Mucking in to save a life

A farmer is
shunned by his local community due to the effects of depression and fails to
look after his animals properly. In his isolation he attempts suicide. Chris
Coates (left) tells Graham Hopkins how joining the farmer in the fields helped
him regain his self-respect

Craig
Marston (not his real name), a farmer from a well established farming family,
was referred to the national lottery-funded Rural Emotional Support Team on its
first day of existence. He was in serious trouble. His erratic behaviour and
history of mental health problems had seen his family exclude him. Also, like
the agricultural community at large, he had refused support from health or
social services.

“Farmers
are very proud people who have their own culture,” says Chris Coates, co-ordinator
of Rest. “Because of the isolated manner of their work, they don’t want outside
help. They value and respect each other, so once shunned by that community
where does (Marston) get that respect from?”

It was this
lack of respect that Coates set about restoring. Marston was due in court
facing possible imprisonment for, among other things, cruelty to animals and
non-payment of fines. “When we went to find him,” says Coates, “we didn’t know
where he was in this village. People just said ‘Oh the lunatic – he’s up the
road. What do you want to do anything for him for? – he’s a pest.’ They’d made
their judgments. But we hadn’t.

“He
wouldn’t comply with Trading Standards – and incurred fine after fine,” adds
Coates. “But they lost the plot also. All Trading Standards could see was that
he was not doing what he had been told. The RSPCA turned up one day and shot
his animals – some of them in front of him. But these animals were also his
friends, his company. He attempted suicide.”

Coates,
while attempting to convince Trading Standards, RSPCA and the police to  view Marston differently, set about gaining
Marston’s respect. Coates’s own agricultural background helped as did his
willingness to work the fields – and know what he was doing. “We talk his
language,” he says. “One day I used a word – I think it was ‘therapeutic’ – and
he just looked at me as if I was talking Swahili. You’ve got to talk to people
at their level – in a way they understand.”

The court
case was very humiliating for Marston – his name and photo made the paper.
“This just isolated him more and more,” Coates recalls. But despite the loss of
his house and what little livelihood he had, previous suicide attempts and the
killing of his animals, Coates was convinced that Marston should stay out of
care and in his caravan.

“We stood
for hours with him in the fields – in the freezing cold. We spent time with
him. We weren’t going to bring police in and arrest him as had happened before.
We spoke to police and said ‘hold on – this is the real situation, not what had
been said by villagers.’

“We want
him to have the life he wants. However, there are boundaries to this. We said
he’s got to start talking to Trading Standards – not shouting at them. And keep
his appointments. He has to face up to his responsibilities. Sometimes that
means going back to his caravan upset. And that’s the risk we take – what’s he
going to do when he’s there? Especially when he looks out on an empty field.

“But we
give him reassurances,” continues Coates, “we say that we will be back tomorrow
– we are his friends, we’re not going to judge him. We’d have hours of crying
and extreme upset and threats to kill himself and so on. But we were there. We
were there to listen to him.”

The risk of
keeping Marston in the community, for Coates, diminished quite quickly. “We
talked to him like a human being for starters,” he says, “and we explained what
the symptoms he displayed were. And so we looked at ways he could cope with
that and, importantly, what he can do to help himself.”

It certainly
wasn’t a one-way furrow being ploughed: “He has tested us,” admits Coates.
“He’ll say he wants this and he wants that. And sometimes we’ll say ‘yeah,
fine’. Other things we’ll say ‘no’. But we explain what we won’t or can’t do
and we won’t leave until he understands why. He understood we knew what he was
going through because we were speaking the same language as him.”

The reason
Marston hasn’t made any suicide attempts since Rest has been involved is clear
to Coates: “We have given him back his self-respect by showing him respect –
which is something nobody else has really done.”

Case notes:

PRACTITIONER:
Chris Coates

FIELD:
Co-ordinator of the Rural Emotional Support Team (Rest)

LOCATION:
South Staffordshire

CLIENT:
Craig Marston (not his real name) is a 63 year-old farmer from a large and
well-established farming family.  He has
been variously diagnosed with severe depression and schizophrenia.

CASE
HISTORY: Marston was admitted to a psychiatric hospital about 20 years
ago.  Shunned by his family, he later
resumed farming, but this failed.  Three
years ago he bought a house with some land and began to take in sheep.  However, he had clearly lost the rationale
for farming and began buying old ewes that he felt sorry for.  Unable to afford to keep them properly, they
began dying.  He didn’t dispose of them
properly. Neighbours reported him and over 18 months a case was built up to
prosecute Marston for cruelty. He moved into a caravan – which even his sheep
stayed in.  Nobody recognised the mental
health problems.  

DILEMMA:
The loss of his animals and licence to farm could undermine attempts to
encourage Marston to take responsibility for himself.

RISK
FACTOR:  Marston has attempted to take
his own life in the past and events could prove too much for him if left in the
community.

OUTCOME:
Although banned from farming for 10 years, Marston’s quality of life continues
to improve with strong support from Coates and his team.

Arguments for risk

– For the
first time Marston has been actively engaged by a mental health support service
and has been responding positively.

– Marston’s
positive response was, in part, a reaction to the non-traditional health or
social services model of support being offered, and, crucially, because he felt
that Coates, given his rural background, understood his situation.

– Coates
and his team were not prepared to judge Marston on his history or the picture
painted by family and neighbours.

– Since
Rest’s involvement with the case, Marston has kept appointments. Therefore,
Coates was confident that he was taking responsibility.

– Having
managed to achieve the support of the main players – police, Trading Standards
and the RSPCA – in viewing Marston’s situation as a whole, including his mental
health needs, Coates successfully eased the array of pressures that caused
Marston’s anxiety and fears.

Arguments against risk

– Farmers
have one of the highest suicide rates in Britain (which was the case even
before BSE and Foot & Mouth) – a fact that is underlined by their work and
lifestyle being characterised by isolation and stress.

– Marston
had been shunned by his family and friends. He had lost his farms, most of his
land and his house in order to pay debts. He had nothing except his animals and
his farming – but then both of these were taken away from him. He had made an
attempt at suicide previously and talked about taking his life.

– His
experience of health and social care support had been a very negative one.
Sectioned and admitted to large psychiatric hospitals he received no support
once he was discharged. If he raised mental health issues he feared being
“carted away and locked up again”. This might cause him to consider a more
drastic option.

Independent comment

The earlier
mental health experiences that Craig Marston suffered are reasonably common,
writes Dr Eric Davis.

Craig
Marston displays a classic profile of a farmer who is at moderate to high risk
of suicide due to a range of clinical and actuarial (for example, age, race and
sex) variables. He is also at higher risk because he is male, white, unmarried
and living alone. In addition his recent job loss and depression add to this
risk.

Chris
Coates’s team has done a very good job of assertively engaging Craig Marston.
The Rest team met Marston on his own territory, as opposed to Marston having to
leave his community and enter a psychiatric environment, such as a day centre
or hospital.

Also, the
credibility of Coates and Rest with their rural background, will have helped in
the rapport-building with Marston. The practical nature of the support is
important. Although a mental health problem has been identified, Coates and
colleagues have successfully encouraged Marston to face up to his
responsibilities. This maintains and augments flagging levels of self-respect.
Because Marston has valid goals to aim for, this will, in turn, be expected to
help counter clinical depression, and its deadly counterpart hopelessness,
virtually a constant feature in completed suicides.

The Rest
team should continue their excellent inter-agency liaison work, judging by
their record of work with Trading Standards, RSPCA, and the police.

Dr Eric Davis is consultant clinical psychologist,
East Gloucestershire NHS Trust.