By Ali Maginness MAPS, Rural Clinical School, University of Tasmania and Miranda Stephens MAPS, Clinical Services Team, NW Tasmania Division of General Practice
The impact of climate change has become an every day reality, many of us confronted by it as a result of extreme weather patterns or via the numerous reports in the media. In the past it has generally been discussed from an environmental or financial perspective, however recently there has been an increasing recognition of the impact of climate change on health and wellbeing, communities and quality of life (Horton & McMichael, 2008). In Australia, much of this discussion is based on anecdotal reports of the effect of the drought and natural disasters on rural and farming communities, and is anticipatory as to what we might expect in the future.
Reports on the effect of the drought on farming families have led to the belief that climate change is impacting on rural communities in terms of increased rates of depression and mental illness, and suicide. Research into mental health needs in rural Australia do not fully support this belief, as mental illness rates are reported as much the same in rural areas as in other parts of Australia. Suicide rates, on the other hand, have been consistently reported as higher in the farming population for some years (Judd et al, 2006; Kilkkinen et al, 2007). A range of biopsychosocial factors have been proposed to explain why the suicide rate is high in the farming population but as yet there is no definitive answer, and the impact of climate change on suicidal behaviour so far has only been inferred.
An explanation for these anomalies may lie in how rural communities express distress (and seek help) when challenged by the impact of climate change on their environment, way of life and wellbeing. New constructs such as ‘psychoterratic' illnesses have recently been introduced into the literature in an attempt to describe what people experience with environment change. These constructs focus more on the experience of distress as opposed to the diagnosis of mental illness. For example, ‘solastalgia' is a new concept that has been developed to promote understanding of environmentally-induced distress. It refers to the pain and distress caused by the loss of, or inability to derive, solace from a home environment which has been subject to physical desolation (Albrecht et al, 2007).
Demoralisation is a second construct that refers to non-specific psychological distress distinct from depression and other psychiatric disorders. Central to demoralisation is a breakdown in coping and this can lead to subsequent feelings of incompetence, helplessness, and hopelessness. Hopelessness has been identified as the hallmark of demoralisation and frequently associated with the wish to die (Clark & Kissane, 2002). Although it has not specifically investigated climate change, a study investigating the construct of solastalgia described individuals reporting similar symptoms to demoralisation (Albrecht et al, 2007). As such, demoralisation offers itself as a separate construct to explain the effects of climate change apart from the environmental impact per se.
We suggest that investigating rural mental health using traditional methods and assessment tools may result in misleading rates of mental illness and fail to detect psychological distress underlying suicidal thinking and behaviour. Shifting the research focus away from the "depression-as-disease" model (Summerfield, 2008, p. 326) opens up opportunities to explore how climate change is experienced by individuals, and the community within which they live. The introduction of alternative models and innovative constructs in research design would have a twofold effect in terms of lessening the propensity to pathologise and stigmatise the individual, whilst at the same time examining what individuals and communities are doing to cope with the challenges that face them. The sense of place that a community gives can highlight practical issues that impact on how services are delivered in rural communities, and identify strengths and resources otherwise overlooked.
In conjunction with reviewing research design and methods to assess mental health needs in rural communities, we suggest that it is also important to consider mental health service delivery in rural communities. Small communities lacking ease of access to basic mental health type services cannot afford to have agencies operating with tight exclusionary criteria or a duplication of services. Both government and non-government organisations need to be flexible, innovative, listen to community needs and actively work together to share skills, resources and essentially fill gaps. There is a need in many places to move beyond small town politics, personality and ideological differences for the good of the local community and wellbeing.
Allan, Ball and Alston (2007) suggest that rather than increase the amount of health services in rural areas, there is a need to concentrate on flexibility in service provision and work practices, role diversity for health and community workers and community profiling. We propose that psychologists working in rural communities consider a paradigm shift that integrates the principles of positive psychology and community approaches with clinical practice. This would occur within a shift of practice from purely ‘individual-based treatment' models of psychology to a blend of three levels of intervention: facilitative, collaborative and consultative.
Rural psychologists can lead the way in working as facilitators in rural communities to promote social cohesion and connectiveness, and stimulate community innovation and problem solving. By stepping outside traditional roles we can, for example, co-facilitate community events with relevant organisations to foster connectedness, impart information and stimulate discussion regarding climate change problems and solutions. It is hypothesised that using the local knowledge and expertise of the community to problem solve would help to promote working towards the collective good, and in doing so promote eudaemonic processes and resilience. This in turn would ameliorate tendencies individuals and communities may have towards feelings of helplessness and victimhood, and potential demoralisation. Such ideas may not be novel to some, and may even be practised in pockets of Australia, but there is little in the literature reporting on this type of approach as yet. Our experience is such that it is not common practice for psychologists working in government or non-government settings to work in such a manner.
Recent literature on mental health service provision in rural communities points to the need for collaboration of service providers in order to enhance wellbeing in rural communities (Allan et al, 2007; Cooper, 2003) With some innovative thinking, flexibility within management and the fostering of good interagency relations, rural psychologists can work collaboratively with other organisations to deliver clinical, education and support services. Also, working with locally established and community specific organisations that already gather people together and function to promote connectedness may be a way to strengthen existing resources. Rural psychologists have a role to educate other rural workers and agencies in order to improve mental health literacy, support the community and enhance referral processes. This broadens the impact of psychology when compared to traditional models.
This follows the more traditional role of psychologists in the provision of mental health services. This would include assessment, through to treatment and liaison but we would like to stress the importance of framing care in a social context. In addition to this, evidence supporting the principles associated with positive psychology is accruing and we believe this is important to enhance individual and community resilience.
There is now no doubt that climate change is occurring and for many rural Australian communities the impact in the last decade has already been devastating. Psychologically, the effects appear to be of psychological distress not particularly fitting with our traditional medical model diagnostic system. We suggest further research into concepts and models such as solastalgia, demoralisation and resilience may assist our understandings. The impact of sense of place and communities upon wellbeing is crucial in rural settings and we encourage rural psychologists to broaden traditional practice models to incorporate these ideas in a positive psychology framework with an integration of facilitative, collaborative and consultative methods.
|Levels of psychological intervention in rural communities|
Enabling role within the community
Collaborative role with other service providers
Consultancy role as a health service provider
Allan, J., Ball, P., & Alston, M. (2007). Developing sustainable models of rural health care: a community development approach. Rural and Remote Health, 7 (online), 818.
Cooper, R. (2003). Reporting the drought support workers' experience. Paper presented at Wisdom from the drought: A consultative conference, University of Newcastle.
Judd, F., Jackson, H., Fraser, C., Murray, G., Robins, G., & Komiti, A. (2006). Understanding suicide in Australian farmers. Social Psychiatry and Psychiatric Epidemiology, 41, 1-10.
Kilkkinen, A., Kao-Philpot, A. O'Neill, A., Philpot, B., Reddy, P., Bunker, S., & Dunbar, J. (2007). Prevalence of psychological distress, anxiety and depression in rural communities in Australia. Australian Journal of Rural Health, 15, 114-119.
Horton, G., & McMichael, T. (2008). Climate Change Health Check 2020. The Climate Institute, Australia.
Summerfield, D. (2008). Proposal for massive expansion of psychological therapies would be counterproductive across society. British Journal of Psychiatry, 192, 326-330.