was just being fobbed off.”
Sarah said after being knocked back by a GP for the fourth time, her son wanted to give up, but she persevered and they found a GP that would provide him with ongoing support.
Her son now has a mental health plan and is booked in to see a psychologist, but Sarah said she worried about people who simply fell through the cracks and never accessed support.
“The outcome for us could have led to suicide for my son; it doesn’t get much worse than that.
“There must be so many people where the system is just too hard to navigate … and the implications of that are just frightening.”
Regional Australians say they are falling through the cracks of a complicated system. (ABC News: Alice Roberts)
Stories paint grim picture of country Australia
Sarah, Chris and Mal Coutts are all based in Victoria, where a royal commission into the mental health system is promising a “bold and innovative approach” to reform, with final recommendations due in February.
But an ABC crowdsourcing project, which asked people to share their experiences with regional health care, revealed similar issues right across rural and regional Australia.
More than 300 people told their stories, and struggling to access mental health in a timely manner was a recurring theme.
Regional residents painted a picture of a disjointed, inflexible mental health system that was difficult to penetrate.
One woman said she had been living in Perth for seven years because she was unable to find mental health support in her home town.
“I would love to be with my husband,” she said.
A woman in rural New South Wales described a long and fruitless search to find a psychologist willing to see her 11-year-old son.
“Thank God for the school counsellor, because the healthcare system totally failed us,” she said.
In regional Tasmania, a father said he wrote to the ABC because there was no-one left to reach out to.
“I’ve just given up really after the last GP did nothing again. I’m not really trying anymore and every day just gets harder,” he said.
Mal Coutts (left) and Mitch Binkerton became mates after meeting through an outreach program. (ABC Central Victoria: Larissa Romensky)
Looking beyond the numbers
Mr Coutts knows he and his two counterparts have saved lives.
The 11 local agencies behind the outreach program believe it should be rolled out across the country.
They have asked Swinburne University to document the gaps in the system, the demand, and the outcomes for people who engage with the three outreach workers.
From January 2019 to March 2020, the outreach workers visited around 300 people needing help across four local government areas in western Victoria and conducted 490 follow-up visits.
But Mr Coutts said issues with the existing system were reflected in the way programs like his were assessed and valued.
“It’s all about statistics,” he said.
“Politicians like to hear how many people you’ve seen and how many boxes you can tick.
“It’s not so much about how many people you see, it’s about the outcome for the people you do see.”
For enduring change Mr Coutts said there needed to be a shift away from looking at numbers and toward people’s lived experiences of trying to navigate a complicated mental health system in which people are referred from one place to another.
“I’d like to take some of the ministers and people from government out with me for a couple of days,” he said.
“When they figure out how to get everyone working together and focused on the people, they won’t need people like me to fill all the holes.”
Tell us your story
The ongoing coronavirus pandemic has renewed focus on the many challenges in regional health care across Australia.
We are aware that regional people have, for years, experienced issues with funding, governance, and access to specialists and timely care.
We know staff in regional health services are often trying to do the best they can in difficult circumstances and that poor care and systemic failures can occur for a host of reasons.
However, the “postcode health gap” is one of the reasons that people in the regions have worse health outcomes overall.
We need your help to build a better picture of what is happening in our regional health services, and why, so issues can be highlighted and addressed.
We are keen to hear from staff, patients or carers who have a story to tell.
Your identity will be treated as strictly confidential by the ABC, unless otherwise agreed with you, and any sensitive information you provide to us will not be published without your express permission.
For details about how the information we collect during crowdsourced investigations is handled, see the ABC Crowdsourcing Collection Statement.
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