Mental Health and Financial Counselling:Building Effective Links

PROF BRIAN KELLYUNIVERSITY OF NEWCASTLE

• Rob is a 57 year old farmer living with his wife June on an isolated pastoral property in the north of the state.

• Rob had been worried about the financial status of the family property and he has made application recently for financial assistance in response to the drought through “Exceptional Circumstances” assistance.

• He has been talking with a rural financial counsellor, and recently with his bank manager about the property increasing debt level.

• His marriage has been under some strain for some time. June is now worried about Rob – he doesn’t get of the farm very often, and spends more and more of his time on his own on the property.

• He is drinking more than usual, and appears to have lost interest in the property and his usual social activities. He has trouble concentrating, difficulty making decisions, and has been avoiding the “pile of accounts” – “its all too much bad news”.

• A friend of Rob and June’s (a fellow farmer in the district) died by suicide 6 months ago and June is becoming worried about how Rob is coping.

• Financial Hardship and Mental Health

• Evidence from rural sector

• Model of partnerships/linkages between mental health and financial sector

• Challenges

• Impact of financial strain on mental health of individuals and families

• Impact of mental health problems on skills to manage financial adversity

• Rural financial counsellors: • Assisting people to adapt to realities of financial

situation• High level of mental health need among clients• first points of referral contact in primary mental

health care

• Window of opportunity for intervention

RFCs provide a unique blend of general counselling in addition to financial counselling. While this can fill a

social and emotional void … many Counsellors are not trained in this field

(Acknowledgement: Prof J Fuller, Flinders University)

•Local•Accessible•Knowledge of available assistance•Little embarrassment associated with use

To improve referrals59% thought referrals could be improved

Figure 2. Strategies to improve referrals

0 10 20 30 40 50

training

referral guide

netw ork w ith mental health/ other counsellors

formal referral process betw een organisations

more service in my region

number (3 responses/counsellor n=68)

(Fuller and Broadbent, Aust J Rural Health 2006)

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Building Service Collaboration to Support Early Identification and Intervention for Mental Health Problems

• 112 agencies from 149 identified (75%) completed a telephone-based survey.

• 70% indicated that two thirds of their clients were in need of assistance for mental health related problems.

• Agricultural support sector rated links with the health sector as less effective than did the health sector (p<.05).

• The most highly linked agency across all towns across all mental health exchanges came from agricultural support (rural financial counselor),

(Fuller J, Kelly B,et al, BMC Health Services Research 2009)

Funded by Australian Rotary Health Research Fund

NSW Farmers Mental Health Network • BLUEPRINT – 22 Key Action Areas

Pathways to Health

Pathways to Breakdown

Mental Health First Aid Training

NSW Farmers Mental Health

Network

External Factors

Isolation / loneliness

Alcohol misuse

Family Breakdown

Suicide

Access to Counselling

Building Social Networks

Raise Awareness = Reduce Stigma

Advocacy for Farm Support

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Farmers mental health – collaborating organisations

• NSW Farmers Association MH Network

• Anglicare• Australian Centre for Agricultural

Health and Safety• Australian Rotary Health Research

Fund• beyondblue• Black Dog Institute• Centre for Mental Health Research,

Australian National University• Centrelink• Centre for Social Research, Charles

Sturt University• Country Women’s Association of

NSW

• Department of Primary Industries: Drought Support Workers

• NSW Association of Rural Financial Counselling Groups

• NSW Farmers’ Association• Presentation Sisters Rural Outreach

Service• Rural Doctors Association of

Australia• St Vincent de Paul Society• Suicide Safety Network• Salvation Army• Wesley Life Counselling/LifeForce

• Building confidence and capacity– Mental Health First Aid Training

• Building collaboration between local services across health, welfare and financial support sectors

Local Mental Health Networks

• Planning workshops with wide range of agencies• Banks, accountants, RFCs• Vets, stock and station agents• GPs, community nurses• Mental health services

• What are the needs? • what resources do we have?• What are our experiences and roles? • How can we work effectively together?

Challenges

• Financial Sector• Confidence in knowing what to say and/or do• Role definition ..”but I am not a counsellor”• Understanding roles and pathways through health system• Personal strain of the role

• Health sector• Confidence in working with sectors outside health• Understanding of roles of workers in financial sector• Less accustomed to considering the importance of this “first

contact” role

Mental health help is wider than mental health services

• Local helpers will be used as first points of contact

• Local helpers are best included in the local system

• Inclusion by networks, training and protocols (guide)