Bushfires have a significant impact on both the physical and mental health of communities. In addition to immediate and short-term stressors, psychological trauma from losses suffered during bushfires can have long-lasting effects. The severity of the 2019–20 bushfire season exacerbated these impacts.
Submitters highlighted that the scale, longevity and severity of the 2019–20 bushfire season, including the unprecedented scale of bushfire smoke, demonstrated an urgent need to better understand the health risks posed by bushfires in extreme weather conditions, and to better prepare and equip the community and the health sector to respond to the health impacts of future bushfires.
Submitters also emphasised the importance of needing to better understand the mental and physical impacts on first responders, such as firefighters and frontline volunteers, especially given the prolonged and intense response required by these groups during the 2019–20 bushfire season. Health impacts on these groups include issues related to respiratory health, mental health, exposure to contaminants, burns and other injuries.
This chapter examines the physical and mental health impacts of the bushfires, and the various government actions taken to address health concerns—including the provision of telehealth services.
Physical health impacts
The impacts of the fires on human health should not be underestimated. The Public Health Association of Australia (PHAA) recognised that in addition to the tragic 33 fatalities, there were also hundreds of deaths attributed to bushfire smoke exposure, while 'hundreds of people were treated for injuries' and 'thousands were evacuated or displaced'.
The PHAA pointed out that 'of all people involved in fire emergencies, those at greatest risk of harm and mortality are fire-fighting personnel'. This includes professional workers, trained volunteers, and 'individuals caught up in emergencies'.
The PHAA made the important point that with the fires increasing in scale, severity and length in future, there will be increasing demand for more firefighting personnel, who will be 'active over longer periods of time, in more inherently dangerous conditions'. The PHAA viewed this as a 'specific public health challenge'.
The PHAA concluded that:
It is not ethical for Australians to expect extraordinary service from firefighters without minimising the hazards to which they are exposed and adequately resourcing their work. Every possible means of minimising the risks facing those on active service protecting their communities should be taken.
The Australian Medical Association (AMA) submitted that 'perhaps the most significant health effect of the 2019–20 bushfires was the exposure of large swathes of the Australian population to harmful levels of bushfire smoke'. It has been estimated that approximately 11 million Australians had some exposure to smoke from the 2019–20 bushfires.
Throughout the bushfire season, there were prolonged periods of smoke exposure in many cities and regional areas. Many rural towns, multiple regional centres, as well as the capital cities of Sydney, Canberra, and Melbourne, all saw smoke pollution exceed hazardous levels during the bushfire season.
Ms Kathryn Michie detailed to the committee the impacts of the bushfires on her family’s health, despite being indirectly affected by the fires:
I live with my young family just a few kilometres from the centre of Sydney. Our lives, home and livelihoods were safe from the immediate impacts of the bushfires, yet my and my family’s health and well-being were affected for weeks.
Myself and my immediate family are all healthy, with no pre-existing conditions. The constant sore throats and stinging eyes was bad for us. I am scared of possible long-term damage to my children’s’ growing lungs. How bad was it for people with asthma?
I have no history of anxiety or mental health issues, but I awoke each day with a feeling of fear and unease.
As noted in the submission from the Grattan Institute, there is no safe level of particulate matter from bushfire smoke. Bushfire smoke is a 'complex mix of particles and gases', including particulate matter less than 2.5 micrometres in diameter—known as PM2.5. The micrograms of PM2.5 per cubic metre of air are the key measurement to monitor air quality related to bushfires. The Grattan Institute observed that the World Health Organisation and the Australian National Air Quality Standards set a 'safe' threshold of 25 PM2.5 micrograms per cubic metre of air, on average, over 24 hours. New South Wales (NSW) categorises 50 PM2.5 micrograms per cubic metre as a 'hazardous' level.
As a result of the bushfires, the Australian Capital Territory (ACT) recorded the worst air quality in the world in January 2020, and experienced 56 days of smoke pollution above healthy levels. Victoria experienced days where PM2.5 levels where recorded at over 300 and 500, well in excess of safe levels, while in NSW, there were several days of poor air quality, with some measurements recorded as being 10 to 14 times the hazardous level.
It was reported that smoke and particles from the Australian bushfires had travelled to New Zealand, Antarctica and several countries in South America.
Asthma Australia commented on the fact that the given the minute size of particulate matter, it is able to be inhaled into the lungs, causing inflammation, and can also enter the blood stream, which effects other bodily systems.
Further, several submitters commented on the increased risks of those with pre-existing medical conditions and how exposure to bushfire smoke could exacerbate such conditions. Bushfire smoke also has a disproportionate impact on various population groups within the community, including:
people with asthma of all severities;
pregnant women and unborn children;
people with pre-existing respiratory or heart conditions.
Asthma Australia pointed to research indicating an increase in mortality, hospital admissions, emergency department presentations, ambulance callouts and general practitioner consultations during the period of bushfire smoke exposure. The AMA cited recent research which quantified these numbers and estimated that 'in total, 417 excess deaths could be attributed to bushfire smoke exposure from 1 October 2019 and 10 February 2020', while:
… 1124 hospitalisations for cardiovascular problems, 2027 hospitalisations for respiratory problems, and 1305 emergency department presentations for asthma were attributable to bushfire smoke exposure during the same period.
In their submission, Doctors for the Environment drew attention to evidence detailing the many other negative health impacts that can occur as a result of bushfire smoke, including:
an increase in all-cause mortality rates during bushfires;
a direct association between bushfire smoke exposure and exacerbations of asthma and chronic obstructive pulmonary disease (COPD);
an increase in emergency department presentations and hospital admission rates;
an increase in out of hospital cardiac arrests;
an increase in ambulance callouts; and
an increase in adverse birth outcomes.
A survey conducted by Asthma Australia found that 94 per cent of respondents with asthma reported symptoms due to the bushfire smoke. Further, the smoke had a significant impact on their daily lives, as shown in the following survey findings:
66 per cent had reduced capacity in their daily activities;
33 per cent were sick for more than one week;
35 per cent had to cancel an important sport or social engagement;
29 per cent were absent from work or school;
25 per cent experienced financial stress; and
A core concern arising from submissions was the gap in medical knowledge about prolonged exposure to bushfire smoke and the long term health impacts of such exposure. For example, Asthma Australia stated that:
… there is limited research into the health impacts of prolonged exposure to poor and hazardous air quality resulting from bushfires. Research has focused on short term exposure because bushfire events have typically neem brief in the past.
The Australian Academy of Health and Medical Sciences (AAHMS) explained that there remain many unknowns about the impact of the bushfire smoke on respiratory health in the short, medium and long term. The AAHMS identified some of the concerns about this, noting it had:
… made it difficult to provide accurate health advice and has caused anxiety among affected communities and the wider public. Gaps in our knowledge relate not only to the health outcomes, but also to the underlying biological mechanisms and our ability to monitor and assess the risks – and then to provide sound advice on management …
In response to this gap in knowledge, several submitters commented on the need to fund research and extensive studies into the long-term effects of exposure to hazardous levels of bushfire smoke, particularly for those with pre-existing medical conditions and those vulnerable populations.
Submitters, including the Grattan Institute and Doctors for the Environment, were of the view that people with pre-existing health conditions and those within vulnerable populations may need targeted or specialised interventions in response to exposure to bushfire smoke.
Response to bushfire smoke
On 7 and 10 January 2020, the Commonwealth Government announced it would supply P2 face masks to the ACT, Victoria, South Australia and Tasmania, the Australian Defence Force, Australian Federal Police and Australia Post personnel, bringing the total number of P2 masks provided and reserved to almost 3.5 million. Acting Chief Medical Officer, Professor Paul Kelly, said available supplies of P2 masks should be allocated as a priority to those most at risk of significant health effects from smoke.
While the provision of face masks was welcomed by submitters, several issues were raised regarding their use, including around incorrect use. For example, the AAHMS stated that:
Incorrect use of facemasks can lead to a false sense of security, when the user may unknowingly still be exposed to unhealthy levels of air pollution. The correct fit of a P2/N95 mask, which is easily compromised by factors such as facial hair, is key to sufficiently protecting its user. We need more guidance on the effective use of face masks.
Similarly, Doctors for the Environment observed that paper and simple cloth facemasks were 'ineffective at filtering very small smoke particles or toxic gases'. The organisation submitter that:
P2/N95 facemasks, usually used in occupational exposures may filter out small particulate matter but do not offer protection from toxic gases. They are often uncomfortable or inefficient (e.g. facial hair), need to be properly fitted and are impractical for children’s use.
More research is needed into evaluating the effectiveness and drawbacks of commercially available face masks, particularly for their use in children.
The AAHMS commented on the need to provide targeted advice on the use of facemasks, submitting that '[w]e need targeted health/health protection advice for families with children, especially considering that children sized facemasks are not readily available. Evidence-based advice to parents is urgently needed.'
The Royal Australian College of General Practitioners also noted that there was limited health information available both to and about vulnerable groups, including:
… pregnant women, people with heart disease, young children and older people during the bushfire events. It is recommended that tailored information is developed to ensure these more vulnerable groups are receiving specific health information and advice pertinent to their personal situations, and to alleviate any anxiety that may be experienced.
This sentiment was echoed by other submitters such as Asthma Australia, which recommended tailored guidance for asthma sufferers with regard to bushfire smoke.
Evidence was received about the communication to the public of hazardous air pollution levels. For example, it was discussed how reporting of air quality was not standardised across state and government departments, with some jurisdictions using the Air Quality Index (which is a composite measurement based on multiple pollutants), and others using PM2.5 levels, which is confusing for the public.
It was therefore recommended that consistency of air quality information and related public health advice be developed across jurisdictions, and that the government should develop health alert systems for both bushfire smoke and heatwaves.
Mental health impacts
In addition to the physical impacts, a number of submitters highlighted the mental health impacts of the bushfires. Immediate stressors and traumas such as loss of life and property, evacuating from the family home, uncertainty and prolonged fear during a bushfire (among other factors) can affect the mental health and wellbeing of those directly and indirectly exposed to such events. These immediate stressors and experiences of trauma can have long-lasting mental health consequences.
Mental Health Australia highlighted that heightened distress is very likely and is to be expected during all stages of disaster and that for most disaster survivors they will 'recover without professional intervention within a number of months'. However, they also noted that psychological trauma experienced during bushfires can be long lasting and or emerge or re-emerge 'throughout any time in an affected individual’s life'.
Similar to the long-term impacts of physical health conditions, the mental health impacts of bushfires can have long-term ramifications. Mr Noel Clement, Director of Australian Programs for the Australian Red Cross pointed out that while mental and physical health impacts are well understood, 'what actually occurs is often more complex and nuanced that is generally understood'. Mr Clement continued that:
Ongoing research to develop a greater understanding of individual and community impacts is invaluable to designing effective recovery programs. Evidence shows us that, three years after Black Saturday, 25 per cent of people involved still experience significant mental health issues, and at the five-year mark this had dropped to only 20 per cent.
The sentiments expressed by Mr Clement were echoed by the AMA, which noted that while the full mental health impacts of the 2019–20 bushfire season would not be understood for some time, it was clear that:
… affected communities have already suffered mental ill-health as a result of the fires and will likely see these impacts continuing into the long‑term. The intense, prolonged fear experienced during a bushfire event and its anticipation, as well as grief and anger in the immediate aftermath, can contribute to severe trauma and/or exacerbate existing mental health conditions.
The committee received numerous accounts from individuals and local communities about the fear and anxiety experienced during the 2019–20 bushfires. For example, Dr Keely Boom, a resident of the NSW South Coast described her experiences during the bushfires:
After the New Year’s Eve fire, thousands of people fled the South Coast driving along roads surrounded by fires. The roads were full and local supplies for fuel and other essentials were low. I worried for my Mum who was still at her farm near bushland but planning to evacuate once the fires got closer. I worried for my Dad and my brothers who were planning to defend the family farm. I went to the RFS headquarters in Moruya to speak with our local brigade captain. I wanted to check if the rumours were true that the RFS would only be defending town. He wasn’t there, but his wife was. She said to me that the RFS [Rural Fire Service] wouldn’t be able to defend anywhere outside of town, the fires were just too big. She said to tell my family to get out, it was just too much. We both cried and held each other, fearing for our loved ones. I tried to convince my family members to change their plans, but had no success.
Further, the Maloneys Beach Residents Association stated that:
The efforts of the fire services, and fortunate changes of wind direction, saved our small community from being burnt but we were evacuated more than once, without power and communication for days on numerous occasions, smoke affected for weeks, in fear of ember attack, and under real threat from fire on three separate occasions.
The Climate Justice Programme also included personal stories of the mental ill health experienced by those in fire-ravaged communities:
There are still people living here in tents, there are still people with inadequate water, there are still people with no sanitation.
My mental health is not good – probably similar to most of the people around here – I have good days and I have bad days.
The PHAA also noted that the experiences of bushfires and climate change are leading to a new form of anxiety:
The psychological trauma caused by directly experiencing uncontrolled bushfires, and the destruction or loss of life they cause, can be profound and long lasting. Indirect mental health impacts can include feelings of fear, dread, powerlessness, and worry about the future that can result from either experiencing, or the expectation of, gradual changes in the climate and environment that occur over the long-term and impact people’s lives. These climate change related emotions have been referred to as ecoanxiety.
Moreover, the mental health impacts of bushfires can vary between different groups within the population. One example is the effects of the loss of Country and cultural connection for First Nations people as described by the National Aboriginal Community Controlled Health Organisation (NACCHO):
The impact of the 2019-20 bushfire crisis on the land is particularly devastating for Aboriginal and Torres Strait Islander peoples … The devastation of the land and evacuation from and loss of homes will have an enduring impact on the social and emotional wellbeing of Aboriginal and Torres Strait Islander communities. These effects will also be significantly amplified for those people who are already vulnerable due to the social determinants of health.
Mental health and first responders
Mental health is a significant issue for firefighters and other first responders. Beyond the immediate mental health impacts for first responders and emergency workers in responding to bushfire events, they may also be personally impacted by losses incurred during bushfires.
The AAHMS highlighted in its submission the importance of adequately preparing for the health impacts on first responders, such as firefighters and frontline volunteers, especially given the prolonged and intense response required by these groups during the 2019–20 bushfire season.
As noted by Doctors for the Environment, many firefighters lost homes, stock and property. It was important that the mental health and well‑being of firefighters:
… be a high priority in any review of this disaster. There is heavy reliance on volunteer firefighters who work for some months, losing time at work and time with their families, and at least one study has highlighted significant mental health impacts. With longer and more intense fire seasons expected that situation may not be tenable in the future.
The committee received further evidence regarding the mental health of firefighters and first responders. The United Firefighters Union of Australia submitted research, from 2013 and 2017, regarding the mental health of firefighters, which found that:
68 per cent of Victorian (Country Fire Authority and Metropolitan Fire Brigade) career firefighters had indicated a moderate level of post-traumatic stress symptoms (a number which was likely to increase given the nature of the work
The most stressful incidents were the death or serious injury of a co‑worker, a fire with multiple deaths, sudden infant death, a seriously injured child, death of a patient after a lengthy attempted resuscitation, assisting a seriously injured friend or relative and multi-casualty events
Approximately 50 per cent of South Australian Metropolitan Fire Service (SAMFS) career firefighters met the criteria of a mental health disorder in their lifetime, with the most common 12-month disorders being post‑traumatic stress injury (PTSI), panic attacks and depressive episodes
The risk of PTSI was significantly elevated among SAMFS who reported experiencing traumas they would commonly be exposed to during the course of their duty, including dealing with a deceased person and mass casualties.
An inquiry of the Senate Education and Employment References Committee (E&E Committee) specifically examined the mental health of first responders. The E&E Committee reported in 2019 and found that there were significant levels of a range mental health issues present amongst firefighters. These issues included anxiety, alcohol disorders, post-traumatic stress disorder and forms of psychological distress.
The E&E Committee noted that mental health issues can be the result of a singular incident that impacts the first responder, or as the result of 'the cumulative effect of repeat exposure to confronting situations'. The committee made 14 recommendations about the mental health of first responders, the majority of which were supported by the government.
Further, the NSW inquiry into the 2019–20 bushfire season examined the mental health of firefighters and first responders. The inquiry considered 'mental health support to be an essential component of ensuring first responder safety'. The NSW inquiry made a number of recommendations, including that:
the NSW Rural Fire Service (RFS) expand in‑house mental health support for members, to ensure members can access the support they need (Recommendation 41); and
the NSW Government work with the Commonwealth Government to provide a free mental health screen to firefighters post-fire event, and waive any gap payments if additional treatment is required, while creating a new Medicare Benefits Scheme item number in order to track demand for mental health services from firefighters over time (Recommendation 42).
As noted by Doctors for the Environment and other submitters, the mental health impacts of bushfires are not distributed equally amongst groups within Australian society, and vulnerable groups are disproportionately affected by mental health impacts.
Vulnerable groups include:
women—particularly from marginalised and disadvantage groups;
Aboriginal and Torres Strait Islander peoples; and
communities in rural, regional and remote areas.
The PHAA advised that those aged between 40 and 60 could also be more at risk of mental health issues, due to the competing demands of employment, parenting, and caring for elderly family members. In addition, the PHAA indicated that:
Those most at risk of persistent or delayed mental health problems are those who are exposed to the more severe trauma exposure during the disaster, as well as those who suffer adverse life events in the aftermath of the event.
The National Women's Alliances (NWA) submitted that 'the impacts of disaster are cleared gendered' and 'all disaster preparation, management, response and recovery efforts need to include a gender analysis at all levels, within government and non‐government organisations'. The NWA recommended that as a first step, the Commonwealth Government support:
… nation-wide implementation of the Gender and Emergency Management (GEM) Guidelines developed in Victoria, which outlines a strategy for gender-responsive disaster management.
Evidence was received by the committee about the support offered by governments and others for those suffering mental health impacts in vulnerably parts of the community. For example, ReachOut expressed concern that the Commonwealth Government's $76 million mental health package to support bushfire-affected communities (discussed later in this chapter) did not:
… specifically take into account the service needs and preferences of young people; specifically, the important fact that even when young people know they need help, many are unwilling or unable to do so.
The National Enterprise for Rural Community Wellbeing (NERCW) submitted that the 2019–20 bushfires have 'disproportionately affected' Australian rural communities, '[a]nd yet, Australian policies of recovery in relation to physical and mental health have consistently been crisis-driven'.
A similar sentiment regarding the need for targeted mental health approaches was received from the NACCHO, which commented on the need to provide mental health support services in a culturally sensitive manner. The NACCHO indicated that it had received anecdotal evidence, suggesting a lack of support being provided to Aboriginal and Torres Strait Islander people, both during and after the 2019–20 bushfires. The NACCHO had heard evidence of 'experiences of racism and discrimination when evacuating and accessing emergency support and supplies (including at evacuation centres)'. The NACCHO noted the limitations of some of the support services available:
In some cases, these national organisations do not have the community access and trust required to provide services to Aboriginal and Torres Strait Islander peoples, which means they are unlikely to reach out to these charities for support or accept support when it is offered …
In some cases, there may be a cultural stigma attached to reaching outside the Aboriginal and Torres Strait Islander network for help. This stigma may have discouraged some Aboriginal and Torres Strait Islander peoples from requesting evacuation and recovery support from any organisation apart from their local community controlled services. This places an additional, and unexpected, burden on these community controlled services as they provide emergency and recovery support they are not funded or resourced to do.
The Local Government Association of Queensland (LGAQ) summarised the sentiments expressed by a number of submitters, in noting that metal health, while difficult to measure, was 'one of the most prevalent and impacting consequences, nationally and internationally, from the impact of disaster events'. The LGAQ recommended that:
… response agencies, including local governments, are appropriately funded, at least in part by the Commonwealth, to undertake psychological first aid training and have the necessary local capacity to undertake preliminary assessment and care [as the] cornerstone of effective and holistic disaster relief and recovery.
Submitters also emphasised that the effects of the bushfires need to be viewed in conjunction with the mental health impacts of COVID-19 pandemic. Mental Health Australia put forward that:
Measures required to suppress the spread of COVID-19 will have a compounding impact on the mental health of people in bushfire-affected communities. Local economic downturn from lost tourism revenue during the fires has been compounded by national (and global) economic downturn related to the COVID-19 pandemic.
Government responses to health impacts
In response to the immense physical and mental health toll experienced during the 2019-20 bushfires, the Commonwealth Government introduced a range of initiatives to help those affected by the bushfires. These initiatives included immediate responses, such as the provision of face masks to combat the effects of bushfire smoke, and longer term programs such as additional funding for mental health services.
On 12 January 2020, the Commonwealth Government announced $76 million over two years would be allocated from the bushfire recovery fund to provide distress counselling and mental health support services to firefighters, emergency personnel, individuals and communities impacted by the bushfires.
On 15 January 2020, the Minister for Health announced $3 million for research into the physiological impacts of prolonged bushfire smoke exposure.
The Commonwealth Government's health response to the 2019–20 bushfires was outlined in the submission from the Department of Health. The response is summarised as follows:
the provision of almost 3.5 million P2 face masks from the National Medical Stockpile for frontline workers and high-risk members of the public in smoke affected communities;
the announcement, on 12 January 2020, of a $76 million mental health package, followed by further funding commitments including an additional $13.4 million for Primary Health Networks to provide localised emotional and mental health support for bushfire‑affected individuals, and an additional $2 million for Lifeline Australia and Kids Helpline to increase their capacity to service those affected by bushfires; and
the allocation of $64.1 million to build youth resilience, and support those who have attempted or lost someone to suicide; $74 million to support mental health and wellbeing during the COVID-19 pandemic; $48.1 million to support the Mental Health and Wellbeing Pandemic Response Plan; and a further $20 million for research to improve mental health care and reduce suicide rates in Australia.
The response also included the investment of $5 million, via the Medical Research Future Fund's (MRFF) 2020 Bushfire Impact Research grants, to fund nine research projects to investigate the medium-term health impacts of exposure to ash and smoke haze, reduced air quality and ongoing mental health effects of the fires.
The nine projects receiving funding under the MRFF funding includes the following projects assessing the physiological impacts of bushfire smoke:
a Newcastle University study into the bushfire impact on vulnerable groups, the respiratory burden and effective community solutions;
a University of Technology Sydney study into defining and treating the physiological effects of bushfire smoke exposure;
a University of NSW randomised controlled trial of mask use in control of respiratory outcomes during bushfire season; and
a Monash University study into the Physiological impacts of prolonged bushfire smoke exposure on first responders and outdoor workers.
In addition, the Australian National University (ANU), in partnership with the Universities of Wollongong and Canberra, the Canberra Health Service and NSW Health, announced in August 2020 that they would examine the effects of the 2019–20 bushfires on pregnant women and their babies from the ACT and south-eastern NSW. The study will examine the direct and indirect impact of the bushfires on the health and wellbeing 'of new mothers and their babies, whether through their living conditions or their mental and physical health'.
The study will also examine vulnerable groups within the research cohort, with the ANU stating that:
The effects of the bushfire on Aboriginal and Torres Strait Islander women and their babies will be given particular focus as this group has been severely affected within this region.
It is hoped that better understanding of the impact of these two crises on the health of mothers and babies will inform the design of interventions to improve the outcomes of those most affected, now and in future years.
Submitters welcomed the Commonwealth Government's funding announcements to assist in recovery, however some outlined how the 2019–20 bushfire season had demonstrated the need for governments to increase targeted support and assistance to vulnerable groups within the community post-disaster, including children and young people, women, and Aboriginal and Torres Strait Islander peoples.
The AMA made reference to its previous emphasis on the risk of deaths and injury resulting from predicted increases in bushfire frequency and intensity, and recommended a number of actions to the Commonwealth Government to reduce health risks arising from bushfires. For example, the AMA recommended that the Commonwealth Government:
commission quantitative modelling of the health impacts and costs associated with extreme weather events, including identification of highly vulnerable groups and regions;
develop and implement a National Strategy for Health and Climate Change which would 'include a comprehensive and broad reaching adaptation plan to ensure the health sector is adequately resourced to meet the significant demands of bushfires and their associated health effects';
establish a National Centre for Disease Control to provide a trusted and nationally consistent source of advice about health threats and how to protect against them; and
pursue emissions reduction more ambitiously to reduce future fire risks, and related health effects.
The AAHMS also argued that health risks needed to be addressed in preparedness strategies and action plans for communities in advance of future bushfires. Further issues raised by submitters around health preparedness for future bushfire seasons included:
the gaps in knowledge about how bushfire smoke impact on respiratory health in the short-, medium- and long- term;
the gaps in knowledge about the mental health impacts on individuals and communities directly affected by bushfires;
the gaps in knowledge about the health impacts on first responders, such as firefighters and frontline volunteers;
the need to fund targeted research to fill the identified knowledge gaps; and
the need for targeted health advice and intervention to protect vulnerable groups.
Supporting vulnerable community groups
In reference to the mental health package announced by the Commonwealth Government, the NERCW asserted that:
… this policy is adopts [sic] a highly medicalised and economic approach to recovery that does not adequately consider the timeframe of the recovery process, the diversity of the recovery process, the limited mental health resources available in rural communities, the non-financial barriers to accessing support, the expertise of rural communities in understanding their unique needs, nor the broader societal factors involved in wellbeing. The very viability of rural and regional communities is at stake if policies do not focus on long-term, socially-oriented, community resilience over short-term, reactive, individualised aid.
Similarly, the National Rural Health Alliance submitted that 'the biggest question mark around the response to the 2019–20 bushfires is whether or not rural communities are being looked after in the long term'. Professor Alan Rosen's submission echoed this view:
The Commonwealth effort, including the National Bushfire Mental Health Package should provide financial incentives for states and territories to rebuild and sustain these facilities to provide a stable presence and ongoing continuity of care as required. This would be far preferable than just importing well-meaning but transient clinicians &/or support workers, some undertrained for this purpose, funded only to provide services for the short-term.
Better Access Bushfire Recovery Telehealth initiative
The $76 million mental health package announced on 12 January 2020 included funding for the Better Access Bushfire Recovery initiative, providing face‑to‑face mental health support, as well as the Better Access Bushfire Recovery Telehealth initiative. As explained by the Department of Health, the Telehealth initiative was established so that:
Individuals, families and emergency response personnel who cannot easily access mental health professionals in person, will be able to obtain counselling and support through video telehealth services, with Medicare rebates.
The initiatives are available to individuals or their families who have been impacted by the 2019–20 bushfires, and to first responders or emergency management employees or volunteers who worked during the 2019–20 bushfires. The services provided by both the face‑to‑face and telehealth bushfire recovery initiatives are available until 31 December 2021.
A core element of the provision of telehealth services is the inclusion of telehealth services in the Medicare Benefit Scheme (MBS). The Commonwealth Government introduced 12 new MBS items to enable those affected by bushfires to access telehealth services. The creating of the new MBS items enabled practitioners to provide Medicare rebates for telehealth services. Telehealth services are now included in the rebate which allows 10 individual mental health services in a calendar year.
While there was broad support for telehealth initiatives, several issues were identified in the submissions in regards to the rollout and accessibility of telehealth services.
The Rural Doctors Association of Australia highlighted the difficulties people living in rural communities faced in accessing telehealth services, due to inadequate communications infrastructure way of example, it observed that:
… in some bushfire affected areas the repair of telecommunication infrastructure for both landline and mobile devices is still underway four months later. While initiatives to increase access to mental health telehealth consultations were introduced in response to the bushfires, the provision and uptake of these services is more difficult in these areas because of patchy access to mobile services and damaged landline and NBN infrastructure.
The committee also received evidence that a more integrated health approach between telehealth and in-person consultations is required. For example, Professor Rosen submitted that:
Psychiatrists and other clinicians offering telehealth consultations and advice are best provided in combination and balance with intermittent in‑person psychiatric consultations and reviews, optimally by the same psychiatrist or by the same rostered and collegiate group of psychiatrists, providing local team and GP consultation, and clinically hand over to each other. Such a combination should provide better engagement, greater accuracy of assessment and review, better appraisal of physical health needs, better communication and clinical supervision with local gp’s and community mental health teams, and better peer review.
The Rural Doctors Association of Australia shared this sentiment and submitted that '[t]elehealth must be part of the continuous primary care that includes face-to-face consultations'. It also advocated for videoconferencing, and noted that:
Video conferencing should be the preferred method for telehealth consultations with telephone consultations undertaken when the patient does not have access to video conferencing or the connection has failed.
Submissions received by the committee in regards to the provision of telehealth services overwhelmingly recommended that funding be maintained for these services.
The committee acknowledges the immense pain and suffering, both physical and mental, experienced by first responders and communities as a result of the Black Summer bushfires. These effects of the 2019–20 bushfire season are still being felt today, and will continue to for a long time.
Clearer communication is needed to ensure the most effective and proven health advice is provided to communities at risk of bushfire smoke, particularly with regard to the efficacy and safe use of face masks. There is also a need for consistency between jurisdictions about advice on air quality and bushfire smoke.
There remain many unknowns about the impact of bushfire smoke and ash on human health. The bushfire smoke reached unhealthy and hazardous levels for nearly two months in Canberra alone, highlighting the need to understand the impact of this exposure. As was noted in evidence to the inquiry, there is no safe level of particulate matter from bushfire smoke.
The evidence to the committee suggests that there is a gap in the medical knowledge about prolonged exposure to bushfire smoke and the long-term health impacts. The committee accepts the evidence of submitters that long‑term funding and research is needed to more definitively determine the impact of hazardous smoke exposure and inhalation on individuals and the community.
The committee notes with concern that there is limited information currently available about both the medium and long‑term impacts of exposure to toxic levels of smoke and ash, and particularly the impact of the smoke on vulnerable groups. The more vulnerable groups within our communities need more tailored support and health advice in order to address their unique circumstances.
The committee considers the research which has commenced into examining the physiological impact of bushfire smoke on the population, and in particular on pregnant women, unborn children and infants as with the ANU study, will play a key role in reducing health risks and improving health outcomes in future bushfire events.
While the committee welcomes the $5 million funding provided through the MRFF's 2020 Bushfire Impact Research grants, this funding will be allocated over nine projects, and the committee is of the view that increased funding over the long‑term is needed to better understand this issue.
The committee therefore recommends that funding is allocated for ongoing research into the health impacts of unhealthy and hazardous levels of bushfire smoke on the population. The committee further considers that research funding be allocated to those projects underway examining the impacts of the smoke on pregnant women, unborn children and infants.
The committee recommends that the Commonwealth Government provide the Department of Health with increased and ongoing funding for research into the health impacts of unhealthy and hazardous levels of bushfire smoke on the population, with specific funding allocated for research into the health impacts of bushfire smoke on pregnant women, unborn children, and infants.
Mental health support
The key messages from submitters for enhancing future preparedness for the mental health impacts of bushfires include:
the need to recognise that the fire emergency brought indirect mental health effects at a broader population level, including vicarious trauma, worry and anxiety about the future potential impact of a bushfire and climate change more broadly;
ensuring government policy and funding responses recognise the long‑lasting mental health impacts of the bushfires, by providing access to psychological support over the long-term;
considering the role of the community context and social determinants of health in framing all policy responses to the bushfires; and
governments adequately resourcing ongoing, regular, in-community mental health services in rural and regional communities.
The committee congratulates the government for its prompt provision of funding to mental health support services, particularly for firefighters and emergency personnel. As noted in Chapter 2, funding has been spent on various mental health initiatives, and this will continue into 2020–21.
The committee encourages the government to maintain funding levels to a sufficient level to ensure that ongoing mental health support is provided to all those who need it. Additional appropriations should be made as a matter of urgency, if gaps in support are identified. This is particularly important given the substantial amount of evidence indicating that the mental health impacts of both the 2019–20 bushfires and other major natural disaster events will be long‑term.
Better Access Bushfire Recovery initiatives
The committee supports the implementation of the Better Access Bushfire Recovery initiative, and the Better Access Bushfire Recovery Telehealth initiative. These initiatives, which provide up to 10 mental health treatment services for those affected by the bushfires, are important resources available to the community.
Telehealth, despite its noted limitations linked to inadequate communications infrastructure, has been shown to have broad support, particularly if telehealth services are provided in conjunction with face‑to‑face primary care (where possible). The inclusion of telehealth services in the MBS is of benefit and will help more people access the support they need. The committee notes that these services are also of considerable benefit to regional, rural and remote areas, where mental health services may not be readily available.
However, the committee is concerned that these initiatives will cease as of 31 December 2021—right in the middle of another bushfire season. As has been shown through evidence received by this and other inquiries, the impact of the bushfires will be felt for a long time to come, and with other bushfire seasons to contend with in the meantime.
The committee therefore recommends that the Better Access Bushfire Recovery initiative and the Better Access Bushfire Recovery Telehealth initiative be made permanent, and continue to be included on the MBS.
This will provide first responders, emergency management employees, volunteers as well as affected individuals and families with access to timely and appropriate mental health support, and some peace of mind that this support will be there for the long‑term. The initiatives should receive adequate and long-term funding over the next forward estimates.
The committee recommends that the Commonwealth Government make the Better Access Bushfire Recovery initiative and the Better Access Bushfire Recovery Telehealth initiative permanent mental health support services, with both initiatives properly funded over the forward estimates.