Mental health has never been more central to the national conversation than it is in 2020
Mental ill health has no boundaries; both a poignant and challenging issue across all age groups.
Governments and service providers are used to thinking about mental health service needs in terms of ‘vulnerable’ or ‘at-risk’ groups. What is truly unprecedented about the COVID-19 crisis is that it has triggered a set of conditions that make our entire community more vulnerable to mental ill-health.
The World Health Organisation has identified a range of risk factors which increase vulnerability to mental ill-health, including loneliness, social exclusion, work stress or unemployment, physical illness, poor access to basic services and bereavement. Bushfire-affected communities across Australia’s south-east were already experiencing many of these stressors before COVID-19 triggered national disruption. Now, it would be hard to find a single Australian who has not been touched by one or more of them. The huge uncertainty about how long the current situation will last and what the world will look like on the other side only deepens the strain on mental health and wellbeing.
Recognising that Australians are likely to experience depression, anxiety and grief at a community-wide scale, there are valuable lessons to learn from evidence and practice in post-disaster mental healthcare.
In a disaster recovery context, planning for the delivery of mental health supports often includes the following principles:
• Reducing the stigma that can attach to mental ill-health by emphasising that stress and grief are normal reactions to life-threatening or extreme situations.
• Making proactive outreach a priority as affected individuals may not see themselves as needing mental health services and will not actively seek these out.
• Harnessing the protective power of community – family, community leaders and familiar supportive sites like schools – as the first line of response ahead of formal, clinical interventions.
These principles could form a strong basis for the coordinated delivery of mental health supports across all levels of government and community in response to COVID-19. Importantly too, approaching the current context through the lens of disaster recovery would foster the sense of shared purpose and focused effort that is often seen across our community after natural disasters.
One age group, often overlooked is our older Australians – particularly as they live through the COVID-19 pandemic.
With older Australians being most vulnerable to serious illness and death from COVID-19, they face even greater restrictions during the pandemic, often isolated from their family and other ongoing support and without the regular social contact of employment. Fear of the illness can also create significant anxiety for older people as they contemplate the serious consequences – particularly those living in residential aged care as they observe the alarming spread through these facilities.
Research by the National Ageing Research Institute prior to the current crisis found up to 50 percent of older people living in residential aged care experience depression, anxiety or both. The 2018 Aged Care Royal Commission highlighted a lack of available mental health supports within residential care settings as an impediment to proper care. In 2019 the Australian Government provided $74 million to Australia’s 31 Primary Health Networks to strengthen the delivery of mental health care for Australians living in residential aged care.
This has given the aged care sector a head start on stepping up mental health support for older Australians. Unfortunately during COVID-19 progress has slowed because of the more immediate priorities of protecting residents from the virus.
There is no doubt the pandemic increased the urgency and scale of need for better mental health supports but it is equally clear Australians will continue to experience greater mental health risks into the future. That is why the steps we take now must link into longer-term reform, to drive lasting change where it will make the most difference.
In seeking to connect the current crisis with longer-term mental health reform, there are a number of important enablers and opportunities that are already coming into focus. These include:
• Embedding mental healthcare where early intervention and prevention can happen as part of transitioning back to normal operations – particularly workplaces, schools and primary healthcare.
• Leveraging the innovations and adaptations spurred by COVID-19 – including scaled-up models of e-health care and stronger channels of coordination between different levels of government and service providers.
• Strengthening non-clinical, community and peer-led mental health supports which do not rely on the infrastructure and resources of our medical systems for delivery – harnessing the protective power of communities to better support each other.
It must be acknowledged that ‘going back to normal’ isn’t good enough for many Australians. Where COVID-19 has accelerated positive changes in the way services and systems work, we need to lock this progress in. Where the crisis has laid bare deep existing inequalities in the mental health and wellbeing of Australians, we need to build back better. And where the huge disruptions of the past few months have created the chance to re-think how things are done, we need to seize this opportunity.
Our shared focus should be on ensuring the work we do now builds towards better mental health and wellbeing for Australians well past the horizon of the current crisis.
Thanks also to Jennifer Rayner for her contribution to the final report.
If you need to talk to someone about mental health:
Beyond Blue: 1300 22 4636
Lifeline: 13 11 14