SUICIDE in RURAL & REMOTE AREAS of AUSTRALIA - Living is for ...

64
Suicide in rural and remote areas of Australia
Case Study 3: Male Agricultural Worker
The deceased was in his forties at the time of his
death. He died from an overdose in his car. He
had been living with his mother. He had a Year 10
education and had been employed as an agricultural
worker for a few months before his death.
Psychological autopsy interviews were conducted
with his mother, psychiatrist and mental health case
manager, a psychiatric nurse.
He was divorced; his ex-wife had custody of his two
children. They had ongoing arguments which greatly
upset the deceased. He worried that his children
would “think he was a loser”; however, while his
daughter did not want much to do with him, his son
had visited happily during the holidays. The deceased
would often get into depressed moods after talking
with his ex-wife; his mental health case manager felt
that the divorce was “the backbone of his problems”.
His ex-wife gave him “mixed messages” about the
status of their relationship and there were ongoing
maintenance and custody issues. Every time he had
contact with her, his self-harm and suicidal ideation
would become more acute; these negative thoughts
were “so damn hard to shift”.
In the past, the deceased had issues with alcohol
and drugs. When he met his case manager, he was
seriously abusing alcohol, taking amphetamines
and “taking whatever he could get his hands
on”. After crashing his mother’s car, he moved to
another town and “sorted himself out”. When he
moved back to his mother’s house, he started
drinking again but did not seem to take drugs
anymore. The deceased was trying to get his life
back on track. He was in contact with a former
mentor which seemed to be a positive relationship.
However, in the six months prior to his death, the
deceased appeared in court as a result of his car
accident as he was driving while intoxicated.
The deceased’s mental health affected his
employment. He could fi nd work easily but could
only manage a few days at a time before he’d
become paranoid and “get quite stressed” and have
to leave the job. It was felt that while the deceased
“was a nice bloke... [he] would get himself into all
sorts of dramas before he knew it”. However, at
the time of his death, he’d started working out in a
gym, trying to become fi tter so he could get a job
in the mines.
The deceased was diagnosed with: bipolar disorder,
according to his mother; chronic dysthymia, major
depressive disorder, borderline personality disorder,
alcohol dependency and amphetamine abuse,
according to his psychiatrist; and, depression
and chronic impulsive suicidality, according to his
mental health case manager. The case manager
did not agree with the borderline diagnosis as the
deceased “had a lot of warmth about him...did have
a lot to offer”. The deceased saw many GPs and
psychiatrists over the years and his medications
were always changing; he was admitted to different
hospitals and mental health units over the years.
However, both the deceased and his mother liked
his mental health case manager; the deceased
would always attend his scheduled appointments
and was always there for home visits. However, the
case manager reported that he had to chase up the
hospital for different reports or information whenever
the deceased was admitted to hospital. The
psychiatrist believed the deceased was not always
compliant with his pharmacological treatment and,
a few days before his death, stopped taking all his
prescription medication and began self-medicating
with alcohol and non-prescription drugs. The case
GriffithBook FINAL 20/09.indd 64
15/11/12 4:28 PM