After the funeral, when the flowers stopped arriving and everything went quiet, Kim Edgar took an axe to the hibiscus outside Dan's bedroom window.
Its trunk had cracked down the middle the week before Dan died by suicide at the age of 17 in 2018.
Kim had gripped the axe and thrown herself into the bush, tearing apart its dry branches, and ripping out its damp roots.
It felt good, she thought.
Gardening gave her something to do, a distraction from the anger and sadness that had calcified into a never-ending stream of retrospective questions: what if I'd been home more, should I have asked different questions, should I have hugged him more, hugged him less?
How do you keep going after a child dies?
'He should be there'
Two years after Dan died, five boys aged between 15 and 17 died by suicide in the regional city of Geelong within a six-month period.
One of those boys was Tom Barnett.
Tom struggled with "usual teenage stuff", his mum Catriona Barnett says, but nothing out of the ordinary that she knew of.
She cries easily when she speaks about Tom, her grief simmering close to the surface.
It's the absence of milestones her son will never reach that sting when she sees other young people growing up and enjoying their lives.
"He should be there, he should have been part of those things," she says.
The 2020 deaths came seven years after a 2013 inquest into the suicide deaths of three other teenagers.
It found systemic issues with data collection and communication between agencies contributed to a weak public health system.
Psychiatrists and parents of those who have lost their children since fear not much has changed.
And that despite the attention on mental health over the past 30 years, gaps in the system are exacerbated across regional and rural Australia.
'Real-time data means knowing what's happening every day'
Professor Ian Hickie, from Sydney University's Brain and Mind Centre, has been at the fore of research into Australia's mental health systems for more than three decades.
He says despite huge leaps in technology, there's been little political will to invest in suicide surveillance to the extent recommended by the coroner in 2013.
But there have been moves towards a better system.
In 2019, the federal government gave the Australian Institute of Health and Welfare $5 million a year over three years to create a National Suicide and Self-harm Monitoring Project.
It's been funded another $4.2 million per year between 2021-22 and 2024-25 to keep the project going.
It's Australia's most comprehensive public resource data and information on suicide and self‐harm, according to University of Melbourne researchers who completed an evaluation of the project in June.
They noted suicide and self-harm data was helping at a broad level, and was used by some government departments when making decisions about COVID-19 lockdowns.
But they made a raft of recommendations, including how data could be shared more quickly and locally for tailored responses on the ground.
They also recommended new technologies be funded "to improve closer‐to‐real‐time detection of unexpected increases of suicide and self‐harm" and ultimately to inform and prompt local service responses.
"Surveillance means real-time data, it means knowing what is happening every day and every week in the communities in which you live," Professor Hickie says.
"And if there is a significant outbreak or a significant change, that you get local responses.
"We've never had the infrastructure in mental health and suicide prevention for that degree of local and real-time surveillance to inform local and coordinated responses."
In 2014, the coroner recommended local community response plans be in place for when a youth suicide occurs.
Without local responses, the findings say, "it is difficult to fathom how how suicide reductions will be achieved in the short or long term".
Regions struggling with 'elevated barriers to help'
Megan Turner says young people in Geelong aren't struggling with anything outside the norm.
She's worked as a child and adolescent clinical psychologist in Geelong for six years and says anxiety, relationships, social media, body image and trauma reach into all communities.
But the service responses, do not.
People in regional Australia, "are struggling with elevated barriers to getting help", Dr Turner says.
"Less infrastructure, fewer services, not enough psychiatrists."
Until last year there was only one headspace office in Geelong. Another opened in Ocean Grove and funding was committed for a third in Armstrong Creek.
While Dr Turner and Professor Hickie say it's great to see the investment, they echo each other's concerns that it's only one part of a complex puzzle.
"A lot of the people at headspace are great at diagnosing but they can't write prescriptions, they can't write the documents for the NDIS or disability support because you have to be a specialist," Dr Turner says.
"So they are put on waiting lists to see specialists, and it creates a backlog."
A spokesperson from headspace says it provides tele-psychiatry to young people in regional and rural areas where there are few working psychiatrists, who can advise on prescriptions to a GP.
They also say headspace GPs can prescribe medication, but not all headspace clinics in regional and rural areas employ GPs.
The lack of psychiatry services is worse in regional centres than metro, and worse still in rural areas.
Data from the Australian Institute of Health and Welfare shows that in 2020, there were 20 psychiatrists per 100,000 people in Melbourne.
That fell to eight in Victoria's inner regional centres, and two in the state's outer regions.
In NSW and South Australian regional centres, the figures were even lower.
In most remote and very remote areas, there were none.
And the number that specialise in youth mental health are few and far between, Dr Turner says.
It's a time-consuming professional avenue to go down, she says, requiring contact with a child's parents and visiting their school, and you can't bill that time because Medicare only covers the time the child is a therapy session.
"The medical system is set up for physical problems, not mental health issues," she says.
The lack of communication and coordination between federal, state, and local healthcare providers creates a fragmented system that is difficult to navigate, she says, leading to duplicative services, gaps in care, and confusion for consumers and providers.
"There has to be a way for that to change."
'Too sick' for hospital care
All of this comes as no surprise to Tara Gersekowski whose daughter Willow died by suicide last year aged 21.
Willow was diagnosed with borderline personality disorder and autism as a teenager and had been in and out of psychiatric wards for years. She had been on medication and seen dozens of counsellors, but her mental health continued to decline.
There was one psychiatrist she clicked with, Tara says, he understood Willow's autism and found ways to help her communicate, but then he left town and Willow darkened.
Her family wanted her kept in Geelong's psychiatric unit The Swanston Centre, but she was discharged twice because she was "too sick".
Willow made multiple attempts on her life while in the centre and had self-harmed, Tara says.
"I don't know how you can be too sick to be in the psych ward. But that's what I was told. Come and get her she's too sick to be here," Tara says.
Barwon Health's mental health director Steve Moylan said he could not comment on specific cases, but that hospital admission was not always the best option for people.
"Decisions regarding mental health inpatient care (including admission, discharge and how long a consumer stays in hospital) are undertaken by our clinical teams in collaboration with consumers and carers, taking into account factors such as the person's presenting mental health diagnosis and treatment pathway," he said in a statement.
Professor Hickie says he still hears stories every day "of people being told they're not sick enough to get care or tragically they're too sick to be cared for" because the mental health system is so under-resourced – there aren't enough specialists to meet the needs of patients and the specialists who are there are quickly overwhelmed.
This "missing middle" was identified over and over again in Victoria's 2019 mental health royal commission.
The state government's most recent budget allocated a record $3.8 billion in mental health and has committed to implement all the commission's findings.
A spokesperson for the state health department says it is making sure tailored care is "available to every Victorian who needs it, with dedicated hubs across the state". They pointed to the establishment of a five-bed hub at University Hospital Geelong and six-bed hubs at St Vincent's Hospital, Monash Medical Centre and Sunshine Hospital, which are up and running.
Effective intervention for children 'never developed'
For more than 35 years, Professor Hickie says he's watched successive state and federal governments deny Australians the services they need to recover from poor mental health.
He's sick of announcements about years-long construction plans for a few more beds to be added to a hospital.
He's tired of gaping holes in the number of services available in rural and regional communities being filled with social interventions like sports programs because no-one is putting the money and effort towards professional, medical support.
He agrees social interventions play a role in helping young people with loneliness and isolation, but says they are often used as an excuse to not invest in more psychologists and psychiatrists at the community level.
"Effective intervention for children is something we have never developed," he says.
"We don't need a construction boom, we need a services boom."
In June, the national healthcare index found of 11,000 Australians waiting for mental health care, more than two-thirds are waiting at least three months.
"We have more press releases than real action," he says.
For Professor Hickie, real action is the boring stuff no-one wants to own. It's organising responses in Australia's regions, it's taking responsibility, it's collecting data. It's long-term and it's expensive.
But critically, it's increasing specialist services. There are a lot of doors to walk through, he says, where someone can be assessed for what service they need, but there's no increase in the actual services provided.
The ones that are there are choked with waiting lists and reliant on workers who often realise they'll make more money and work fewer hours in the private sector in inner-metro suburbs.
Maybe, for someone, it helps
One service that's helped parents in the wake of teen suicide in Geelong is Hope Bereavement, a non-profit organisation of counsellors that are available to anyone who has lost someone to suicide for as long as they need.
It receives no government funding and is reliant on a staunch band of parents, friends and siblings of those who have died by suicide to remain afloat.
Those who have been affected by suicide are at an elevated risk of dying in the same way, the risk of experiencing anxiety or depression can double, and the risk of PTSD can quadruple.
This is why people like Kim and Catriona and countless others fundraise at markets and train for marathons and 24-hour walks all to make sure Hope can keep its doors open.
Kim's latest venture for Hope is linked to an awareness campaign called The Blue Tree Project — a mental health awareness campaign that began in Western Australia where dead trees next to highways and walking paths and schools are painted blue to broach the topic of wellbeing.
Now, in a corner of Kim's garden next to the billowing lavender and runners of woodland violets spreading across the ground, are the fallen branches of a gum tree.
The branches have been painted blue and arranged into a bouquet in the ground.
A half-hour drive from her home, along a stretch of highway in Geelong's south towards the surf coast, a dead gum with silver branches reaching up sits next to a walking path.
"Oh this is good," Kim says, approaching the tree for the first time.
It's big and bold and obvious, she thinks.
She imagines a sausage sizzle on the grassy patch next to the path, and dozens of people with brushes clambering up the tree and sweeping its smooth branches with paint.
She imagines people driving and walking and cycling past the big tree and noticing and wondering why it's blue.
Maybe some of those people stop and read the plaque at the base of the tree that tells everyone what it's all about.
Maybe some of those people go home and talk to someone about how they're feeling and why they're feeling that way.
And maybe, for someone, it helps.
