Happy Christmas? Not for everyone

Melissa Petrakis

Dr Melissa Petrakis

By Melissa Petrakis

Comparison to other family members, and to peers of a similar age who appear to be more successful in work and relationships, is also felt very strongly as the end of the year approaches. At this time people reflect on what has been gained and lost over the year and whether they are where they ‘should’ be or thought they ‘would’ be by now in their lives.

The problem is exacerbated by the fact that many staff working in support and treatment services also take leave over late December and early January. This means that professional help is less freely available for people requiring assistance to get them through stress when it arises during this period.

Depression and suicidality are closely linked, however most people suffering depression are not actively suicidal. This makes detection of suicidal thought tricky since, at the time of engaging in a suicide attempt, people are typically suffering from depression that has crept up on them gradually or that they do not themselves recognise as depression, let alone a severe form of the condition.

As part of my doctorate I worked as Project Manager and one of two Senior Clinicians conducting the Western Area Suicide Prevention Strategy at Western Hospital, a Department of Health and Ageing-funded National Suicide Prevention Strategy innovation project. Many people I worked with during my research said they were ‘very tired,’ ‘more sad than usual,’ ‘very grumpy and irritated with everyone,’ or ‘not very optimistic or positive anymore’. Many did not have a personal or family history of mental illness. They did not describe themselves as ‘depressed,’ and so did not reach out for help available.

It is worth remembering that the things that make a difference in reducing depression are, for the most part, the same things that sustain us all and improve quality of life in general: exercise, support, fulfilling work, relaxation, good nutrition. When improvements in these factors don’t help shift depression, quality professional counselling and medication can lift mood and assist a person to raise their head out of the dark fog they feel they are trapped in such that they can reassess and make choices and make small steps forward again.

However, there continues to be stigma associated with any mental illness, including depression, even with the excellent consciousness-raising of initiatives like beyondblue. We think of it as a particularly Australian trait to be stoic and just get on with things, and that for men in particular it is a sign of weakness to reach out for help. In fact though, internationally, most people still feel embarrassment regarding mental illness; they fear that things might be even worse than they imagine if they open the ‘can of worms’ of their emotions, and there is social stigma and a sense of contagion whereby if they admit to mental health problems they will shame family and friends.

Although we know that depression care is effective in reducing suicide rates, studies have shown that only 28 per cent of depressed people actually talk to their general practitioner about their depression and access help available.

According to the Australian Bureau of Statistics there are at present more than 2,200 suicide deaths annually in Australia. It is important to acknowledge that there has been a drop in suicide rates in Australia since 1998 thanks to a combination of factors, including 15 years of our National Suicide Prevention Strategy, firearm reduction measures, and the increased connectivity people experience with widespread mobile phone use. Nevertheless, perhaps it is time to re-invest in and re-invigorate our national response to suicide prevention.

Relationship conflict is a key precipitant to self-harm, and I believe we need to develop stronger links between clinical services and relationship counselling and family support services. Further, patients should receive at least three months of intensive support following a suicide attempt, with a further three to six months of less intensive follow-up for those with identified challenges in problem solving, with co-occurring physical health problems, and/or with relationship issues. For those people with a diagnosed psychiatric condition who are suicidal, management of risk needs to be longer-term and is best when coordinated through the mental health service in their local area.

Untreated depression is debilitating to those suffering, and the experience is a remarkably isolating one that strips people of their usual coping skills, confidence and capacity to hold on to hope. The experience of losing a loved one to suicide is devastating for a family, leaving so many unanswerable questions in its wake. In the true spirit of Christmas, this next couple of weeks is an important time to let anyone we know who may be struggling that we care about them and that to access professional help is in fact a demonstration of bravery and wisdom.

Dr Melissa Petrakis, is a Lecturer in the Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, at Monash University and Research Fellow, St Vincent's Mental Health Service.