Global and national life changing events – the COVID-19 pandemic and natural disasters such as bushfires, droughts, cyclones, storms, heat extremes and floods – have substantially elevated levels of anxiety and depression relative to usual population data. The significant impact that these events played on individuals and communities is explored in this chapter.
Since the start of the COVID-19 pandemic the Australian Government has announced funding for a number of initiatives and programs to support the mental health of Australians and mitigate suicide risks.
Within the 2021-22 Budget, the Australian Government announced that it would allocate $2.3 billion towards a National Mental Health and Suicide Prevention Plan.
The Budget contained funding designed to improve a number of mental health and wellbeing services for new and expectant parents, family violence and mental health legal support, employment, aged care, suicide prevention, treatment, supporting the vulnerable, increasing the size of the mental health workforce, boosting allied health professionals in rural and remote communities, mental health research, supporting veterans and their families, and responding to COVID-19.
In addition to the funding allocated as part of the 2021-22 Budget, the Australian Government announced further support for mental health and wellbeing services in response to the COVID-19 pandemic.
As part of the additional funding, $48.1 million was provided for the National Mental Health Commission (NMHC) to develop a National Mental Health and Wellbeing Pandemic Response Plan (the Pandemic Response Plan). The Plan contained three core objectives:
meet the mental health and wellbeing needs of all Australians to reduce negative impacts of the pandemic in the short and long-term;
outline core principles and priority areas to inform jurisdictions as they respond to the challenges of COVID-19, including as restrictions ease, to balance national consistency with flexibility for locally-appropriate community-based responses and solutions and ensuring that any risks posed by relaxation of restrictions are assessed and responded to; and
define governance, coordination and implementation requirements including data collection and sharing across jurisdictions to facilitate informed planning and decision making.
Appendix D provides further details of COVID-19 mental health funding announcements.
The COVID-19 pandemic has impacted all Australians’ lives in significant ways: emotionally, socially, and economically. These effects have directly impacted on people of all ages and have taken a particular toll on their emotional health and wellbeing.
Throughout the inquiry the Committee has received evidence highlighting the impact that the pandemic has had on mental health and wellbeing within organisations, on individuals and across the wider community.
The Black Dog Institute identified prolonged unemployment, financial stress and debt as the biggest risk factors for the surge in mental health problems.
Similar factors were raised by the National Aboriginal Community Controlled Health Organisation (NACCHO):
Never have mental health and social and emotional wellbeing been so front of mind for so many people, including governments. The immediate impact of COVID-19 on everyone, from job losses to isolation, has seen more people have a lived experience of stress, anxiety and depression.’
National charity, Prevention United summed up the impact of COVD-19 across society:
So many Australians are doing it tough right now as a result of COVID-19. We're tired and we're stressed, especially in Victoria and New South Wales, but the whole country has been impacted. Everyone has been affected, but maybe some more than others: our kids and our teens; frazzled parents trying to juggle work, home schooling and other responsibilities; the self-employed; and small-business owners, to name a few. Indeed, we can see in ABS [Australian Bureau of Statistics] data and community surveys by university researchers that there's been a sharp rise in anxiety and depressive symptoms, but not only that; the pandemic has triggered a rise in the incidence of new cases of mental health conditions and so many people now require mental health care. In the background, there are probably literally tens of thousands, if not hundreds of thousands, of people who are languishing and stressed but not clinically unwell.
Increased demand for services
Overwhelmingly, mental health providers experienced substantial increases in demand for services throughout the COVID-19 pandemic and in particular through extended lockdowns.
The Black Dog Institute observed:
… Australia is enduring further periods of lockdown. In Sydney, where I am, that's particularly relevant. We know that's having a compounding impact on the mental health of Australians. We ourselves, through our online services and other services, have seen a spike in distress and people trying to access services.
MindSpot elaborated on the overall increase in demand experienced, and the spikes around lockdown periods:
Throughout the COVID period up until now, we saw an overall increase in demand of about 25 to 30 per cent. It increased dramatically during some of the lockdown periods last year. I think we had a 90 per cent increase on regular numbers. MindSpot, on average, will have about 450 to 550 new consumers seeking services every week. In August last year, there was a period when we had about 800 to 900 new people seeking services from MindSpot.
Smiling Mind, also a digital service provider, noted that the increase in demand over the COVID-19 period has seen ‘a huge volume of people coming to seek support through the digital environment’:
I think what we're seeing, particularly as a result of this pandemic, is that the embracing of digital tools and resources has grown significantly. We can see that in terms of the rate of access on our platform in particular and a whole range of other platforms.
PANDA – Perinatal Anxiety and Depression Australia – saw a significant rise in new parents seeking assistance:
… we've gone from delivering approximately 19,000 calls to vulnerable parents in 2019 to now being on track to deliver 42,000 calls. So we've doubled in terms of our throughput of services. We've doubled in terms of the new parents reaching out to support and we've seen a real change in the trajectory of the way in which people are accessing care throughout COVID but also the kinds of things that they're presenting for.
… Historically, before COVID, we had people calling us predominately at seven to 12 months of their parenting journey following the birth of their bub, and now 25 per cent of our community calls are within that first month of baby's life. We know that this is as a result of the changing service system and increased stressors because people haven't been as exposed to those initial health checks and guides with midwives and maternal health nurses.
The Gidget Foundation, also a not-for-profit organisation that supports the emotional wellbeing of expectant and new parents, experienced an increase in demand, and highlighted the role of compounding traumatic events – in this case, the 2019 bushfires followed by COVID-19:
… because bushfires and pandemics are both natural disasters—we are finding that the levels of resilience to manage throughout these periods are reduced, because of the compounding effect of one kind of trauma after another. So, yes, we are, absolutely, seeing such significant demand. Just trying to manage the triage process with people on the ground picking up the phone and calling us, and they're crying on the other end of the phone, saying, 'Please can I get support; please can I get into your services.' That's the reality of it. We've got people begging us for support, but we can only offer what we can offer, because there is only so much capacity that we have—even though, as I said, we are opening seven new sites this year alone. It's just not enough.
The Black Dog Institute agreed with the view that compounding traumatic events were leading to an increase in the demand for mental health services:
… the cumulative adversity builds up, but it's not a simple linear relation: most people are resilient until they're not. The problem is, once somebody has developed mental health problems, we know that they are then at increased risk of further mental health problems throughout their life. So we are really concerned about those groups that have had multiple hits through drought, bushfires, floods, COVID.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) pointed out that the increased demand in services had also affected the waiting times to access mental health services across the sector:
I've got colleagues [psychiatrists] who have waiting lists that run into four, five or six months. That has increased during the pandemic. Despite the fact that, in the last 12 to 18 months, the number of services provided through psychiatry MBS [Medicare Benefits Schedule] has gone up, because people haven't taken holidays and have continued to work, demand has grown significantly, and those waiting lists continue to grow. We have got enough information around that that we are pretty confident that those waiting figures have grown quite significantly across the sector. It's not just in certain areas; it's across the sector.
It is not only people with mental health problems seeking help that have been impacted. HelpingMinds underscored the impact of carers not being able to access face-to-face services during the pandemic:
Carers have been impacted by the pandemic, and there's been a marked increase in the level of distress and demand for services noted by our teams. I've been with HelpingMinds since 2013, and in the last six months we have had the most number of people with suicidal ideation contacting us on the phone. We're not a crisis service, and we have never had the number of calls that we have been having with people showing that ideation. We work with other organisations to make sure that we are able to provide the supports that they need at that time. Carers are reporting that they are feeling disconnected because of the move to telehealth and AV [audio visual] sessions, but we have seen that these services are helping, though, to build that social connection in times of lockdown.
RANZCP suggested that Australia will see an overall increase in the demand for mental health services over the next few years:
… we will continue to see the increase in demand for mental health services over a slightly longer period of time. There's a bit of a lag period in terms of how these disasters affect people. Some people, of course, got affected quite early on and needed to seek help at that time, but for some people, it is a lag period. We will continue to see that over the next two to three years.
Further discussion on the accessibility of mental health services is included in Chapter 3.
Impact on vulnerable communities and individuals
Several witnesses highlighted the effects that the COVID-19 pandemic was having on the more vulnerable sections of our communities including Indigenous communities, people with disabilities, rural and remote communities, low socio-economic regions, LGBTIQ+ communities, children and young people, and women as well as carers and support networks.
A survey undertaken by Monash University of nationwide mental health during the height of the restrictions in Australia found that ‘some groups were especially vulnerable to mental health problems during the COVID‐19 restrictions: women and people aged 18–29 years; people living in regional and rural areas or in the lowest socio‐economic positions, and those not in paid employment before the pandemic; people who had lost jobs or opportunities for study; people living alone, who have fewer opportunities for daily interactions with family and friends; and people whose main occupation is to provide unpaid care for children or other dependent family members.’
The Kimberley Aboriginal Law and Cultural Centre commented on the wider impact of the pandemic on its festivals and camps, noting that culturally based programs are a primary protective factor for wellbeing and building resilience in Aboriginal communities:
Our standard operating procedures, which go to workshops and on-country camps, have been impossible, particularly in the context of remote Aboriginal communities because they are the most vulnerable communities for COVID, so we haven't been able to do our festivals and cultural camps in the way we have in the past.
Yellow Ladybugs and the Olga Tennison Autism Research Centre spoke about the challenges both non-autistic and autistic adults and children have faced during COVID-19 lockdowns and how it has impacted on their mental health and wellbeing. Yellow Ladybugs stated:
I also want to make sure we don't overlook the fact that we've got children who are self-harming, have eating disorders—their cups were already full before COVID, but we're facing a crisis where we don't have access to paediatric psychiatrists. The waiting lists have become so long because of COVID and the general population trying to access supports, let alone the children, teenagers and young adults who are struggling.
The Australian Rural Health Education Network expressed concern about people in rural and remote communities accessing appropriate mental health care services:
The difficulty for us in rural and remote is the people in the middle. When you have a look at your stepped care model, they're the people that are too severe for 10 sessions or 20 sessions of Medicare over telehealth but not severe enough for public mental health. They're the ones in our rural and more remote communities that we're the most worried about. The service needs are really high for them, and COVID's impacted on our ability to be able to meet their needs.
The Queensland Mental Health Commissioner voiced concerns about the long term effects of the pandemic on young people:
We have become increasingly concerned with the disproportionate impact on children and young people, particularly with recent lockdowns and the impact of the new delta strain. We're starting to see increased presentations for psychological distress, particularly depression, anxiety, suicidal ideation, self-harm and eating disorders, particularly in young people. Overall, though, people are not accessing services early enough, which results in delayed presentations with more complex and severe symptoms.
PANDA and yourtown, a mental health service provider for young people, commented that they both had seen increases in child protection issues. yourtown provided evidence on the serious harm being inflicted on young people since the start of the pandemic:
… one of the things we've noticed across most of our services and programs is that we are seeing, since COVID struck early last year, much more complex case presentations, particularly among our young people, so more child abuse. As child protection services, when lockdowns curb the ability of departments to get out and investigate notifications of abuse, so young people are turning to us. We are seeing an increase in suicidal ideation. That's 37 per cent of what we call our duty-of-cares, where we have to contact ambulance, police or child protection, and we are also seeing quite a significant increase in family conflict and people needing ongoing support. Where before we might have had more people having occasional contact, for example, with some of our helplines, we are seeing more people requiring ongoing support for quite complex issues.
National not-for-profit organisation for women, Jean Hailes put forward that overall ‘women's mental health has been disproportionately impacted by COVID-19’, and set out findings of Professor Jane Fisher that:
… during the pandemic women are experiencing moderate to severe symptoms of depression and anxiety at up to six times higher rates during severe lockdown than at non-COVID times. These are most prevalent among women who've lost jobs, are homeschooling children, are caring for family members with special needs or disabilities and are living in the socioeconomic positions who lack access possibly to telehealth because they are not computer literate or because they lack privacy.
Jean Hailes highlighted the particular vulnerabilities of young women during the pandemic:
The other component of it is that there are a lot of young women who are feeling increasingly isolated. They're not mixing with their peers at the moment, they have increased screen time and the only control they have over their lives is through their eating or by self-harming. That's what we're seeing. In our clinics we've seen an increase in both eating disorders and self-harm. You've absolutely identified some key problem areas, which have always existed but have become more prevalent during COVID.
Options for care and additional support when starting a new family have also been impacted. The Gidget Foundation highlighted the loss of support networks for new parents due to COVID-19 restrictions:
At the moment, we've lost mothers' groups, we've lost fathers' groups, we've lost library visits, we've lost local playgroups, we've lost music opportunities at local centres, we've lost the opportunity to go to see child and family health in a face-to-face, drop-in style of format. There are so many restrictions that are limiting the support networks for this cohort—even something as simple as having your mum with you or your dad with you or your sister with you.
headspace suggested that the recent crises have ‘emphasised the powerful role that friends and families play in early intervention and in supporting a young person's recovery’. However, it may not always be families that are best placed to provide the support needed. The Trans Health Research Group outlined the findings of their recent survey on resilience and support in the trans community during the COVID-19 pandemic which found:
… trans people describe being stuck at home with transphobic household members and loss of support: 61 per cent were clinically depressed and 49 per cent experienced thoughts of self-harm or suicide in the early months of the pandemic. This is fourfold that of the general population and higher than before the pandemic.
RANZCP and the Black Dog Institute raised concerns for the welfare of families in low socio-economic areas during the pandemic. The Black Dog Institute noted that the pandemic is:
… amplifying social disadvantage. Particularly within Western Sydney, the families that are suffering the most are those who had the least resources at the start: the groups who are trying to do home schooling in small flats with limited IT [information technology] resources, who previously had been able to earn extra money while also receiving some government benefits. They're the groups that we're worried about. What we know is that most people and most communities are resilient but that that resilience gets chipped away as adversity accumulates and as it lasts longer.
Not-for-profit provider of relationship services, Interrelate, agreed that ‘COVID-19 has further magnified social and economic vulnerabilities, factors associated with increases in loneliness, social isolation, poor mental health and lower quality of life’. Interrelate added that it had ‘seen increased levels of loneliness for many people, even people who were not previously experiencing mental health issues and are presenting as otherwise healthy.’
When discussing the impact of the pandemic on disadvantaged groups, the Australian Council of State School Organisations added:
In terms of our most disadvantaged, their situation has only been made worse by the pandemic, because there is a general perception that everybody has internet at home; everybody has devices at home and everybody has fast internet at home, and that's just not the reality. For those children who don't have one or all of those components, it's made learning remotely extremely difficult, if not impossible.
Impact on health professionals
Several witnesses commented on the impact the COVID-19 pandemic has had on mental health professionals around Australia. The Western Australian Association for Mental Health (WAAMH) believed that ‘COVID exposed the limits of all of our services systems, and that was no different for mental health.’
The Psychology Board of Australia spoke about the importance of having a healthy workplace, particularly in the health related field with a focus on fatigue management.
The Royal Australian College of General Practitioners commented on how challenging and demanding it has been for general practitioners (GPs) to try and ‘support patients and look after them with all the uncertainty around COVID’.
The Queensland Nurses and Midwives' Union called for mental health support for healthcare workers adding:
COVID-19 has shown the stress and strain that these workers are faced with and the need for workplaces to support their employees and their psychological health and safety.
The Australian Physiotherapy Association commented that its members found it frustrating being unable to provide a face-to-face service during lockdowns, even though classed as an essential service, and ‘seeing the frustrations of the patients regressing, escalating care to accident and emergency departments [EDs] and increasing the impact of isolation on their patients.’
Impact on carers and volunteers
The Pandemic Response Plan acknowledged the role of volunteers and the unpaid workforce as well as the importance of ‘attracting, training, accrediting and retaining key professional and volunteer workforces.’
Mental Health Carers Australia noted the impact that the reduction in face-to-face mental health services during COVID-19 has had on families:
The temporary reduction or cessation of services has meant that, again, families have often had to step into the breach to undertake the support that the person would have otherwise received. Obviously concerns around PPE [personal protective equipment], with support workers coming into the home to provide support, and concerns around transmission of the virus have added significantly to people's distress. Also, regarding people moving back home, a year ago a lot of family members were moving back home, and that had an impact on family dynamics.
Jean Hailes elaborated on women as carers, both in the family and in the workforce, and the additional challenges faced during the pandemic:
We know from research that's been done in Victoria that most of that work is done by women. What women are trying to do is combine home schooling and caring with, if they are in paid employment, their paid employment. Secondly, a lot of the professions that are at the coalface of COVID are conducted by women. If you're looking at first responders, if you're looking at people in aged-care facilities, if you're looking at nursing staff—I'm not saying all of them are women, but the majority of them are women. Many women are in casual employment. More women are in casual employment or contract employment than men are, so their workplace security has been severely impacted by COVID. So it's a combination of four or five factors in that space which has increased their anxiety and stress levels.
Volunteering Australia referred to research it conducted with the Australian National University (ANU) which ‘showed that Australians who stopped volunteering since 2019 had a greater loss of life satisfaction than those who continued’ which led to a sense of loneliness. VolunteeringACT also pointed out that that in the Australian Capital Territory (ACT), volunteers – predominantly in social and health services – were stood down during the pandemic while conversely demand in those services increased.
Volunteering Australia did however observe that people were very willing to contribute and help the community in times of crisis and suggested developing appropriate infrastructure to be able to deal with surge capacity.
Positive outcomes of COVID-19
The Queensland Mental Health Commissioner and ReachOut, an online mental health service for young people and their parents, highlighted that a possible positive outcome from the COVID-19 pandemic was an increase in the willingness for individuals to seek help in times of hardship.
The Queensland Mental Health Commissioner stated:
One positive result from COVID-19, if there is a positive result, is that it appears there is a reduction in the overall stigma associated with mental ill-health in our community, which has resulted in an increase in help-seeking behaviours across the board. This of course has resulted in increased demand for supports and services in an already stretched and under-resourced system.
ReachOut concurred with the view that an increase in the willingness to talk about mental health has seen ‘a reduction in stigma and a greater understanding that it's actually okay to seek support.’
PANDA also accentuated the positive aspects of people seeking support during the pandemic:
One of the amazing levelling impacts that COVID has had in our experience as a mental health organisation is that we are hearing more and more people open up and talk about vulnerability and not feeling well. That's been an amazing thing to be witness to in Australia, having worked in the mental health space for such a long time.
PANDA elaborated on the benefits of seeking support earlier and asking for help:
Ultimately, we keep saying to people: ‘If you feel it, say it. Don't sit on this stuff,’ because it makes it harder for us to be able to support people. It makes it harder when there's compound grief, loss, trauma and existing mental vulnerability, stressors or suicidal ideation to be able to unpack that box when there's more stuff in there. So we do talk to our community very much by saying: ‘Your needs are as great as the next person's. Don't judge yourself; just reach out for help.’ We also say that there's no right or wrong way in asking for help. I think quite often people feel that they need to be able to understand it to then be able to share it, and that's not always the case. You don't need to have the right words to talk about it.
The Productivity Commission and Department of Health pointed out that telehealth, particularly telehealth for mental health services, has been taken up at a huge rate by both health professionals and the community.
While some witnesses expressed concerns with the move away from face-to-face health services to digital and telehealth services, others believed that it was a positive response to seeking help during the pandemic.
Dietitians Australia, Stride Mental Health, Speech Pathology Australia, and the Black Dog Institute were all supportive of the utilisation of telehealth services and called for them to be extended.
Dietitians Australia suggested that not only does telehealth provide access in a more equitable way, it also provides access to those in quarantine or lockdown, as well as:
… addresses things like stigma—so allowing people with a mental health condition to access these services in their home environment without these increasing levels of anxiety that people may see when seeing a health professional.
The Women’s Mental Health Alliance spoke positively about the benefits of telehealth for rural and remote communities commenting that it ‘has literally been a life saver for some people’:
COVID has been awful and terrible for many things, but it has shown us such positive things as well. I know from having worked in regional Victoria for some time that people talked about telehealth, and that has been funded because of COVID. It wasn't for everybody; but for regional and rural areas to actually be able to access a service through telehealth or through other means now, with other practitioners and not just GPs, has made a huge difference for people who are isolated.
NACCHO advocated for the expansion of the telehealth services, adding:
The COVID-19 pandemic has highlighted the urgent need to develop and invest heavily in telehealth and digital social and emotional wellbeing supports and services for Aboriginal and Torres Strait Islander communities. Opportunities for telehealth expansion should be supported but not at the expense of further development of the local workforce.
The Australian Association of Psychologists Inc agreed with the above views that telehealth should be kept as part of a suite of other mental health services as it was not always fit for purpose:
We would also like to see telehealth remain a permanent feature of the MBS. It has many, many benefits that improve access to psychologists. We've seen throughout the COVID pandemic that it has been essential in keeping services going to those that need services. Especially for our rural and remote communities, it is essential.
Telehealth and digital services are discussed further in Chapter 4.
Responding to the impact of COVID-19
The long term effects of the COVID-19 pandemic and lockdowns on the mental health and wellbeing of individuals and our communities have yet to be quantified. Witnesses provided a number of suggestions on how best to respond to possible adverse effects, and reinforced that Australia’s response would be critical in supporting mental health going forward.
The Pandemic Response Plan stated that it ‘is essential to safeguard the capacity and capability of existing services to continue core business operations, meeting the needs of current consumers and responding to surges in demand brought about by the pandemic.’
The Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney outlined three priorities for mental health in the COVID-19 decade identified by the COVID-19 Mental Health Response Independent Think Tank:
Australia's first mental health think tank has focused on innovative responses. In June this year, the think tank met for the first time, and three areas really became the major areas of focus for that think tank: (1) strengthening the social fabric that connects Australia; (2) tackling the impacts of economic exclusion, especially in our young Australians; and (3) enhancing access to high-quality, comprehensive mental health care across Australia.
WAAMH called for a holistic response both supporting mental health and implementing social support mechanisms:
… the massive disruption to social determinants and the vulnerability around social determinants that people with existing mental health issues face in the face of COVID, and then their ability to adapt, mean that it's not necessarily just the mental health interventions that are needed; it's also things like people's level of income, be that through income support or the opportunity to have paid employment. We're seeing big impacts here at the moment in our COVID recovery around housing.
Suicide Prevention Australia stated that ‘having sufficient money to survive is a critical safety element, a preventive factor, for a person reaching suicidal distress.’
Suicide Prevention Australia, the Brain and Mind Centre of the University of Sydney, and the Black Dog Institute noted the benefits of ensuring employees and job seekers maintain financial stability during uncertain times and suggested keeping or extending economic support programs such as JobKeeper and JobSeeker. The Black Dog Institute explained:
What we know helps is both economic support and being able to maintain their link with their employer to know that they've got a job to go back to at the end. If you look at what are major risk factors for mental ill health and suicide, yes, it's economic adversity and debt, but it's also job insecurity. When those things are combined, as is happening at the moment, that is particularly problematic, and that is why we're now saying, given we know that, at least in New South Wales, a lockdown is going to be continuing for longer, we need to look at resetting some of those economic supports to better meet the mental health needs of what's going on.
The Committee heard evidence from several witnesses calling for equitable responses to the COVID-19 mental health crises.
The Brain and Mind Centre contended that ‘less was done to support female employment in casual industries, in hospitality, in the caring industries, in tourism and in part-time work elsewhere in those programs’, and called for direct economic and employment support for women:
… just as for men, economic support through [the COVID-19] period was one of the two most important protective factors against poor mental health outcomes—economic support being one and social connection being the other. Economic support is a lot easier to provide than social connection in a particular way. So we had to emphasise for younger women educational opportunities and training opportunities and, for women of workforce age, generally speaking, the need for direct economic support and employment support but also, importantly, child care.
Youth mental health policy think tank, Orygen believed that there was an inconsistency in the delivery of mental health services compared to responding to the COVID-19 crisis directly, adding:
A mental health life is not valued so highly. We're still happy to turn people away from EDs, many of whom are at risk of dying. They're the same people, potentially. I'm very conscious of the equity issue here. What do we do in COVID? We redeploy people from other areas of the health sector to meet the need. They certainly did this in other countries, where the COVID surge was much stronger; they pulled people out of mental health services and made them work in COVID related activities, as health professionals. We need to do that in reverse now for mental health, because the unmet need level in mental health and the risk of dying are much higher in that space. We lose 3,000 people a year to suicide.
Orygen suggested applying the same strategies and techniques that have been used to combat COVID-19 to mental health support:
What I'm trying to say is that we need to have the same mentality. There are many generically trained health professionals, like nurses, doctors and GPs, who could be redeployed, with the right incentives and the right leadership, into meeting this mental health crisis much more effectively than currently.
headspace advocated for a need to plan holistically to provide mental health services for young people:
We will see a rise in not just the numbers of people coming forward for supports but actually the complex needs, the trauma that's associated with lockdowns or, indeed, living with the pandemic in an ongoing way. And for that we really do need to plan holistically as a community and as a country—to ensure that young people are not the ones who will be disadvantaged to the point where the hopes and the aspirations that they had pre pandemic are not dashed … We have to think positively about a hopeful future, provide the optimism, but in doing so provide the backup scaffolding that needs to be there for when they do need supports along the way.
Natural disasters such as bushfires, droughts, floods, storms and cyclones, and heat extremes destroy lives, homes, properties, land, and businesses. They not only have an economic impact but also a serious and long term emotional impact on individuals and communities.
The cascading effects of natural disasters have impacted Australian communities, industries and individuals. The cost to the mental health and wellbeing of first responders and people who have experienced or witnessed a natural disaster is significant.
The report of the Royal Commission into National Natural Disaster Arrangements (Royal Commission) highlighted the extent of natural disasters faced by the Australian community since 2019:
For many communities, the bushfires were not the only disaster they faced that summer. After the drought and the fires came storms and floods, and before the last fire was extinguished, Australia announced its first case of COVID-19. Australia’s ability to coordinate nationally, learn and adapt, in the face of deep uncertainties and rising risks, had been tested.
A study by researchers at the ANU has shown ‘that fires are recurring at far shorter than natural return intervals, such as in forest types that should burn no more frequently than every 75 to 150 years on average.’
During the 2019-20 bushfire season over 17 million hectares were burnt across New South Wales, Victoria, Queensland, ACT, Western Australia and South Australia. In Victoria, 1.5 million hectares were burnt; the largest area impacted by wildfires since 1939 (when 3.4 million hectares burned).
In response to the bushfires, the National Bushfire Recovery Agency was established on 6 January 2020, along with an allocation of $2 billion to the National Bushfire Recovery Fund.
In its submission, the Department of Home Affairs (Home Affairs) stated that the Australian Government also allocated $15.9 million, including:
$10 million in grant funding to deliver trauma care services, including for post-traumatic stress disorder, to emergency service workers who responded to the 2019-20 Black Summer bushfire season,
$1.5 million in grant funding to establish a pilot program for a social support and mental health literacy network for emergency services workers and their families, and
Approximately $4.4 million for the development of the first mental health national action plan for emergency services workers.
The Australian Government contributed ‘$40.46 million (cost-shared on a 50:50 basis with relevant states and territories) to support community and emergency services mental health programs in bushfire affected areas of Victoria, New South Wales, Queensland and South Australia.’
Appendix D outlines the range of mental health support measures that were provided in response to the 2019-20 bushfires.
Commonwealth grants were provided to the Black Dog Institute and Fortem Australia for the delivery of clinical psychologist mental health services to emergency services workers and volunteers who responded to the 2019-20 Black Summer bushfires and their families.
On 1 July 2020, Home Affairs established a Mental Health Policy Taskforce which is in the process of developing ‘the first mental health national action plan for emergency services workers, including volunteers and former and retired emergency services workers.’ Home Affairs added that the ‘aim of the national action plan is to lower suicide rates and improve mental health outcomes among Australia’s current and former emergency services workers.’
Royal Commission into National Natural Disaster Arrangements
Established in response to the 2019-20 Black Summer bushfires, the Royal Commission examined the wide ranging effects that natural disasters have on individuals’ mental health, and found:
There is compelling evidence of the impacts of natural disasters on mental health. Natural disasters give rise to increased rates of stress, depression, anxiety, post-traumatic stress disorder (PTSD), alcohol and substance abuse, aggression and violence, suicide, and exacerbation of other underlying mental health problems. Individuals may also experience somatic symptoms, disorders where a person has excessive or abnormal feelings or thoughts about physical conditions. People can also suffer from insomnia and broken sleep.
The Royal Commission noted that:
the mental health effects of natural disasters can also endure over an extended period and it may take time for symptoms to present
geographical barriers, unsafe conditions and loss of essential services all arise after a disaster and can lead to significant delays in support, prolonging trauma and exacerbating emotional distress
children, young people and first responders are particularly susceptible to ongoing mental health effects following natural disasters.
The Royal Commission made two recommendations aimed at supporting the mental health of individuals and communities during and after natural disasters:
Recommendation 15.3 Prioritising mental health during and after natural disasters. Australian, state and territory governments should refine arrangements to support localised planning and the delivery of appropriate mental health services following a natural disaster.
Recommendation 15.4 Enhance health and mental health datasets. Australian, state and territory governments should agree to:
1) develop consistent and compatible methods and metrics to measure health impacts related to natural disasters, including mental health; and
2) take steps to ensure appropriate sharing of health and mental health datasets.
Learning from other jurisdictions and systems
In its report the Royal Commission into National Natural Disaster Arrangements drew attention to the benefits of developing a nationally consistent approach to the delivery of mental health services:
All state and territory governments should develop and implement plans or policies to guide the delivery of mental health services during and after an emergency incident, such as a natural disaster. This could build on the National Natural Disaster Mental Health Framework, once completed.
We were informed that states are considering the lessons identified during the 2019-2020 bushfire response as part of reviews of their public health emergency plans. Consideration should be given to establishing mechanisms for sharing identified lessons nationally.
While commending governments for providing responsive and nuanced responses throughout COVID-19, PANDA suggested that more could be done to learn across jurisdictions:
Interestingly, the same that we saw in Victoria last year played out recently in New South Wales. It was surprising to see that what we learnt in Victoria, about how to guide people through a safe birth and the follow-up limiting of family members and things in Victoria, which was the position they got to once they understood and mapped out the process, wasn't replicated in New South Wales. So it has been surprising to us that we did see the very same issues that had occurred in Victoria occur in New South Wales more recently and that the opportunities for learning hadn't been there.
Mental Health Australia called for governments across all levels to work together:
It is imperative that the Australian government also work with the states and territories to create an integrated mental health system—for example, work with the Victorian government to ensure cohesive implementation of federal and state initiatives that will provide a blueprint for work across other jurisdictions.
Ms Christine Morgan, the National Suicide Prevention Adviser to the Prime Minister, agreed that it was important to take a ‘whole-of-governments’ approach to unlock the potential and use the leverage across portfolios as well as adopting national approaches. Ms Morgan elaborated:
We need each jurisdiction, from the Commonwealth jurisdiction down, to ask, 'What are we doing across our portfolios?' Likewise with each of the states and territories. The national approach, so what are we doing across whole-of-governments? And that is in particular when you look at the national approach, what are those things which, but for taking a national approach, will not benefit everybody.
Surge workforce and long term support
Witnesses to the inquiry commented on the need to have surge capacity to respond to crisis events as well as provide long term support for communities affected by a pandemic or natural disaster.
The Queensland Mental Health Commissioner stated that the ‘mental health and wellbeing impacts of COVID are not yet fully realised. They will continue to impact over time and will depend on individual practice.’
As noted above, Volunteering Australia suggested developing appropriate infrastructure to be able to deal with surge capacity in a crisis:
The barrier that is created is that there isn't the infrastructure to be able to identify, properly resource and allocate volunteers in a surge capacity fashion. So we see these crises occur and people will put up their hand, but oftentimes, because of the fact that the organisations which would benefit from … those volunteers on the ground are not properly resourced, they are not able to take as many volunteers as they would need, for example, to support community at that time. So one of the challenges we face is to develop appropriate infrastructure to be able to deal with surge capacity.
Suicide Prevention Australia considered it critical to have a surge workforce as well as embedding crisis management capability in the existing workforce. Suicide Prevention Australia elaborated on the critical need to provide the right support at the right time:
You need to have the fundamentals. But then inevitably where you have a natural disaster of some form you are going to have to ramp up and so there needs to be allowance and planning for that, and that needs to be well-coordinated planning. There are multiple different services that can be offered and the timing of those services is often important and making sure that the various different services are linking to each other and are well resourced to link to each other so that they're providing the right support at the right time is critically important.
While commending the need for preparedness and emergency responses, Wesley Mission observed the need for long term support for communities effected by bushfires, floods or COVID-19:
In response to some of the natural disasters … our experience is that there is a lot of emergency crisis relief response immediately, whereas the work that we do is longer term … particularly around things like anniversaries, is critical in bushfire or flood-impacted communities.
Witnesses emphasised that services need to be available in the longer-term to provide ongoing care and support for people to connect to mental health services and re-establish their lives. Suicide Prevention Australia explained:
We've seen examples, for example, in Queensland when we've had cyclones. It's three years after, 2½ years after, when services are withdrawn when that initial push is withdrawn that we see distress increase in communities. While the attention is on that community, particularly the focus that we place in this country on responding to crises exceptionally well, once those resources are withdrawn is when we see distress escalate in communities and suicide increase.
The Black Dog Institute suggested that the full extent of the cumulative adversity of the bushfires and COVID-19 is likely to be seen over the next 12 to 18 months.
The Mountains Youth Services Team advocated for a study on the longitudinal impacts of successive community trauma:
It would be good for us to know, too. We're an early intervention service, but we're dealing with so much crisis, and it's difficult to know how long that will go. If we knew that it was five years, we could go: 'Alright, what can we put in place for five years?' If it's going to be 10 years, it's: 'What do we put in place for 10 years?' We don't really know what we're dealing with, so I think step 1 is actually having the research to understand what's going on.
Prevention and strengthening community supports
Investment in prevention and early intervention measures, and the benefits that it can provide in the event of a crisis, was raised by several witnesses.
WAAMH called for investment in prevention measures to build resilience in individuals and communities:
For us it comes back mostly to the need to invest in prevention and community support options so that, whether it's climate change or some other challenge that arises, we know that people have been supported to have good mental health in as far as they can, like from the get go—so taking a life course approach, taking a prevention approach, taking that population public health type approach to mental health—so that people have had the chance to learn the skills and live in environments and societies that support their mental health up until that crisis point. Then, if that crisis point does arise, that there are services or options available to people who don't necessarily rely entirely on acute and hospital based services, so that there is a range of support and a range of things people can call on in their time of need that don't all rely on having to go to hospital or having to present to an ED.
SANE Australia agreed that a consistent investment in additional services and capacity was important:
… it's beyond mental health. I absolutely think that investments in additional services and capacity and really making those links between the primary care and the face-to-face services and the digital services need to be extended beyond the theoretical end date of regular lockdowns being so likely. We need to continue those investments, because the fallout will continue to appear, particularly because, for people who, coming into the pandemic, already had a pre-existing major distress or incident in their life or an existing mental illness, the pandemic is likely to have been the straw that broke the camel's back, especially when you add home-schooling on top of that.
SANE Australia also suggested wider investment in the social determinants of mental health noting the benefits that they provide:
We could also be thinking about things like investment in the arts and in sports, employment and training initiatives, supporting people who are on unemployment, early childhood support and support for people dealing with domestic violence—the kinds of social factors and determinants that sit around and greatly influence someone's ability to cope and even engage in mental health treatment if they're experiencing a mental illness, because it becomes a bit of a Maslow's hierarchy of needs for many people.
Smiling Mind pointed to a 2016 report from NMHC on the impact of poor mental health on the economic agenda and noted the benefits of investing in prevention and early intervention can reduce the need for more complex and costly interventions. Smiling Mind added:
This report indicated a return on investment of around $3 for every $1 invested in prevention; however, mental health promotion and prevention remains significantly underfunded. There's no national mental health promotion approach, and prevention is often confined to discussions of suicide prevention, which is obviously vitally important but does not allow for a full and targeted approach to preventing a range of mental health conditions—particularly relevant right now in the context of the mental health impact of the pandemic.
In the last 10 years Australians have experienced successive traumatic events such as heatwaves, floods, cyclones, bushfires, hail storms, drought and the COVID-19 pandemic.
Any one of these events alone can have a significant impact on the mental health and wellbeing of people who experience or witness them. Many will have elevated levels of anxiety and depression and suffer from post-traumatic stress. People who have experienced successive traumatic events even more so.
In order to implement the most appropriate mental health services before, during and after multiple traumatic events we need to ascertain how they impact the mental health of those involved.
Understanding extreme events and critical incidents and how they impact on the mental health of individuals, first responders, service providers and the wider community is critical in enhancing policy and decision making and strengthening organisational, institutional and community resilience.
It is important that the Australian Government invest funding into the longitudinal impacts of compounding trauma and successive disasters on the mental health, suicidality, and the social and emotional wellbeing of individuals and communities.
The Committee recommends that the Australian Government invest in research to determine the longitudinal impacts of compounding trauma and successive disasters including extreme weather events caused by climate change on the mental health, suicidality, and the social and emotional wellbeing of individuals and communities.
In order to ensure that governments are making the best policy decisions for the communities they represent, it is critical that they receive high quality expert advice.
Throughout the COVID-19 pandemic, governments at all levels have relied upon the expert advice of chief medical officers before making decisions that affect entire communities. It is particularly important in a long-term crisis such as the pandemic where the spiralling mental health impacts of COVID-19 are evident, as well as the impacts of successive traumatic events, that governments seek the advice of chief psychiatrists.
The Committee therefore is of the view that chief psychiatrists for Commonwealth, state and territory governments should be present to provide advice at all crisis meetings.
The Committee recommends that the Australian Government ensure that the Deputy Chief Medical Officer for Mental Health is present to provide advice and actively participate at all crisis meetings, and encourage states and territories to adopt an equivalent position, if they have not yet done so.