Drought, drying and mental health: Lessons from recent experiences for future risk-lessening policies

Rural and Indigenous communities in many regions of the world are bearing the brunt of early human-induced climate change. The dust has, at last, begun to settle on the primary debate over climate change and its human input. However, as global climate change progresses over coming decades, dust, smoke, flames, water and wind will impinge more damagingly on many of Australia's rural and remote communities. Property, harvests, incomes, jobs and community vitality are at risk. More troubling, there are great risks to physical and, in particular, mental health. Dorothea Mackellar, penning her homesick poem in London a century ago, was right: Australia is a land of droughts and flooding rains. But now there is more. Human-induced climate change will not just raise the average temperature; it will bring a more variable climate. Droughts, floods, fires and storms will tend to become more severe. And as the world warms the high pressure, low rainfall, band that naturally runs west–east across the central desert region of Australia (the meteorologists' ‘sub-tropical ridge’) will slowly drift towards the south. This, in turn, will displace southwards the rain-bearing weather systems that come from the west and that ‘water’ the rivers and farmlands of southern and south-eastern Australia. Australians have weathered a tough decade of drought and a dramatic year of floods. While city-dwellers have adjusted to brown front-lawns and unwashed cars, the impacts of the recent long and severe drought in many rural and remote regions have been more fundamental. Always more elusive than physical injury and organic disease, and therefore often underestimated in the health system's case-counting, the mental health impacts of drought now loom increasingly large on the Australian landscape. The manifest mental health stresses due to drought should help bring this general category of health risk into sharper focus. This might provide some comfort, albeit cold, to the clinical practitioners, service-provider agencies and researchers who have long struggled against the underrecognition of mental health. Indeed, there are hopeful signs that authorities and professionals are beginning to see, more clearly, that the amelioration and management of the adverse impacts of drought cannot be based on financial relief. The problem is essentially ‘human’; it extends well beyond economic stress and material loss. The challenge – and its extension into a future more drought-prone world – is to understand the extent, nature and distribution of these risks to mental health. In this issue of the journal are four papers that will help us to understand that challenge. They are a set; not just a collection. They all seek to learn from the recent drought experiences of New South Wales' rural and remote communities – rural communities at large, older farmers, younger people and Indigenous Australians. The studies are not of the case-counting and case-explaining epidemiological type. Their emphasis is on understanding people's drought experiences; testing community-level interventions; exploring the concerns, fears and anxieties of the old, the young and Australian Aboriginals; and clarifying the short-comings of some of the forms of support that were on offer from governments and community agencies. The leading paper, reporting a study of a community-development intervention in rural communities (the Rural Adversity Mental Health Program), provides encouraging evidence that a combination of mental health literacy, enhanced social and service provider networking and activity, and education about coping with drought can engage whole communities in collective response to the threats posed by drought.1 This type of program lays important foundations for building greater long-term resilience, that is, more health-protecting social capital, in those communities. That core community-oriented program, as shown in the additional three papers, can then be attuned to the circumstances and needs of major population subgroups. The second study evaluated the experiences of 150 older NSW farmers.2 It found that, although they faced the same drought-related pressures as their younger peers, their difficulties were compounded by the constraints of ageing, by seeming to fight a losing battle to cope with rapid social and agricultural changes (including the perceived high-handed imposition, by government, of new procedural demands on farmers), and by the draining experience of a pervasive sense of loss. Further, many of them were reluctant to use mental health services that lacked a familiar, simple, setting with the human face of known and trusted providers. The third study sought to understand the experiences and feelings of young people.3 Six youth and community forums were conducted, and from the discussions it emerged that many young people harboured private mental health difficulties, and many worried about the impact of drought on their families, communities and futures, both economic and social. Other research in Australia has shown the particular form of anxiety and post-event mental trauma in children associated with extreme climatic episodes and the great importance of children's social connectedness.4 The forums revealed a need for help in relation to immediate worries, including a more coordinated support system within rural schools, more information about mental health and where to go for support for themselves and their friends – from people who really understand drought and rural circumstances. School-based mental health programs, usually developed in metropolitan settings, need to be adapted for use in rural schools. The fourth study explored the experiences, needs and wishes of Indigenous Australians in rural NSW.5 Via the voluntary participation in group discussions by Aboriginal people, service providers and other local stakeholders, it emerged that the recent drought had adversely affected Aboriginal social and emotional well-being – by disrupting culture, exacerbating money pressures and causing a sense of loss, particularly in relation to the land. Much evidence shows that the experience of caring for the land improves well-being and health in Aboriginal communities, and one positive outcome of the drought, revealed by this study, is a heightened commitment to care for the land. The challenge, of course, will be to work collectively to ensure that this renewed aspiration, and its support by the wider Australian community, endures and prospers. If so, then a greater appreciation by all parties of the benefits of culturally attuned well-being programs, along with the ideas and energies arising from Aboriginal Dreaming, can nurture within Aboriginal communities a greater connectedness to land, to each other and to other Australians. Each of these four studies indicates ways that communities, service providers, practitioners and policy advisors can more effectively and sensitively respond to the immediate needs of affected communities and groups. The studies also point to the general need (a need that is commanding more of our attention these days) for understanding in terms of human ecology the threats, anticipations and impacts of changes in the climatic and environmental conditions of rural and remote ways of living. Understanding, that is, how whole groups, communities and cultures are affected by changes in climatic, environmental and living conditions. Such understanding can greatly enhance how we plan for the future. That planning will seek to boost the resilience of communities, to minimise differences in subgroup vulnerabilities, and thus to lessen the threats to well-being, health and life otherwise posed by anxieties, depression, post-traumatic stress disorders and, tragically, suicidal thoughts and acts. The set of four papers herein provides timely insights as to how we should think about and plan for that future – a future which, in so many ways, will differ from the past.