THE stigma of suicide can silence generations.

When Alison Fairleigh was asked to speak at the Border’s Winter Solstice event, she didn’t automatically say yes.

The 2013 Queensland Rural Women’s Award winner wondered if she had something to say that people needed to hear.

Even though she has worked in mental health and suicide prevention for years.

At first she did not feel qualified because she felt she had not lost someone in her immediate family to suicide.

But she had.

Her grandmother took her own life when Ms Fairleigh’s mother was pregnant with her.

And Ms Fairleigh spent her childhood thinking she was to blame.

“My grandmother had lived with mental ill health most of her life,” Ms Fairleigh explains.

“She would have been diagnosed with bipolar disorder in the modern world and she had been institutionalised at various points.”

But because the death was talked about in hushed tones behind closed doors, the young Ms Fairleigh only gleaned bits and pieces of the story.

“It was so hidden,” she says.

“The way it had been communicated to me as a child, I thought my grandmother had taken her life because she was angry my mother was pregnant with me.”

That awful secret hung over Ms Fairleigh until she was in her late 20s when she had her first “real” conversation with her mother about the death.

“I was then able to understand it,” she says.

Yet it wasn’t until three men took their lives in the space of three weeks in a small community in north Queensland where she was working that Ms Fairleigh was galvanised into action.

“Two of them were known to me and I was responsible for the partial care of my students (at the agricultural college) and colleagues affected by the suicide,” she says. 

It was to alter the course of Ms Fairleigh’s own life.

She is now a passionate and pro-active campaigner for rural communities and their mental health.

What she has seen and learned out on the road, in paddocks, in farmhouse kitchens and school classrooms is that communities need to be empowered to care for themselves.

“I am deeply and acutely aware of the impact that suicide has in a community,” she says.

“When we look at how communities cope post-suicide, particularly rural communities, they want to stick their heads in the sand.

“Even though everybody knows, they want to pretend it didn’t happen.”

That doesn’t help anyone, according to Ms Fairleigh,

“It exacerbates, it frustrates and it intensifies the grief that families feel,” she says.

That’s why Ms Fairleigh decided she did have something to share with the Border community — with an event supporting those who have lost a loved one to suicide.

But, at the same time, Ms Fairleigh believes solutions and support need to be targeted to suit individual communities.

“Awareness is a word often bandied about,” she says.

“It’s a big word but we need to be a bit specific about the people who are suffering with this.”

And, while she acknowledges suicide does not discriminate, she says there are sections of the population at higher risk.

Like farmers.

“They don’t often have a lot of people out there speaking for them or trying to create awareness that they are a high-risk demographic,” Ms Fairleigh says.

She adds that men in their 70s and 80s are the highest risk for suicide in Australia, closely followed by men between the ages of 29 and 59.

There are many factors that can bring these men to that point — isolation, lack of access to services, stigma, male stoicism and attitudes around manliness, and financial hardship.

But Ms Fairleigh says what might surprise many people is that one of the biggest contributing factors to suicide in this demographic is the lack of a significant relationship.

“In post-interviews with families who have lost somebody to suicide the over-riding factor is there has been a relationship that has broken up,” she says.

“It can be a marriage, it can be a family that has been torn apart by succession planning, or lack thereof, or the lack of a relationship.”

This knowledge makes community collaboration and networking all the more important particularly in rural areas, according to Ms Fairleigh.

“We need it desperately,” she says.

“When you have people living in isolation or independently going about their business they can be particularly at risk.

“The kids might have gone off to university and there is only the husband and wife left on the farm struggling to cope with financial pressures.

“Men will go into a cave and they will stop talking and they will isolate themselves more.”

That’s where the community network has to step in.

“You need neighbours that are aware of what is happening and who can start to reach out and build those bridges and give people a break,” Ms Fairleigh says.

The other thing to recognise, she says, is the differences between how men and women communicate and support each other.

“People tend to think that men don’t talk together,” she says.

“They do talk, they just talk differently.

“They talk side by side.”

That’s why she says many counselling and mental health services are not truly accessible to the men who might be struggling.

“We expect them to come into a room and sit directly opposite somebody and pour out their innermost feelings in an environment that is already unnatural to them,” she says.

It’s why solutions to suicide prevention are more likely to be found quite literally out in the paddock.

“That’s why I talk so much about empowering communities to meet these problems,” she says.

“When we have people working collaboratively from all aspects of our community addressing the issue that is when we see the rates of suicide decrease.”

But it does require leadership.

“It requires just one person who is willing to step up to the mark and bring together medical services, doctors, community groups, business associations and school principals in one room and say we need a strategy for our community.”

That is often easier said than done when there is still so much stigma and fear around the subject.

Even the language discriminates.

“People still say things like ‘commit suicide’,” Ms Fairleigh says.

“Commit implies a crime or a sin … we have to remember these people were ill.

“We say people die of cancer or they die in a car accident.

“It’s OK to say someone died by suicide.”

But how do we get past the stigma?

Ms Fairleigh believes the best place to start is the funeral.

“We can still love and cherish that person’s life even though they died by suicide,” she says.

“It’s giving people permission to say they lived.”

That’s what Ms Fairleigh will have in her heart when she makes her address to the Border next weekend.

She hopes she can offer encouragement to the community to put in place solutions that are going to prevent the tragedy of suicide.

To prevent families having to go through what she has witnessed.

But she also wants to leave the Border with the message that we also need to celebrate the life of those we have lost to suicide.

“Celebration gives us a sense of hope and with hope then we can move forward,” she says.

“When there is no hope, then that is a very dark place for everyone.”

THE warning signs for suicide should be treated as a triple-0 emergency, says a GP who has spent nearly three decades on a personal crusade to stop its tragic toll.

Graham Fleming believes we solve the problem of suicide the same way we do coronary heart disease.

“We’ve had a campaign for at least 50 years now that if you have someone with bad central chest pain, you ring triple-0 and they are taken by ambulance to hospital because it’s a life-threatening illness,” he says.

“Well, if you think life is not worth living it’s exactly the same.

“You need to be taken to hospital or taken to a counsellor or taken to somebody to work out what’s going on and to sort out the problem.”

The South Australian doctor, who was awarded an Order of Australia medal this year for his work in mental health and suicide prevention, has proven he not only practises what he preaches … but that it works.

He will share those insights with the Border community as a guest speaker at the Winter Solstice for Survivors of Suicide event at The Cube Wodonga next Saturday night.

In the tiny community of Tumby Bay where he lives, some 600 kilometres from Adelaide, Dr Fleming embarked on what appeared an almost impossible project prompted by the suicide of a schoolboy in 1986.

In the 10 years to 1995 the district with a population of 3000 lost 12 people to suicide.

The no-nonsense, straight-talking doc was not going to stand for such a “shocking waste” of life and he embarked on a mission to stem the suicide rate.

What he learned and what he did became the basis of a thesis, complete with rigorous statistical analysis, which earned him glowing accolades from his peers.

But, much more importantly to Dr Fleming, it saved lives.

He is still saving them.

Interestingly, and perhaps a little controversially, Dr Fleming doesn’t believe suicide prevention needs lots of money.

“I think it needs people in the community who care,” he says.

“If you really want to stop suicide it has to be community owned and community driven.

“I sort of laugh at all these millions of dollars they throw at mental health.

“All it really needs is people.”

You also need somebody with the enthusiasm to drive such a campaign.

Dr Fleming is one of those people.

Yet the path that led him there was, by his own admission, “all very bizarre”.

“I started out of medical school with no psychiatric training and ended up in one of the most isolated towns in South Australia, which was full of misfits,” Dr Fleming says.

So my first three years of practice were at Leigh Creek in the middle of nowhere and all the problems I had to solve on my own.

“I did all my psychiatry on the job.”

Then when he moved to Tumby Bay and a 15-year-old boy committed suicide, Dr Fleming knew something had to be done.

“When I looked back I could see the warning signs because I understood mental illness better than my colleagues at that stage,” he recalls.

“I said ‘we need to get help for these people with depression before they kill themselves’.

“I went around taking people off valium and putting them on anti-depressants and they actually got better, which was a surprise to everybody.”

Dr Fleming also went into the local school and worked with the principal and teachers to spot at-risk children early.

“In the end the teachers actually got very astute at picking these kids up,” he says.

“We had everybody looking out for these kids and turning them all around.

“It was just amazing. That was early intervention at its very best.”

However, when a popular local teacher and friend of Dr Fleming’s took his life out of the blue, it shook his resolve to the core.

It made him question his work and pushed him to the brink of giving up on general practice. Obstetrics, he thought, might be the go.

But the then principal of the school and director of nursing sat him down and urged him to continue and told him they believed he was on the right track.

And they offered to join Dr Fleming in his quest.

The upshot of that was the realisation more people needed to be trained to recognise the warning signs and look out for each other.

“We are all our brother’s keeper,” Dr Fleming says.

“And whether we like it or not we have a responsibility to do that as human beings.

“That might be a grandiose idea but it’s one of the things I sold to our community.”

So Dr Fleming soldiered on and worked harder and longer hours.

He had already been working on the premise that if we find depression in the community and fix that, then maybe we can cut the suicide rate.

But he broadened his focus to mental health and set about educating his community to look after itself.

He reckons you can teach most people to understand the difference between poor mental health and good mental health in less than an hour.

“Once people have some understanding of poor mental health and they are not scared about it, then we can tell them there are remedies for these problems,” he says.

“We need to teach people and communities suicide is not an option, that what they are feeling is a sickness.

“If a neighbour has bad chest pain you are going to dial triple-0 and get an ambulance and get them to hospital.

“If people are going to talk about suicide or you have a change in personality, they withdraw or start to drink excessively then you’ve got an obligation to get them help.”

In addition to educating people, they also need to be trained, according to Dr Fleming.

“My wife used to be a teacher; I said we don’t need teachers here, we need counsellors so she went and did some training and became a mental health counsellor,” he says.

“We need all those supports and services.”

And you’ll find many of the resources already exist within communities, he says.

Like retirees, for example; retired teachers that could go back into schools to do reading recovery or listen as counsellors.

Nurses who understand mental illness and GPs also have a very important role to play, he adds.

Dr Fleming is certainly proof of that.

“I’m not a religious person but I am quite a spiritual person and I believe we have all been given gifts,” he says.

“And we are expected to use those gifts.

“My ability is as a good communicator which is a very useful asset as a doctor.”

Being a good communicator is one thing; getting people to listen is another.

Dr Fleming says he has found the best time for a community to listen is after suicide.

“Everybody wants know why and everyone wants to understand,” he says.

What Dr Fleming wants everybody else to understand is people have to be picked up before it’s too late.

“Suicide is just one awful waste,” he says.

“It’s not only a waste of that life but the lives of everybody else who is grieving.”

And in his 40 years of general practice he has not learnt to cope with adolescent or childhood death for any reason.

“These are kids with maximum potential who are no longer here,” he says.

“We need to make sure this person’s life is worthwhile by stopping other deaths.”

That’s why he is an advocate for events such as the Border’s Winter Solstice evening, which he believes is an important rite of passage in grieving.

It’s an opportunity for people to gather in mutual support but it’s also an opportunity for people to be given easily digestible messages to take home with them, Dr Fleming says.

And perhaps one more life can be saved.