Today has been a very cold, grey day, a day for introspection - or not, depending on what your introspection may lead to. I'm one of the lucky ones; I've noticed that the "indoorness" of winter days here does give you the chance to become more creative in some ways, not distracted by the spectacular natural world outside; things rise to the surface that might otherwise have remained squashed down by day to day life. Sometimes a good thing; sometimes less good.
So, what's been happening? I only started writing this post to keep my hand in, feeling that "absolutely nothing" was the probable answer, but realised as I did so that in fact there's been a lot going on - in many different ways and on many different levels.
A sense of some progress on the island has been marked by large bits of machinery arriving to clear the site for our new Bunkhouse, a funded project aimed at providing community-owned, up to date accommodation for visitors; it will be right by the campsite with views out over the bay and should have beds for up to around 20 people (http://www.isleofrum.com/blog-84-community-bunkhouse-project-takes-a-step-forward-july-2013). The diggers and tractors can be heard night and day, and ominous-looking smoke signals arise from the shore road where the huge tree trunks are being burned (although these are only a tiny proportion of all the trees on that site, thank goodness). Anyway, the new Project Manager for the Bunkhouse came over to get to know the island, and got stuck on Rum on his very first outing, as no boat came today. We were all rather incensed by this as we feel we've survived the gales and storms of December only to be refused a boat in much more "clement" weather, although of course, it's better to be safe than sorry. However, Rum people love a gossip and speculation abounds that it is a new "wussy" skipper who won't brave the admittedly choppy waters. "It was far worse than this when we came over before Christmas!" we complain, then speculate further that this is precisely why the former skipper has gone elsewhere - traumatised by the sudden turn at right angles out of Muck's dodgy waters and into the coastline of Rum with a westerly gale trying to shove the boat in exactly the opposite direction. I remember it well - at least my stomach does.
So the contractors were a bit desperate. One in particular was so dismayed by the weather, lack of TV and lack of - well, anything really that he's used to, that he waited for the school boat (a tiny little ferry bringing two of the teenagers back to the island for the weekend) and asked the skipper to take him back to the mainland.
On days like today I can't blame him. It seems to be about eight weeks max that we can enjoy Rum without feeling a pressing need to escape and see other places, other people, especially familiar people; people we love and who love us. I am still not able to get to grips with the total lack of sociable-ness the majority of islanders display (there are lovely exceptions and you know who you are), and was quite disconcerted when I realised last week that our newest resident, Debs, who has just moved up to join her husband, was the first person except for the Goddards to actually ask me to "pop in whenever I felt like it" for a cup of coffee/tea/something stronger. This affected me more than I like to admit, as I realised how lonely I had been feeling. But I know it to be a temporary situation, I am luckier than some.
Loneliness can go so much deeper. Our most recent copy of West Word, our local community newspaper, told us that a resident of neighbouring Eigg had been found dead, and we understand that he killed himself on New Year's Day. This terrible news - terrible for the islands as well as for his family - can't be glibly explained; I don't know the reasons why he killed himself, although I've since found out that suicide is more common in Scotland than elsewhere in the UK and more common in the Highlands (as a proportion of the population) than anywhere else apart from Glasgow. Men are at particular risk, and so are people who are poor, suffer from addiction, have lost their jobs or simply live somewhere where there are high levels of deprivation (http://www.samaritans.org/sites/default/files/kcfinder/files/research/Samaritans%20Suicide%20Statistics%20Report%202013.pdf). Whatever the reason, it prompted sombre reflections from other islanders writing in the same paper, our very own Fliss bravely noting that while outsiders may envy us for the beauty of our landscape and apparently idyllic communities, these cannot be taken for granted and may conceal hidden isolation, pain and loneliness.
My questions were of a different nature, my first thought being, well where would you go if you did need help? We are so lacking not only in medical, but also emotional and psychological support resources up here in the Highlands; and on the Small Isles we have only one locum (there was a three month gap between his last two visits to Rum). Mallaig itself currently has only one GP to cover its entire catchment area (around 3000 people), despite ongoing attempts to woo doctors to the practice. Nick Clegg's statement yesterday that mental health services in the UK must be transformed so that mental distress is given as much help and as much funding as physical illness, only drove the message home. Like many people I know I have suffered from depression and anxiety in the past (and am always vulnerable to anxiety), and apart from one very unusual exception, the service I received from the NHS was appalling, to the point where I would find it very difficult to seek out a doctor if it should happen again. One lady on a Radio 4 programme I was listening to described her experience of being passed from doctor, to A&E, to the police, and back to the doctor, with none of them having the time or understanding to actually listen to what she needed. And my experience is that doctors rarely have time or expertise to deal with psychological illness; their attitude often seems to be "if we can't throw a pill at it it doesn't exist." Only last year did the NHS in Scotland finally put in place a more coherent strategy for addressing suicide and depression (http://www.scotland.gov.uk/Publications/2013/12/7616), and services are just not joined up, even if they are publicised, which I haven't noticed so far.
The problems with suicide in Scotland have been known for a long time, so why does it take so long for things to change? Yes, rates have dropped since the introduction of the "Choose Life" project in 2002, but a recession can and does change that, with job losses and the resulting isolation and anxiety meaning far more people become vulnerable (I'm not making this up, have a look at the Samaritans website for more stats if you like that kind of thing). I did some research and found that searching for "mental health provision Mallaig" and similar, led to a page telling me to get in touch with my GP (what GP? see above) or dial 999 in the case of emergency, and failing this, the Samaritans. There was a page called "Who can I turn to?" but I found it addressed only physical problems... Why is there is no intermediate kind of intervention; no centres where you can just go to explore the options, talk to someone who understands what is going on? Why is our model of care always medical in the first instance, even though the new strategy notes that interventions must become "person-centred" and "compassionate" to be effective? (And seeing as we're in 2014, not 1914, one would think that being compassionate and "person-centred" towards people in distress would be a given...but clearly not.)
There are other ways. In Berlin there is an outstanding model of care known as the "Krisenberatung" (literally "crisis advice") - these are centres dotted about the city, each staffed by a small team of medical and psychological experts. Their role is not to judge or to medicate but to act as a net to catch those in danger of falling further into the psychological pit of despair, whether this be due to everyday anxieties, circumstances such as poverty or bereavement, a new situation (e.g. marriage breakdown, loss of a job) which someone can no longer cope with alone, or underlying disorders such as addiction, psychosis, schizophrenia or paranoia. The team listens to you, and can advise on next steps; if needed they can refer to a psychiatric hospital, a group or a clinic where further help can be obtained. They are free and open to all, and operate seven nights a week, that is, as an "out of hours" service for those who cannot or don't want to talk to their GP. They are funded by a partnership between the city government, the health system, and a number of charities such as the German equivalent of the Samaritans. I used this service on several occasions for various reasons (none of which required medical treatment as such) and was always overwhelmed by the team's compassion, common-sense and use of non-medical language to describe what was going on; their ability to engage with each individual, not just try to fit those individuals into a textbook description. This is so lacking in the UK; and yet, as the Radio 4 lady pointed out today, it's the lack of joined up care that is costing money, not its provision.
Maybe things are better in London where there is a greater number of people who work with different models of health and wellbeing, and more support groups. What is certain is that up here, where it is needed so desperately, there is very little help available (or if there is, why isn't it emblazoned in ten-foot-high letters on every information board and shop window?). One can easily feel that there is no-one to help, unless you are lucky enough to be able to talk to family or friends, which isn't always the case; sometimes people have no friends or family, sometimes they don't want to burden them, sometimes family and friends are not equipped to deal with the level of suffering that they are confronted with. Sometimes people don't know themselves what's wrong. Sometimes no-one ever discusses it; as on Rum where there is a bit of a culture that it's wrong to find things hard or scary; everyone knows who's alcoholic, or may guess at who's otherwise struggling, but how to talk about it?
We've been asked to give our views as to what we'd like to see in the way of medical provision up in Lochaber. Well, my vote will be for more support. It doesn't have to be a GP costing £75k a year, though that might be nice. Even more helpful would be some joining up of people who can provide a variety of services: support for carers, help with addiction, preventative screening through nurse clinics, wellbeing classes, forums where people can talk about their experience of life up here and what happens when you don't fit into the traditional community or don't feel that you do.
So I will get on and write a letter now. But everyone out there - if you get a chance to tell the government and the NHS what you think, please do. And a final word - none of this takes away from the beauty and wonder of the Highlands, or people's love for their communities; it would just be nice to have a little bit more support to be able to enjoy it.