It may sound crazy, but the best mental health service in many rural communities is the local football club. Hundreds of people in rural communities — gatekeepers, coaches, canteen workers, scorers, umpires, players and the kids walking the boundary with the raffle results — enjoy the benefits of rural football.
Rural football clubs are important community institutions. They unite many people, particularly during hard times. To have somewhere to go, someone who expects you to turn up on time, and someone to share your troubles with, and help you forget them, is invaluable. These people help to keep us healthy, both physically and mentally.
But football is not always associated with healthy activities. Last week a front-page story reminded us how our footy culture promotes the misuse of alcohol. Many rural football clubs now promote a culture of responsible drinking.
With the responsible serving of alcohol, rural football clubs are creating friendly environments for families. They provide a sense of belonging, friendships, self-esteem and fun. This helps us to develop the strength and resilience to deal with stress.
We don’t usually think of local football clubs as community mental health services. We have come to associate mental health services with professionals who provide treatment for people with mental illness.
For the most part, the focus of community mental health care is on providing “sick care”, not “health care”. The distinction between “sick care” and “health care” is an important one. In many respects, the distinction determines the way health resources are allocated.
Historically, our health care budget has been spent mostly on sick care. Yet the decline in mortality over the past century has been due to improvements in diet, employment, education, living conditions, sanitation and medical treatments. Medical treatments are only one part of the equation.
Similarly, medical treatments are only one part of the equation in improving mental health. Although people with a mental illness often benefit from medical treatments, social, economic, cultural and environmental factors also play an important role in helping people with a mental illness to get well and stay well. A home, family, friends, employment and meaningful activities, such as a community coming together to organise and play football, are just some of the things that help to keep us all sane.
Here lies a contemporary quandary: both mental illness and mental health are now treated as medical issues. This medicalisation of mental health is utter madness. Although evidence supports mental illness being treated medically, mental health is often a social issue.
Many of us experience stress during our lives. We may experience relationship difficulties, grief, loneliness, sadness, unemployment, drought, bullying, poverty, domestic violence and traumatic childhoods.
When these problems are treated medically, people are treated with medication, counselling or perhaps cognitive behavioural therapy. Although these treatments may be helpful for some individuals, they do not change the underlying social conditions that cause the distress.
As a community, we need to decide whether the promotion of mental health is primarily a medical issue. Or is it also a social, economic and environmental issue? Do we need more funding for community sports clubs, or the prescription of more antidepressants?
We are often told that one in five Australians will experience some form of mental illness. According to this statistic, the majority of Australians (four out of five) will not experience any form of mental illness. However, five out of five Australians are likely to experience some form of relationship difficulty, grief or sadness. These problems will probably cause some form of mental or emotional distress. But will medical treatment be necessary? Or will our friends, family and our community provide enough support?
Providing additional resources for the promotion of mental health may be a cost-effective way of preventing episodes of mental illness.
First published in The Age on 31 July 2007