Lockdowns make people lonely. Here are 3 steps we can take now to help each other


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Michelle H Lim, Swinburne University of TechnologyMillions of Australians are currently living under lockdowns in an effort to curb the rapid spread of the Delta variant of COVID-19.

While lockdowns and other social distancing restrictions are important strategies to protect Australians’ physical health during the pandemic, it’s no secret they take a significant toll on mental health.

As well as financial stressors, including the loss of work, prolonged or frequent lockdowns can affect mental health by disrupting social routines. This puts people in lockdown at risk of loneliness.

So with lockdowns and social restrictions likely to be a part of life in Australia until a significant majority of us are fully vaccinated, it’s timely to think about what we can do to look out for people who may be vulnerable.

Lockdowns and loneliness

Lockdowns reduce our opportunities to connect with loved ones in person, and slow our ability to develop or foster new connections. Many families are also divided across borders — both domestic and international — with little certainty as to when they’ll be able to reunite.

We collected data from the United Kingdom, the United States and Australia, examining loneliness levels in relation to the severity of social restrictions during the first six months of the pandemic.

Although our research is yet to be published, we found, somewhat unsurprisingly, that as social restrictions eased, loneliness levels also dropped significantly.

A man rests his head on his hands.
During lockdowns, the social contact we can have with others face-to-face is limited. This can take a toll on well-being.
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While it’s normal to feel lonely from time to time, some people are at higher risk of problematic levels of loneliness. We found being aged 18-25, being unemployed, and living alone were among the factors that predicted higher levels of loneliness.

Why should we care about loneliness?

For some people, experiencing persistent or distressing levels of loneliness can lead to poor health. In part, this may be because loneliness creates a physiological stress response.

Researchers from Denmark found loneliness increases a person’s chance of developing heart disease by 20%, and type 2 diabetes by 90% within a five-year period.

While people with a mental health disorder are more likely to report being lonely, it goes the other way too. Loneliness predicts more severe depression, social anxiety and paranoia.




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It’s hard to admit we’re lonely, even to ourselves. Here are the signs and how to manage them


There’s increasing recognition that feeling lonely also costs businesses. Loneliness has been estimated to set UK employers back up to £2.53 billion per year, owing to factors such as higher staff turnover, lower job satisfaction and lower productivity.

The adoption of remote working practices beyond the immediate crisis of the COVID-19 pandemic will further limit our ability to form or keep those small, informal but important moments to connect with colleagues.

How can we help those who may be at risk?

Loneliness is a personal and distressing experience that can be complex to resolve.

But for people who are lonely, feeling meaningfully connected to others can help. Here are four steps we can all take to help people who may be experiencing loneliness.

1. Listen out

People who are lonely may not readily or explicitly complain about their loneliness due to fear of judgement or stigma.

If they do reach out, a person who is lonely may ask to connect in an indirect or non-urgent way. This can be because people who feel lonely don’t want to burden others. For example, “when you have time, let’s catch up” may appear non-urgent, but it’s important to respond to these requests.

A hand holds up a smartphone on a video call.
We’re lucky to have digital means to communicate during the pandemic. But loneliness remains a significant health problem.
Ben Collins/Unsplash

2. Check in and share

Living in a lockdown is stressful, but it’s a shared experience. It presents us with opportunities to show kindness to people we may not know well. A simple “hello” can go a long way for many.

Asking others how they are can become part and parcel of our conversations with each other. Indeed, checking in — even with people who we may not know well, such as co-workers, neighbours, or the barista at the local coffee shop — is becoming the new normal.

Where appropriate, more often than not, sharing our lockdown experiences can create an opportunity to bond with and support each other.




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Are the kids alright? Social isolation can take a toll, but play can help


3. Ask the right questions

If someone shares they are feeling lonely, asking “is there anything I can do to help?” facilitates the conversation and lets others know you are there without judgement.

Don’t assume what works for you will work for someone else. Ask them “what do you think could help you?”

Being proactive

Since the pandemic began, many Australians have discovered different ways to keep in touch beyond the zoom call. These include things like writing stories and letters, leaving care packages, and exercising with a friend (while socially distanced and with masks).

Millions of Australians are living with multiple sources of stress right now. But it’s not impossible to show emotional support and care to people around us while still sticking to social distancing rules.

Employers must also take proactive steps to keep workers engaged with each other and to the organisation.




Read more:
Lonely in lockdown? You’re not alone. 1 in 2 Australians feel more lonely since coronavirus


So long as lockdowns are used as a strategy against the virus, there will be a social cost to our well-being. But that only makes it more important than ever that we make the effort to stay meaningfully connected to others.The Conversation

Michelle H Lim, Senior Lecturer and Clinical Psychologist, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How the Groundhog Day grind of lockdown scrambles your memory and sense of time


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Adam Osth, The University of MelbourneWith roughly half of Australia in lockdown at the moment, a common experience is a warped sense of time and poor memory. What day is it? What week is it? Did I go to the supermarket yesterday, or was it the day before? Am I actually in the movie Groundhog Day and experiencing the same day over and over?

While lockdown can have a range of impacts such as anxiety and depression — both of which can impair memory — these aren’t the whole picture. There is increasing theoretical and experimental evidence that suggests both memory and time perception are based on the same underlying principle: a change in your physical and/or mental state.

So it follows that when there is less change, it becomes harder to determine how much time has passed, or to remember what happened and when.

Cognitive scientists are increasingly embracing an elegant theory of memory with profound implications, known as contextual-binding theory. According to this theory, memories are formed by linking what you experience to the context in which it occurred.




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But what is context? Well, everything!

Let’s say an event happens to me: a strange cat walks into my house. I form a memory of this event by linking the cat to the context — in this case, the context includes the physical surroundings (my house) and my mental state (surprise and excitement, because I love cats).

Because my memory has linked all the various aspects of this event together, when I experience a piece of that event (being in the room where I saw the cat, or feeling excited when seeing another cat), it prompts my memory to recall all the other aspects of the event too, triggering a reconstruction in my head of that time a strange cat walked into my house.

Cat sitting on dining room table
Remind you of anything?
Paul Hanaoka/Unsplash, CC BY

But there’s a catch. As we link more and more memories to the same cues, it becomes harder to find a memory with those cues. This is like a Google search – it’s easiest to find what you’re looking for if your search term is unique to that particular thing.

That’s why we often have the best memory for events that occur in different contexts. Imagine you go on holiday and spend an amazing week in the Caribbean. Among your entire lifetime’s memories, relatively few of them happened in the Caribbean, so it’s easy to remember what you did on your holiday.

Lockdown is the exact opposite of this. In lockdown, the events we experience all have more or less the same context. If you’re spending almost all your time in your house, it’s harder to pinpoint individual memories of the things that happened there. It’s like doing a Google search where everything matches your search terms.




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Ah, memories of 2020. Why it’s important to remember our COVID holidays, good or bad


But where does time come in?

Time isn’t something our minds can measure directly. We don’t have clocks or hourglasses in our brains.

Fortunately for us, our minds are very good at constructing concepts we can’t directly measure. Our eyes can’t measure depth directly — instead, we estimate it with the help of cues in our surrounding environment.

So how can we measure how much time has elapsed? We approximate it by evaluating how much has changed between a remembered event and the present moment. When I remember an event, there are things that might be different from the present moment. Was I in a different place? Did I feel different, or look different? The sum total of these changes can produce an estimate of how much time has elapsed between then and now.

This was demonstrated in an intriguing experiment by US psychology researchers Lili Sahakyan and James Smith. Participants learned words in three different lists. Some participants experienced mental context change between each list, whereby they were instructed to think about other things than the previous list. Another group did not experience mental context change, and were instructed simply to keep the previous list in mind.

When there was more context change, memory was better for the words learned in the most recent list. Interestingly, when participants were asked how much time had elapsed since the beginning of the five-minute-long experiment, the “context change” group estimated that the experience was about a minute longer than the group who experienced no context change between lists.

When there was less context change between episodes, which is similar to the conditions of lockdown, subjects had worse memory for the most recent event, and reported that less time had elapsed. Other experiments have demonstrated similar results with changes in physical location..




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Don’t know what day it is or who said what at the last meeting? Blame the coronavirus


So how do we get around this problem and improve our memories? The obvious solution is to create change. Mix up your physical surroundings, or try different exercises or routines on different days to make them more distinct.

And rest assured, your lockdown memory fog is almost certainly temporary. Once lockdown lifts and go back to experiencing events in different places, we will start remembering what day it is again.




Read more:
What Groundhog Day (and my time in a monastery) taught me about lockdown


The Conversation


Adam Osth, Senior Lecturer, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Myths and stigma about ADHD contribute to poorer mental health for those affected


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David Coghill, The University of Melbourne; Alison Poulton, University of Sydney; Louise Brown, Curtin University, and Mark Bellgrove, Monash UniversityAround one in 30 Australians (or 3.4% of the population) have attention-deficit hyperactivity disorder (ADHD). Yet it remains a poorly understood and highly stigmatised disorder.

Our new paper, which reviews the research on community attitudes about ADHD, found misconceptions are common and affect the way people with ADHD are treated and see themselves.

Stigma is an underestimated risk factor for other negative outcomes in ADHD, including the development of additional mental health disorders such as anxiety, depression, alcohol and substance abuse, and eating disorders.

Stigma is also likely to contribute to the increased risk of suicide, with people with ADHD three times more likely than the rest of the population to take their own life.

Early recognition and treatment of ADHD significantly improves the physical, mental and social outcomes of people with the condition who, like everyone else, deserve to live full and rewarding lives.

No, ADHD isn’t caused by too much TV

Our review of the research found many people erroneously attribute ADHD symptoms – particularly in children – to exposure to TV or the internet, lack of parental affection, or being from a broken home.




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Rather, ADHD is a complex disorder that results from inherited, genetically determined differences in the way the brain develops.

People with ADHD have persistent patterns of hyperactive, impulsive and inattentive behaviour that are out of step with the rest of their development. This can affect their ability to function and participate in activities at home, at school or work, and in the broader community.

Boy looks at computer screen with hand in hair, thinking.
ADHD can affect your ability to concentrate.
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There are clear criteria for diagnosing ADHD, and a diagnosis should only be made by a specialist clinician following a comprehensive medical, developmental and mental health review.

No, ADHD isn’t routinely overdiagnosed

Our review of the research found three-quarters of Australian study participants believe the disorder is overdiagnosed.

Based on the international research, an estimated 850,000 Australians are living with ADHD.

Yet current rates of diagnosis are much lower than this, particularly in adults where fewer than one in ten have received a diagnosis.

There is also widespread scepticism in the community about the use of medicines to treat ADHD.

Medication is only one part of the management of ADHD which should always include educational, psychological and social support.

Clinical evidence does, however, support the use of prescription medications as a key part of the treatment for ADHD. And there is evidence to show these medications are seen as helpful by those who take them.




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Although rates of medication treatment have increased over the years, less than one-third of Australian children with ADHD and fewer than one in ten adults with the condition are currently receiving medication. This is much lower than expected, based on international guidelines.

How this stigma feels

People with ADHD can struggle with day-to-day things other people find easy, with little understanding and acknowledgement from others.

Typical examples include butting in to others’ conversations and activities, leaving tasks half done, being forgetful, losing things, and not being able to follow instructions.

The response to these behaviours from family, teachers and friends is often negative, critical and relentless. They’re constantly reminded of just how much they struggle with the day-to-day things most people find easy.

Teenage boy in a hoodie stands against a wall, looking down
People with ADHD know they’re being judged.
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Our review found young people are particularly affected by this judgement and stigma. They’re aware they’re viewed by others in a negative light because of their ADHD and they commonly feel different, devalued, embarrassed, unconfident, inadequate, or incompetent.

Some respond to this constant criticism by acting out with disruptive and delinquent behaviours, which of course usually just escalates the situation.

Stigma can be a barrier to treatment

The perception and experience of stigma can influence whether a parent decides to have their child assessed for ADHD, and can leave parents underestimating the risks associated with untreated ADHD.

The confusion about what parents should believe can also affect their ability to make informed decisions about the diagnosis and treatment of their child. This is concerning because parents play a vital role in ensuring health professionals properly recognise and support their child’s health needs.

When diagnosis is delayed until adulthood, people with ADHD are four times more likely to die early than the rest of the population. This not only reflects the increased risk of suicide, but also an increase in serious accidents which arise due to impulsive behaviours.




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ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed


When we treat people with ADHD, many of these problems dramatically improve. It’s not uncommon for someone who has recently started on treatment to say, “wow, I didn’t know life was meant to be like this”.

Treatment also improves the physical, mental and social well-being for children and adults with the disorder.


If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or visit Headspace.The Conversation

David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne; Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney; Louise Brown, PhD candidate, Curtin University, and Mark Bellgrove, Professor in Cognitive Neuroscience, Director of Research, Turner Institute for Brain and Mental Health; President Australian ADHD Professionals Association (AADPA, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Home quarantine for vaccinated returned travellers is extremely low risk, and won’t damage their mental health


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Gregory Dore, UNSWMany thousands of people need to return to Australia, and many at home wish to reunite with partners and family abroad.

A move away from a one-size-fits-all approach to quarantine is a way to make this happen — including home quarantine for vaccinated returnees.

The federal government implemented home quarantine over a short period in March 2020, before switching to mandatory hotel quarantine for returned residents and other incoming passengers.

But the considerably changed circumstances — most importantly, access to effective vaccines — calls for its reintroduction despite caution among politicians and the community.

The low rate of positive cases, and proven effectiveness of further safeguards to limit breaches, make home quarantine a persuasive strategy.

It’s worth remembering people who contract COVID, and their contacts, have successfully self-isolated at home since the pandemic began.

How will we make sure it’s safe?

There are several protective layers which would ensure extremely limited risk of home quarantine for fully vaccinated returned overseas travellers.

The first is requiring a negative COVID test within three days of departure, which is currently a requirement for all returnees.

The second is COVID vaccination. Recent studies indicate full vaccination provides 60-90% infection risk reduction. In cases where fully vaccinated people do get infected, these “breakthrough cases” are less infectious.

It’s also important to test returnees in home quarantine. A positive case would trigger testing of any contacts and may extend self-isolation.

Also, high levels of testing in the broader community can ensure early detection of outbreaks, enabling a rapid public health response to limit spread, if it did leak out of home quarantine.




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The risk would be extremely low

Data from hotel quarantine in New South Wales, which takes around half of returned travellers in Australia, suggests home quarantine for fully vaccinated returnees would likely present an extremely low risk.

In 2021, NSW has screened around 4,700 returnees a week, with the proportion of positive cases detected during quarantine averaging around 0.6%.

From March 1, since vaccination has become more accessible, only eight of 406 positive cases were fully vaccinated.

Unfortunately we don’t have the overall data on how many returnees were fully vaccinated, but even if only 10-20%, this would equate to a positive rate of around 6-12 per 10,000 among the vaccinated. This is considerably lower than the overall rate of 66 COVID cases per 10,000 since March 1.




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If home quarantine was initially restricted to fully vaccinated returnees from countries with low to moderate caseloads, the rate would be lower again, probably less than five per 10,000.

If NSW increased their quarantine intake by taking an extra 2,500 per week from this population into home quarantine, it would equate to maybe a few positive cases per month, compared to around 120 cases per month in hotel quarantine. As vaccination uptake increases, this capacity could be expanded, with reduced hotel quarantine requirements.

Will people comply?

The enormous desire for stranded Australian residents, overseas partners and family of residents in Australia to return and reunite should ensure a high level of compliance with home quarantine.

Home quarantine has been successfully implemented in other countries with elimination strategies such as Taiwan and Singapore. Taiwan’s system was deployed rapidly and has 99.7% compliance. Singapore uses a grading system to enable lower-risk returnee residents to do seven days in home quarantine, with a negative test required for release on day seven.

Two major reviews of the hotel quarantine system — the Victorian government-commissioned Coate report, and the national review of hotel quarantine — recommended implementing home quarantine with monitoring technology, such as electronic bracelets. Their recommendations were made prior to the approval of vaccines.

Recent data suggests the current hotel quarantine system has harmful effects. Research published in the Medical Journal of Australia in April found mental health issues were responsible for 19% of all emergency department presentations among people in NSW hotel quarantine. It’s highly likely home quarantine would be more beneficial for the mental health of returnees.

What are the barriers?

Issues which would need to be sorted through include:

  • methods for determining how risky different countries are
  • how returnees can prove they’ve been vaccinated
  • how we would test returnees and home-based contacts, and how frequently
  • and how long home quarantine would be for.

But none of these are insurmountable, and small-scale home quarantine already exists in the ACT.

Health authorities could ensure returnees can collect their own COVID testing samples, for example by doing nasal swabs or collecting saliva themselves. This would reduce contact with health workers.

Home quarantine is undoubtedly being considered by major Australian COVID policy committees, along with other measures to enable a larger number of returnees and to increase the safety of the quarantine system.

Australians’ excessive caution continues to have direct consequences for the well-being of many thousands of stranded Australian residents, together with non-resident partners and family members desperate to return.

It’s time to change this situation and make their human rights a public health priority.


The author would like to thank John Kaldor, Esther Rockett, and Liz Hicks for their input.The Conversation

Gregory Dore, Scientia Professor, Kirby Institute; Infectious Diseases Physician, St Vincent’s Hospital, Sydney, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Best evidence suggests antidepressants aren’t very effective in kids and teens. What can be done instead?


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Sarah Hetrick, University of Auckland; Joanne McKenzie, Monash University; Nick Meader, University of York, and Sally Merry, University of AucklandEven before COVID-19 lockdowns, school closures and strict social distancing, depression was on the rise in children and teenagers around the globe.

By the age of 19, around 25% of adolescents are estimated to have experienced a depressive episode. By the age of 30, this figure grows to 53%.

A number of studies point to an increasing use of antidepressants in young people.

So, what do we now know about how well antidepressants work in children and young people?

Our new Cochrane review, published today, found that on average, antidepressants led to only small improvements in depression symptoms compared with placebo in children and adolescents (ranging in age from six to 18 years old).

Antidepressants shouldn’t be the first port of call

Our findings highlight antidepressants are no panacea for depression in young people. The small improvements might be so small as to not be very noticeable to the individual person. What’s more, we can’t say to any one young person whether antidepressants will definitely improve their symptoms.

But it’s critical to note there are multiple and complex pathways that lead to the distress and demoralisation that are key in depression.




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Different people’s responses to antidepressants are therefore quite specific, and young people may experience anything from marked improvement to deterioration.

Another important finding is that antidepressants are associated with an increased risk of suicidal thinking and self-harm.

These are not necessarily new findings, but they represent the best evidence we have so far. They remain a key consideration for GPs and other health professionals who are considering medications for children and young people.

Boxes of fluoxetine, an antidepressant medication
Our new Cochrane review found, on average, antidepressants lead to only small improvements in depression symptoms compared with placebo in kids and teens.
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What is new is our findings on how different antidepressants compare with each other. Many current guidelines recommend fluoxetine as the only first-line medication that should be tried. This is commonly sold under the brand name Prozac.

Fluoxetine is what’s called a “selective serotonin reuptake inhibitor” (SSRI). Serotonin is a neurotransmitter in the brain linked to positive emotions. After it’s used by nerve cells, serotonin is reabsorbed, which is known as “reuptake”. These types of antidepressants work by blocking the reuptake of serotonin, therefore increasing its availability to pass messages between nerve cells.

Our review shows three other antidepressants, including sertraline, escitalopram, and duloxetine, had similar effects to fluoxetine. Though, there’s the caveat that all of these led to only small reductions in depression on average.

However, this finding may extend treatment options for young people with depression. For example, one of these antidepressants may suit one person better than another in terms of side-effects experienced, and the time it takes to work or to wash out of the system.

What other options are there?

Against a backdrop of a global pandemic, there’s a risk we may start to consider depression as the “norm”, passing it over as a given or as insignificant.

But as those with depression, and their parents, families and friends know, depression is anything but. It impacts every facet of life and is often accompanied by a fear it may never improve.




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Depression varies substantially between people with multiple factors at play, so it’s important a range of support and treatments are available for people.

Antidepressants have been, and will remain, only one of many options for young people with depression. Guidelines continue to highlight that antidepressants should not be the first port of call.

When used, they should be used in combination with evidence-based talking therapy, the most common being cognitive behavioural therapy (CBT), and there must be a commitment to ensure close monitoring of their impact.

Kids exercising
Antidepressants should only be considered alongside talk therapy, as well as increased exercise, adequate sleep and good nutrition.
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There’s a range of ways in which young people can and need to be supported. There’s good evidence for regular physical activity, good nutrition, and adequate sleep. Support from family, schools and the broader community is also important.

A decision to use antidepressants should be on the basis of shared decision-making. This refers to conversations where the risks and benefits of all treatment options are described to the young person, and their family, who are then meaningfully involved in making the decision.

If the decision is made to use an antidepressant, it’s critical to ensure health professionals conduct regular (weekly at first) checks on depression symptoms and adverse effects. This is particularly important in terms of monitoring the emergence of suicidal thinking and self-harm.

Treatment with an antidepressant should be in the context of talking therapy, and a holistic approach to well-being.

Ensuring access to support and treatment and conveying a sense of hope is crucial.


If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Sarah Hetrick, Associate Professor of Youth Mental Health, University of Auckland; Joanne McKenzie, Associate Professor, Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University; Nick Meader, Research Fellow, Centre for Reviews and Dissemination, University of York, and Sally Merry, Professor and Cure Kids Duke Family Chair in Child and Adolescent Mental Health, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why the TGA should reschedule MDMA and psilocybin for the treatment of mental illness


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Sarah-Catherine Rodan, University of Sydney and Samuel Banister, University of SydneyThe Therapeutic Goods Administration (TGA) is considering rescheduling psilocybin and MDMA from their current classification as Schedule 9 prohibited substances to Schedule 8 controlled substances.

This would allow psychiatrists to use these drugs in combination with psychotherapy for the treatment of conditions such as depression and post-traumatic stress disorder (PTSD).

Here’s why we believe that would be a good idea.




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A bit of background

On February 3, the TGA announced an interim decision to retain psilocybin and MDMA as Schedule 9 drugs.

The TGA cited limited evidence of therapeutic benefit, safety concerns, potential for abuse, and lack of suitably trained psychiatrists.

But the final ruling, which was expected on April 22, has now been delayed while the TGA seek independent expert advice on the “therapeutic value, risks, and benefits to public health” of the change.

A man sits on the couch during a therapy session.
If MDMA and psilocybin are reclassified, they would be administered in a supervised environment.
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The case for MDMA and psilocybin

Research on psychedelic substances such as LSD and psilocybin first began in the 1960s.

The number of clinical trials involving psilocybin or MDMA has increased steadily in the past decade, with more than 70 studies completed since 2010.

Around 60 trials are underway in Europe and the United States involving MDMA or psilocybin.




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The results of completed studies are very promising.

For example, last month, a study of 59 patients with major depression showed just two sessions of psilocybin-assisted therapy was as effective as a six-week course of the antidepressant escitalopram. The proportion of patients who no longer qualified for a major depression diagnosis after treatment was twice as high in the psilocybin group.

This month saw results of one of the largest trials of MDMA-assisted psychotherapy for PTSD published. The phase 3 study used MDMA-assisted psychotherapy to treat 90 patients with severe, chronic PTSD. After three sessions, 67% of participants no longer qualified for a PTSD diagnosis, compared to just 32% of participants undergoing therapy alone.

These latest studies add to a growing number of trials from around the world showing the therapeutic benefit of psilocybin or MDMA in depression, PTSD, anxiety associated with terminal illness, obsessive-compulsive disorder, alcohol and tobacco dependence, and social anxiety in adults with autism.

Scientists are now investigating the use of psilocybin in other conditions for the first time, such as anorexia nervosa, general anxiety disorder, and opioid and cocaine dependence.

A woman appears unhappy.
Studies are showing MDMA and psilocybin can be effective in treating a variety of mental health problems.
Shutterstock

Are MDMA and psilocybin safe?

Unlike many Schedule 8 medicines, psilocybin- or MDMA-assisted psychotherapy treatments are not taken regularly. The substance is usually used just two or three times with trained specialists as part of a psychotherapy program.

Despite the safety concerns cited by the TGA, there haven’t been any serious adverse reported events due to psilocybin or MDMA from dozens of clinical trials. Less serious effects can include temporary anxiety, paranoia, fear, nausea, post-treatment headaches, or mild increases in blood pressure and heart rate.

Of course, these trials use pharmaceutical-grade drugs administered by a doctor.

However, one of the most comprehensive studies of the harms of commonly used illegal drugs found even illicit forms of psilocybin and MDMA are among the least harmful. In fact, “mushrooms” containing psilocybin had the lowest overall harm score, while illicit forms of clinically-used Schedule 8 substances like cocaine, cannabis and ketamine were all more harmful than psilocybin or MDMA.

We don’t know what dose of psilocybin would be lethal to humans, but it’s estimated to be about 1,000 times greater than the therapeutic dose. No overdose deaths due to psilocybin toxicity alone have ever been reported.

Use of illicitly manufactured MDMA — which often contains other drugs or impurities — has occasionally caused deaths. An estimated 600,000 Australians use illegal MDMA each year, and an average of about three deaths per year since 2000 have been associated with MDMA toxicity alone.

But illicit use of MDMA of unknown dose and purity is much more dangerous than administration of pharmaceutical MDMA under medical supervision in a clinical environment.

A growing field

In recent years, respected academic and medical institutions around the world have launched dedicated centres for psychedelic and MDMA research, including Johns Hopkins University and Imperial College London.

And research into the therapeutic effects of psilocybin and MDMA has recently started in Australia. St Vincent’s Hospital in Melbourne is conducting a clinical trial using psilocybin-assisted psychotherapy to treat anxiety and depression in terminally ill patients. A clinical trial at Monash University is looking at psilocybin-assisted psychotherapy for generalised anxiety disorder and MDMA-assisted psychotherapy for PTSD.

The Australian government recently announced A$15 million in funding for research into the medical potential of psychedelics and MDMA.




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Psychedelics to treat mental illness? Australian researchers are giving it a go


It’s hard to reconcile the TGA’s interim decision to retain Schedule 9 for substances with demonstrated benefit in several mental health conditions and fewer safety concerns than many existing Schedule 8 medicines.

The US medicines regulator recently granted MDMA and psilocybin “breakthrough therapy” designation; a special status for highly promising drugs that speeds up their path to the clinic.

The down-scheduling of psilocybin and MDMA could have enormous medical benefit for Australian patients, especially when Australia spent A$10.6 billion on mental health between 2018-2019.The Conversation

Sarah-Catherine Rodan, PhD candidate, University of Sydney and Samuel Banister, Team Leader in Medicinal Chemistry, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As boundaries between work and home vanish, employees need a ‘right to disconnect’


Mick Tsikas/AAP

Barbara Pocock, University of South AustraliaIf you have been in a children’s playground recently, you may have seen a distracted parent absorbed in an intense phone conversation, swatting a child away.

Sure, some are ordering tickets for The Wiggles, but most are not — they are working. They might have officially knocked off, be on leave or it might be a weekend. But as surely as if they were in the office, they are at work.

Many of us know that tug of double consciousness: the child’s pressing need pitted against a complex issue on the other end of the phone demanding every neurone we can muster.

You do not have to be a carer to feel this tug. It still finds plenty of people who just want some quiet time, an uninterrupted run, a life beyond work.

It’s the growth of this tug, affecting more and more women and men, which has fuelled the push for a “right to disconnect” from work. This includes a recent significant victory for Victoria Police employees to protect their time away from work.

Availability creep

Our forebears would not recognise the ephemeral way we work today, or the absence of boundaries around it. But powerful new technologies have disrupted last century’s clearer, more stable, predictable limits on the time and place of work.

This is called “availability creep”, where employees feel they need to be available all the time to answer emails, calls or simply deal with their workload.

Sydney CBD skyline with headlights on the freeway.
Australians did even more unpaid overtime during COVID than before the pandemic.
Mick Tsikas/AAP

And that was well before a pandemic that piled revolution upon revolution on the way we work. A 2020 mid-pandemic survey showed Australians were working 5.3 hours of unpaid overtime on average per week, up from 4.6 hours the year before.

These longer hours are often associated with job insecurity. In a labour market like Australia’s, where insecure work is widespread, there are strong incentives to “stay sweet” with the boss and work longer, harder and sometimes for nothing.

Health implications

So, work is now untethered from a workplace or a workday, and our workplace regulation lags well behind. This has serious implications for our mental health, work-life stress, productivity and a fair day’s work for a fair day’s pay.

Of course, flexibility is not all bad. As a researcher collecting evidence for decades about the case for greater flexibility for employees, I see silver linings in a pandemic that achieved almost overnight what decades of data-gathering could not: new ways of working that can suit workers (especially women) and their households.




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Forget work-life balance – it’s all about integration in the age of COVID-19


However, this change has a dark side. Digital work and work-from-home have shown themselves to drive long hours of work, and to pollute rest and family time. Poor sleep, stress, burnout, degraded relationships and distracted carers are part of the collateral damage.

Disconnecting in Australia and internationally

A growing international response attests to the importance of disconnection. And it has now reached our shores.

Last month, Victoria Police’s new Enterprise Bargaining Agreement (EBA) included the “right to disconnect” from work. It directs managers to respect leave and rest days and avoid contacting police officers outside work hours, unless in an emergency or to check on their welfare. The goal is to ensure that police, whose jobs are often stressful, can switch off from work when they knock off and get decent rest and recovery time.

Swimmers at Bondi Beach pool.
There is a growing push to protect employees’ time outside work hours.
Bianca De Marchi/AAP

The “right to disconnect” has taken several forms internationally in recent decades. At individual firm level, some large companies such as Volkswagen, BMW and Daimler now simply stop out-of-hours or holiday emails or calls.

Goldman Sachs has also recently re-stated its far from radical “Saturday rule”, under which junior bankers are not expected to be in the office from 9pm Friday to 9am Sunday.

The French example

Some countries now regulate the right nationally.

Since 2017, French companies employing more than 50 people have been required to engage in an annual negotiation with employee representatives to regulate digital devices to ensure respect for rest, personal life and family leave. If they can’t reach agreement, the employer must draw up a charter to define how employees can disconnect and must train and inform their workers about these strategies.

While enforcement of the French law has attracted criticism (as penalties are weak), it has fostered a national conversation —now reaching other countries like Greece, Spain and Ireland. In early 2021, the European Parliament voted to grant workers the right to refrain from email and calls outside working hours, including when on holidays or leave, as well as protection from adverse actions against those who disconnect.

What’s next for Australia?

The Victoria Police EBA has encouraged a new level of discussion in Australia. The ACTU has backed a right to disconnect, especially for workers in stressful jobs.

Individual businesses will now be examining their obligations to ensure maximum hours of work are adhered to and “reasonable” overtime and on-call work is managed to avoid possible claims for unpaid work.




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This week, The Sydney Morning Herald reported that supermarket giant Coles is trying to prevent out-of-hours work.

The consequences for companies can be expensive when digital work is not well managed. In 2018, the French arm of Rentokil was ordered to pay an ex-employee the equivalent of $A92,000 because it required him to leave his phone on to talk to customers and staff.

Beyond fair remuneration, a duty of care to provide a safe and healthy workplace is also implicated in digital work that leaks beyond working hours.

What needs to happen now

Large public sector workplaces are likely to follow Victoria Police’s example. However, EBAs now cover just 15% of workers, so this pathway won’t help most workers, many of whom are instead covered by one of the 100 or so industry or occupational modern awards.

These awards could be amended to include a right to disconnect. But more simply and comprehensively, the National Employment Standards (which apply to all workers regardless of whether covered by an award or an EBA) could be amended to provide an enforceable right to disconnect with consequences for its breach, alongside existing standards of maximum hours of work, flexibility and other minimum rights.

Given many women, low paid, private sector, un-unionised and relatively powerless workers in smaller workplaces have little chance of negotiating or enforcing a right to disconnect, it is vital the right to disconnect applies across the whole workforce.The Conversation

Barbara Pocock, Emeritus Professor University of South Australia, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, OCD in a pandemic doesn’t necessarily get worse with all that extra hand washing


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Carey Wilson, The University of Melbourne and Thibault Renoir, Florey Institute of Neuroscience and Mental HealthAt the beginning of the COVID-19 pandemic, we were concerned infection control measures such as extra hand washing and social distancing might compound the distress of people living with obsessive-compulsive disorder (OCD).

Early anecdotal evidence and case studies reported an apparent increase in OCD relapse rates and symptom severity.

But a year on, we’re learning this is not necessarily the case, and research is giving us a more nuanced understanding of what it’s like to have OCD during a pandemic.




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What is OCD?

OCD is a common and disabling condition, affecting roughly 1.2% of Australians.

It’s characterised by obsessions (repetitive intrusive thoughts) and compulsions (physical actions or mental rituals) that attempt to quell these preoccupations.

There are several subtypes of OCD, including:

  • contamination: characterised by obsessions and compulsions centred around washing, cleaning and concerns around personal hygiene and health
  • overresponsibility: encompassing pathological doubt, concerns over unintentional harm to others or oneself, and persistent urges to check things
  • symmetry: obsessions about things feeling “just right” (for example, uniform and/or symmetrical), resulting in ritualistic behaviours including counting and ordering
  • taboo: characterised by unwanted intrusive thoughts that are often violent, sexual or religious in nature.

Although we don’t fully understand what causes OCD, research points to abnormal activity of specific brain networks, including a network called the cortico-striatal-thalamo-cortical loop.

This network connects key emotional, cognitive and motor hubs in the brain, and it’s particularly important for higher-order cognitive tasks such as thinking flexibly.

No, people with OCD aren’t ‘quirky’

There are several prevailing stereotypes about what it means to live with OCD, such as a belief people with the disorder are just a bit quirky, overly particular, “neat freaks” or “germ-phobic”.

Such ideas are frequently promulgated in popular culture. For example, in 2018 Khloe Kardashian promoted her “KHLO-C-D” branding for an online miniseries in which she gave tips on home organisation and cleanliness. The campaign was widely criticised.

While contamination fears and an affinity for symmetry are better recognised in the community (perhaps owing to portrayals in TV and film), the “taboo” and “overresponsibility” dimensions of OCD are far less understood and are therefore subject to higher levels of stigma.

Are we all OCD now?

The global response to COVID-19 has blurred the line between pathological behaviours and adaptive health and safety measures.

Behaviours that were previously linked to psychiatric illnesses, such as repetitive washing and sanitising rituals, are now encouraged (at least to some extent) by health authorities.

While infection control directives such as social distancing and hand hygiene play an essential role in our fight against the virus, they take a psychological toll too.

The pandemic has had a profound effect on mental health due to increased stress and lifestyle changes. Indeed, scientists have recently proposed a condition called “COVID-19 stress syndrome”. Some of the symptoms significantly overlap with anxiety disorders and OCD.

While we don’t all have OCD now, it’s unquestionable our collective behaviour has changed in ways that make the distinction between “normal” and “pathological” much more complex.

In this light, the International College of Obsessive–Compulsive Spectrum Disorders has highlighted the unique challenges the pandemic poses for accurately diagnosing OCD.




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You can’t be ‘a little bit OCD’ but your everyday obsessions can help end the condition’s stigma


Living with OCD in a pandemic

Having a pre-existing mental health condition appears to be the single most influential predictor of high stress levels during COVID-19.

However, recent evidence from well-controlled studies doesn’t find compelling evidence that people with OCD have been affected by COVID-19 to a greater extent than those with other psychological conditions (such as depression or general anxiety).

One study published in January compared OCD severity in a large group before and during the pandemic. It found the stress induced by COVID-19 increased measures of mental distress across all OCD symptom dimensions (not only those directly related to a public health crisis).

The authors suggested the increase in OCD symptom severity was likely a “non-specific stress-related response”. In other words, it’s the general stress of the pandemic that has worsened OCD in some cases; not the increased focus on infection control.

A woman sitting on the couch, appears pensive or unhappy.
Having a pre-existing mental health condition is the biggest risk factor for having high stress levels during the pandemic.
Shutterstock

Another recent study found the pandemic didn’t lessen the benefits of treatment in a large outpatient group with OCD in India.

Interestingly, the researchers from this study also found prior incomplete disease remission (cases of OCD that persisted even with treatment) and general stress were the best predictors of OCD relapse during the pandemic, rather than “COVID-specific” stress, per se.

After the pandemic

These findings don’t suggest there’s a specific vulnerability to COVID-related stress for people with OCD.

But it’s worth noting cognitive inflexibility, a symptom often seen in OCD, may make it more difficult for people with the disorder to “unlearn” temporary public health directives.

So it’s important we continue to monitor the effects of COVID-related stress on OCD and similar disorders, particularly as we slowly transition from the pandemic.

There’s much we can learn from the study of OCD during COVID-19. Most notably, it appears an “intuitive” understanding of the disorder doesn’t sufficiently capture the breadth of individual OCD experiences.

A deeper understanding of the variability of OCD presentations, and a move away from stereotyped perceptions, may encourage more people to openly discuss their own OCD experience and seek treatment.




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My skin’s dry with all this hand washing. What can I do?


Need support?

If you live in Australia, call Lifeline (13 11 14), Kids Helpline (1800 551 800) or BeyondBlue (1800 512 348). Alternatively, “OCD STOP!” is a free online program designed to help you better understand and manage OCD.

If you simply want to learn more about OCD, online resources are available at SANE Australia and Beyond Blue.The Conversation

Carey Wilson, PhD Candidate, The University of Melbourne and Thibault Renoir, Head of Genes Environment and Behaviour Laboratory, Florey Institute of Neuroscience and Mental Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression, burnout, insomnia, headaches: how a toxic and sexist workplace culture can affect your health


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Xi Wen (Carys) Chan, Griffith University and Paula Brough, Griffith UniversityAs allegations of rape and sexual assault engulf Australian federal politics, several current and former female staffers and politicians have come forward to share their stories of a culture of toxic masculinity within Australia’s political bubble.

It’s unfortunate that while gender roles are evolving at home, gender inequality and overt sexism remain prevalent in Australian political culture and in many workplaces across the country.

While the effects of a culture of toxic masculinity are most detrimental for the victims, other employees in workplaces and the wider community can also be negatively impacted.

This opens up a broader question: how does a toxic and sexist workplace culture affect the health and well-being of employees and organisations?

What does a toxic and sexist workplace look like?

A culture of toxic masculinity is a hostile work environment that undermines women. It’s also known as “masculinity contest culture”, which is characterised by hyper-competition, heavy workloads, long hours, assertiveness and extreme risk-taking. It’s worth noting this type of culture isn’t good for men, either.

Such workplaces often feature “win or die” organisational cultures that focus on personal gain and advancement at the expense of other employees. Many employees embedded in such a culture adopt a “mine’s bigger than yours” contest for workloads, work hours and work resources.

These masculinity contest cultures are prevalent in a wide range of industries, such as medicine, finance, engineering, law, politics, sports, police, fire, corrections, military services, tech organisations and increasingly within our universities.

Microaggressions are common behaviours in workplaces steeped with a masculinity contest culture. These include getting interrupted by men in meetings or being told to dress “appropriately” in a certain way. There are also overtly dominating behaviours such as sexual harassment and violence.

These behaviours tend to keep men on top and reinforce a toxic leadership style involving abusive behaviours such as bullying or controlling others.

Boss upset with employee
A hyper-masculine work environment might look like huge workloads, long hours, hostility, assertiveness, dominance and an extremely competitive culture.
Shutterstock

At a very basic level, workplaces should afford women safety and justice. But women’s issues are left unaddressed in many workplaces, and many fail to provide women employees with psychological safety or the ability to speak up without being punished or humiliated.

This might be because leaders in the organisation are ill-equipped to deal with these issues, feel uncomfortable bringing them up or, in some cases, are sadly not interested at all.




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How does a toxic culture affect our health?

Evidence suggests a toxic workplace culture can negatively affect employees’ psychological, emotional and physical health.

Emotional effects include a higher likelihood of negative emotions such as anger, disappointment, disgust, fear, frustration and humiliation.

As these negative emotions build, they can lead to stress, anxiety, depression, burnout, cynicism, a lack of motivation and feelings of self-doubt.

Research also points to increased chances of physical symptoms, such as hair loss, insomnia, weight loss or gain, headaches and migraines.

Employees in toxic workplaces tend to have poorer overall well-being, and are more likely to be withdrawn and isolated at work and in their personal lives. Over time, this leads to absenteeism, and if problems aren’t addressed, victims may eventually leave the organisation.

For some victims who may not have advanced coping skills, a toxic culture can lead to a downward mental and physical health spiral and contribute to severe long-term mental illness. They may also engage in displaced aggression, in which they bring home their negative emotions and experiences and take out their frustrations on family members.

Woman stressed and isolated at work
Employees in toxic work environments are more likely to be withdrawn and isolated, both in the office and outside of work.
Shutterstock

How can workplaces change?

Workplaces aiming to make a real change should start by promoting an open culture where issues can be discussed via multiple formal and informal feedback channels.

One option is formal survey mechanisms that are anonymous, so employees can be open about their concerns and feel less intimidated by the process.

A good first step is having leaders trained to address these issues.

Traditionally, workplace interventions have focused on victims themselves, putting the onus on them to do the work and come forward. However, a healthy workplace culture should see leaders actively seeking feedback to make sure any forms of toxic masculinity are stamped out.

It’s a shared responsibility, and the onus shouldn’t be solely on employees, but leaders, too.




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The Conversation


Xi Wen (Carys) Chan, Lecturer in Organisational Psychology, Griffith University and Paula Brough, Professor of Organisational Psychology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Youth anxiety and depression are at record levels. Mental health hubs could be the answer


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Christine Grové, Monash UniversityThe COVID pandemic has shone a light on the ongoing decline in young people’s mental health. Psychologists have warned if we don’t start to address the mental health emergency of young people’s anxiety and depression, it may become a “trans-generational disaster”.

Paediatricians have said they are seeing growing numbers of young people coming to the emergency room because of a lack of other treatment options.

In an effort to address the rising rates of anxiety and depression in children, Victoria trialled mental well-being coordinators in ten schools last year. The initiative is now expanding to 26 primary schools in 2021.

Meanwhile, the royal commission into Victoria’s mental health system has recommended youth mental health hubs, some of which will soon be rolled out in priority areas across the state.

Developing specialist youth mental health hubs is one of several strategies also suggested by the Australian Psychological Society to the federal government in a recent budget submission.

So, what are youth mental health hubs, and will they work to stem the tide of mental health issues young people are experiencing?

Everything in one place

Australia’s National Strategy for Young Australians defines youth as young people between 12-24 years of age. Evidence shows half of mental disorders first emerge by the age of 14, and 75% by the age of 24.

Left untreated, these mental health problems have high rates of recurrence and cause negative outcomes for the individual, including reduced economic productivity, as well as social costs.




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Youth mental health hubs provide mental health and social services in one location. This is partly because a range of risk behaviours come with mental health difficulties including tobacco, drug and alcohol use, sexual risk taking, reduced levels of physical activity and poor nutrition. Evidence also suggests young people prefer to have their needs met in one place, rather than across a number of locations and will then be more likely to seek help when they need it.

Youth hubs should therefore have a range of specialists on site, such as trained mental health clinicians, sexual health support counsellors and psychiatrists.

Young people also want and need access to mental health information and resources. So a youth hub should be a safe place for young people to get the information they need.

Youth hubs would be connected physically and/or in partnership with schools, community organisations (such as homelessness services) and with medical specialists.

They are ideally co-designed by experts and youth with lived experience, on equal grounds. Ideally, the hubs are a youth friendly, one-stop-shop for support ranging from referrals, assessment, therapies and intervention.

Don’t we already have youth hubs?

Traditionally, mental health services, including some youth services, have not been accessible to a range of youth needs, instead targeting children or adults. Others are geared towards specific certain types of conditions.

In Australia there are two youth-specific hubs: Orygen and Headspace.

Orygen is co-designed with young people. But it specialises in youth who have had an episode of psychosis, mood disorders, emerging borderline personality disorder, and youth at high risk for a psychotic disorder.

Headspace centres provide early intervention mental health services to 12-25 year olds. The service was created to provide youth with holistic mental health support. But there are shortcomings with the model. It has been described by some experts as not being able to support some youth with complex presentations such as those with personality disorders, schizophrenia and/or substance abuse issues.




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Many other services restrict youth access to support depending on age, diagnosis or additional illness.

Youth engagement in non-youth focused specific services is low, and transitioning youth between and across services is often unsuccessful.

Young people also prefer services that include young people as staff members, which is not common in traditional mental health support. Youth participation as staff was found in only just over half of the mental health services available in Australia.

A young woman talking to a young psychologist.
Young people prefer mental health support that is youth led.
Shutterstock

So, what is the ideal youth hub?

There are youth hubs available across the world, including in Ireland, New Zealand, UK, Canada, France and Australia. All of these provide different services and care. However none provide a single example of best practice yet.

Key elements of youth mental health hubs identified in the World Health Organisation framework include:

  • a co-designed youth-focused approach that is flexible and adapted to youth’s changing mental health needs
  • an accessible, central location (close to shops or transport), with extended spread of opening hours as well as opportunity for self-referral and drop-in services
  • a place that responds to all young people quickly
  • youth working in the hub
  • services and support types personalised as needed by the context.

Research also suggests the hubs should be an informal space, as opposed to clinical looking, such as a shop front or café design. They should also:

  • provide recreational or arts activities, as well as a hang-out space
  • be included and known by the community
  • keep ongoing evaluation of the services provided and provide feedback back to young people.

Keeping all services in one location works well, but it doesn’t necessarily mean a coordinated, collaborative approach to care is provided. Some hubs may house a range of services in one spot but continue to work in a separated way. This defeats the purpose of coordinated care.




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We need better investment to improve current hubs or co-design new ones to enact the WHO guidelines of best practice. This is critical to ensuring more young people access the care they need, for the success of current and future generations.The Conversation

Christine Grové, Senior Lecturer and Educational and Developmental Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.