We can’t ignore mental illness prevention in a COVID-19 world



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Stephen Carbone, University of Melbourne

Despite the incremental easing of Victoria’s restrictions, it’s clear the journey towards COVID-normal is far slower than many people had hoped.

Australians – particularly Victorians – have shown remarkable resilience, but many are suffering emotionally.

The mental health impacts of COVID-19

During the early days of the pandemic, surveys showed a sharp increase in symptoms of anxiety and depression across Australia. These difficulties continued into mid-August. More than 40% of Australians aged 18 years and older feel high levels of anxiety, and around one in six report depressive symptoms.

To target this, federal and state governments have increased telephone, online and face-to-face mental health supports. While this is vital, more needs to be done to prevent people suffering severe mental health problems in the first place.

Girl wearing mask looking out window
Over 40% of Australians aged 18 years and older feel high levels of anxiety, and around 1 in 6 report depressive symptoms.
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Prevention is better than cure

There’s good evidence we can prevent many cases of depression, anxiety and substance abuse. But Australia doesn’t have a mental health prevention plan or policy, and government funding for prevention is just 1% of the total mental health budget.




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The Fifth National Mental Health and Suicide Prevention Plan, the government’s key mental health blueprint, focuses on improving mental health-care services and suicide prevention, but not on preventing the mental health conditions that are a major risk factor for suicide.

What about illness prevention?

Last month the federal government released a consultation paper on its proposed National Preventive Health Strategy, setting out what the strategy will aim to achieve and how it might be done.




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The document’s exciting because it focuses on health promotion and illness prevention, acknowledging we can’t improve the health of the Australian community through health-care measures alone.

But unfortunately, the proposed strategy’s fundamentally focused on physical health issues. In its 20 pages, the consultation paper only mentions mental health three times.

Folders labelled with mental health conditions
Government funding for prevention is just 1% of the total mental health budget. The National Preventive Health Strategy provides an opportunity to shed light on prevention measures for mental health conditions.
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The same principles outlined in the strategy to prevent conditions such as diabetes also apply to preventing mental health conditions such as depression. To prevent either, we need to minimise risk factors and increase protective factors linked to the condition, before it occurs. But some adaptation would be needed for the plan to address both physical and mental health.




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What prevention measures should be added?

A focus on physical activity, healthy eating, and non-smoking will help to promote good mental health as well as physical health.

Man carrying box of office supplies
Unemployment, a risk factor for a number of mental health conditions, is on the rise due to COVID-19.
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To prevent mental health issues we should focus on building people’s health literacy and self-care skills through public information campaigns and online learning programs. Supportive social environments can be encouraged by parenting programs, and school and workplace mental health promotion initiatives.

Local communities could also be mobilised to take positive action on local issues that contribute to poor health and mental health through place-based strategies. Place-based strategies aim to tackle issues existing at a neighbourhood level, such as social isolation and poor housing.




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Services could be reoriented towards prevention. Primary care professionals might provide advice on self-care and use social prescribing to address stress and enhance social supports. Social prescribing involves medical professionals linking patients to non-medical supports. For example, they may provide an “exercise prescription” or “art prescription”.

Finally, appropriate public policy solutions, such as JobSeeker and JobKeeper, that tackle the social and economic determinants of ill-health are needed.

Social factors matter too

Research also points to a strong link between mental health conditions and experience of childhood adversity, family violence, loneliness, racism, homophobia and transphobia. Workplace stressors, financial stress, unemployment and homelessness are also risk factors.

Many of these issues are on the increase because of COVID-19, so to safeguard mental health we need to tackle them and their impact. This will require the use of evidence-based preventive programs outlined above – many of which already exist but are not being implemented well or to sufficient scale. It will also require public policies to soften the economic blow and ease financial stress.

Targeting these issues will not only help to prevent mental health conditions, but physical health conditions as well.




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While better access to mental health-care services is important, it can’t solve all the mental health challenges posed by COVID-19. We also need to strengthen the factors that buffer people against stress, and tackle the underlying factors that contribute to poor mental health.

Whether we create a National Preventive Mental Health Plan, or embed mental health in the current National Preventive Health Strategy, one thing’s for sure: continuing to ignore the prevention of mental health conditions is not an option in a COVID-19 world.The Conversation

Stephen Carbone, Honorary, School for Population and Global Health, University of Melbourne

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

To safeguard children’s mental health during COVID-19, parents must look after their own



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Sarah Whittle, University of Melbourne and Kate Bray, University of Melbourne

The negative mental health impacts of the COVID-19 pandemic are clear, but there is particular concern children will be most affected in the long run.

By the end of March school closures were impacting 91% of the world’s student population and are still affecting more than 60%. These closures limit children’s opportunities for important social interactions, which can harm their mental health.

In particular, home confinement, fears of infection, family stress and financial loss may have negative effects on the mental health of young people. And research carried out earlier in the pandemic suggested these effects may be most pronounced for children with pre-existing mental health problems.

Which children are most at risk?

Parents have an important role to play in safeguarding children’s mental health during COVID-19.

Research shows family relationships are more influential during situations that cause stress over an extended period of time than during acute periods of stress. This means family factors are likely to be even more important to childrens’ mental health during COVID-19 than during more fleeting traumatic experiences such as exposure to a natural disaster.

Parents and their child sitting on a park bench, wearing masks.
The family is most influential during situations that cause stress over an extended period of time.
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In our recent study, we found 81% of children aged 5-17 had experienced at least one trauma symptom during the early phase of COVID-19. For instance, some children had trouble sleeping alone, or acted unusually young or old for their age.

Our unpublished research relied on reports from parents from Australia and the United Kingdom. We also found increases in emotional problems were common. For instance, according to their parents 29% of children were more unhappy than they were before COVID-19.

Importantly, our study found several parent and family factors that were important in predicting changes in children’s mental health problems.

Here are four of our main findings.




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1. Parents’ distress matters

Increased personal distress reported by parents was related to increases in their child’s mental health problems during COVID-19. This distress refers to both general stress in addition to COVID-specific worry and distress. It also includes anxiety related to problems that existed before COVID-19.

For this reason it’s important parents look after their own mental health and stress levels. Seeking psychological help is a good option for parents who are struggling to cope.

Through a GP referral, Australians can receive ten sessions of psychological care per year through Medicare. Victorians who are currently subjected to further restrictions can now receive up to 20 sessions.

A woman with her head in her hand while her children jump on a couch.
If you’re a parent struggling during the pandemic, there’s help available. Though Medicare you can receive 10 sessions of psychological care, or 20 sessions is you’re a Victorian.
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2. Good family relationships help

Higher levels of parental warmth and family cohesion were associated with fewer trauma symptoms in children. “Parental warmth” refers to being interested in what your child does, or encouraging them to talk to you about what they think; “family cohesion” relates to family members helping and supporting each other.

In other research these factors have consistently been found to relate to children’s adjustment to stress and trauma.




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Fortunately, there is a range of resources parents can use to help improve relationships with their children.

Some parents may also find taking part in a parenting course helpful. Partners in Parenting, Triple P and Tuning into Kids are available online.

3. Parents’ optimism can be contagious

Daughter and mother smiling at each other
Children observe their parent’s behaviour – if you can try to see the silver lining your children might too.
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While COVID-19 is having many negative impacts, some parents in our study also identified unexpected positive impacts, such as being able to spend more time with family. Children of these parents were less likely to experience an increase in some problems – particularly problems with peers such as being bullied.

Children observe parents’ behaviours and emotions for cues on how to manage their own emotions during difficult times. Trying to stay positive, or focus on the bright side as much as possible is likely to benefit children.




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4. Some effects are greatest for vulnerable families

We found parents’ behaviour was particularly influential in lower socioeconomic backgrounds and single-parent families. In poorer families, parental warmth was particularly important in buffering children’s trauma symptoms. And in single-parent families, parental stress was more likely to predict behavioural problems in children.

This may be because poorer and single-parent families already face more stress, which can negatively impact children. Parental warmth can counteract the effects of these stresses, whereas high parental stress levels can increase them.

Research has already shown the pandemic will have greater negative impacts on those who have less resources available to them. This points to a need for extra psychological and financial support for these families. Governments and other organisations will need to take this into account when targeting their support packages.




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It’s important to keep in mind child-parent relationships are a two-way street. Our research examined relationships at only one point in time, so we don’t know the extent to which our findings reflect a) parents causing changes in their children’s mental health, or b) changes in children’s mental health impacting parents, or the way a family functions. Research needs to follow children and their families over time to tease apart these possibilities.

Given prevention is always better than cure, parents and families should seek help early to build the right foundations to safeguard the mental health of their children.The Conversation

Sarah Whittle, Associate Professor in Psychiatry, University of Melbourne and Kate Bray, PhD Candidate, University of Melbourne

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

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



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Michelle H Lim, Swinburne University of Technology

The COVID-19 pandemic has drawn attention to loneliness in Australia.

This is especially so as Melburnians entered the strictest lockdown to date. Meanwhile, the rest of Australia braces for the possibility of a second wave and people are adapting to new habits and restrictions.

This has disrupted our social routines, and in many cases has reduced the number of people we interact with. This makes it harder to maintain meaningful social connections, resulting in loneliness.

But sometimes it can be difficult to tell if you’re feeling lonely or feeling something else. And many people are reluctant to admit they’re lonely for fear it makes them seem deficient in some way.

So what are the signs of loneliness? And how can we recognise these signs and therefore manage them?




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I’m not lonely…

Loneliness is complex. Some people can feel lonely despite having extensive networks, while some others might not, even if they live alone. There are many factors behind this, and the COVID-19 pandemic is another significant one.

Social restrictions during the pandemic mean we are more reliant on existing relationships. People who enjoy brief but multiple social interactions in their daily routine, or simply like being around others, may now find it harder to keep loneliness at bay.

When researchers ask people whether they’re lonely, some deny or reject the idea. But when asked in a different way, like whether they want some company, some of those same people would say yes, they would like company.

This is because there’s a social stigma to loneliness. We often think it is somehow our own fault or that it reveals some personal shortcoming. Loneliness evokes a particularly vulnerable image, of someone living alone with no one around them.

One survey also found men are less likely to say they’re feeling lonely, although this research was published before COVID-19.

“Max”, aged 21, was interviewed as part of an upcoming project being done by Ending Loneliness Together, an organisation that addresses loneliness in Australia. He has experienced periods of loneliness, and said:

I think specifically for men, [they] lock themselves away because they don’t know how to verbalise that feeling. It demonstrates the real disparity in the way in which we expect our men to engage in their emotions.

Man lying in bed looking lonely
Men are less likely than women to say they’re feeling lonely, even if they are.
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Because of these misconceptions, many who are lonely will overlook their own emerging signs of loneliness in the hope these feelings will go away once they are around people. But seemingly logical solutions like making more friends or knowing more people may not help, if you perceive these relationships to be unhelpful, neutral, ambivalent, or even sources of conflict.

Nevertheless, ignoring growing levels of loneliness will increase our risk of developing poorer physical and mental health.

Signs you might be lonely

Loneliness is a normal signal to connect with others, so it’s unlikely you’ll be able to rid yourself completely of lonely feelings during this time. Instead, we should aim to manage our loneliness so it doesn’t become severely distressing.

More often than not, we might not be willing to admit even to ourselves that we’re feeling lonely. The COVID-19 pandemic may be a trigger, but there is a range of factors that can lead you to feel lonely, sometimes without even realising.

This can make it hard to be consciously aware of any loneliness you might be experiencing, particularly if the pandemic has left you feeling busier and more stressed than usual.

Here are some signs you might be feeling lonely. To a certain extent, you feel that:

  • you are not “in tune” with others

  • your relationships are not meaningful

  • you do not belong

  • you do not have a group of friends

  • no one understands you

  • you do not have shared interests with others

  • there is no one you can turn to.

It’s important to remember, though, not all of these may relate to you and you may experience these in varying degrees.

Woman staring at computer screen
We’re often hesitant to admit we’re lonely because of the stigma associated with loneliness — that it’s somehow our fault or we’re deficient in some way.
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How to manage your loneliness

Because of the complexity of loneliness, there is no one-size-fits-all solution. To find the best solution for you, reflect on your personal preferences, previous experience, and your capacity to reach out to your social networks.

During the pandemic, the solutions you select will differ depending on the social restrictions in your state. Even under the strictest social restrictions (in Melbourne), some of us have been fortunate to have a friend or a neighbour in our area with whom we can walk and chat while still adhering to public health directives. For others, getting in touch via Zoom or a phone call may be the only option.

For those who can, establishing shared goals or activities with friends, family, or colleagues can be helpful. These provide positive social support and facilitate a sense of achievement when meeting those goals. This might include setting self-care goals such as exercise, meditation, cooking, hobbies, or learning new skills. But equally, it’s not a sign of “failure” if you don’t do these things.

Friendships are good for our health, but making a new friend can be taxing for some people.

Instead, perhaps think about how you can work on existing relationships. Pick what feels right and is feasible for you. If improving the ties you already hold is all you can do, focus on this. And if you are reaching out to people outside your familiar network, it doesn’t have to be confronting. A simple hello is a small step towards more meaningful interactions in the future.

Social restrictions including isolation, quarantining, and social distancing are public health measures we’ve become acquainted with since the onset of COVID-19. Although these restrictions modify our social interactions physically, they don’t mean we can’t stay meaningfully connected to each other. This is why many prefer the alternative term “physical distancing”.

We can, and should, stay socially connected while being physically apart.




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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.

Want to see a therapist but don’t know where to start? Here’s how to get a mental health plan



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Louise Stone, Australian National University

Last week, the Australian government announced it will provide ten extra Medicare-subsidised psychological therapy sessions for Australians in lockdown areas due to COVID-19.

In such a stressful time, many people are experiencing poorer mental health, and some need additional support. However, our mental health system is complex and fragmented, so it can be challenging to find the care you need.

Here’s how to start seeing a therapist if you never have before.

What is a mental health treatment plan?

Under Medicare, you can already access ten subsidised sessions per calendar year with a registered psychologist, social worker or occupational therapist. Twenty sessions are now subsidised “for anybody who has used their initial ten services in a lockdown area under a public health order,” said Federal Health Minister Greg Hunt. Currently this includes all of Victoria.

But to get access to these sessions, first you need to get a mental health treatment plan from your GP. This involves an assessment of your physical and mental health, and a discussion of your particular needs. The GP then helps you decide what services you need.

All GPs who write mental health treatment plans have undergone additional training in mental health. There are also plenty of GPs with further interest and expertise in this area. It can be helpful to ask for recommendations from friends and family if you are unsure who to see.

Physical and mental health issues frequently overlap, so a visit to a GP is an opportunity to assess any physical issues that may impact mental health as well. The GP should explore a person’s strengths and vulnerabilities, before agreeing on a plan for care.

Generally, this process takes 30-40 minutes, so it’s important to book a longer consultation with your doctor. At the end of this consultation, you can have a copy of the plan, and it’s also sent to the therapist of your choice. Once the mental health plan is billed to Medicare, you can get subsidised sessions with your preferred therapist. You will need to make the appointment with the therapist, but GPs or practice nurses will often help make this appointment for patients who are feeling too unwell to manage this phone call.

Using telehealth

Telehealth enables you to get care from your GP by phone or video. The Medicare requirements of telehealth are changing rapidly, so check when you make your appointment to see if telehealth is available and to make sure you will be eligible for a Medicare rebate for this consultation.

At the moment, to get a Medicare rebate for telehealth, you must have seen the GP in their practice face-to-face at some point in the past 12 months.

But this requirement doesn’t apply to:

  • children under 12 months

  • people who are homeless

  • patients living in a COVID-19 impacted area

  • patients receiving an urgent after-hours service

  • patients of medical practitioners at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.

So if you live under the Victorian lockdowns, you can get a mental health care plan via telehealth, even if you have not seen the GP before.

Once you’ve got your care plan, you can do the therapy sessions via telehealth too. And you can now claim them under Medicare (though this wasn’t the case before COVID-19).




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A patient and a doctor doing a consultation via video call
Many GP clinics and psychologists are now conducting sessions via phone or video call.
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Choosing a therapist

Your GP can help you choose a therapist, but it’s important to think about what you need from a psychologist. Psychological care can range from coaching when life is particularly challenging, to deep and complex work helping people manage mental health disorders or trauma.

Also consider the sort of person you prefer to see. Some people prefer practitioners from a particular cultural group, gender or location. You may have a preference for a very structured, problem-solving style, or you may want someone with a more conversational style. You may also have a preference for the type of therapy you need. If your GP can’t recommend someone appropriate, or if you are having trouble finding someone who is available to meet your needs, the Australian Psychological Society has a searchable database of therapists.

Psychologists, occupational therapists and social workers must be registered under Medicare to provide these services, so it’s important to check this with the receptionist when you make your appointment. The Medicare rebate varies according to the qualifications of the practitioner, and a psychologist’s fees may be well above the rebate, so clarify your expected out-of-pocket expenses when you make an initial appointment.

A clinical psychologist has additional training, and will give you a rebate of around $128, whereas a general psychologist has a rebate of around $86. Remember that a psychologist may charge well above the rebate, so you may be out of pocket anywhere from nothing to over $200.




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If you decide seeing a therapist under a mental health plan is not the right option for you, there are some alternatives. Some non-government organisations, like Headspace, provide counselling services through Medicare for no additional cost, as do some schools. Some workplaces also have psychological options like the Employee Assistance Program.

Some people benefit from online programs that teach psychological techniques. Head to Health also provides a searchable database of evidence-based sites to explore. Most are free or very low cost.

If you are very unwell, local mental health services attached to public hospitals can provide crisis support and referral.

These are difficult times.

It’s important to at least discuss your situation with someone you trust if you’re having difficulty sleeping, your mood is affecting you or your family, or you’re having frightening or worrying thoughts. Your GP is a good, confidential first port of call.


If you or someone you know needs assistance, contact Kids Helpline on 1800 55 1800, Lifeline on 13 11 14, or Beyond Blue on 1300 22 4636.The Conversation

Louise Stone, General practitioner; Clinical Associate Professor, ANU Medical School, Australian National University

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

The Victorian government has allocated $60 million to mental health. But who gets the money?


Chris Maylea, RMIT University

The second wave of the coronavirus and the resulting restrictions have impacted all Victorians. Many are struggling, but some are struggling more than others.

In response to the increasing number of people having a hard time coping with the pandemic, the Victorian government yesterday announced an additional A$59.7 million in funding for mental health services.




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More than half of the new funding is for hospital–based services or services for people after they have left hospital. Most of the rest is focused on services for people who are really unwell or distressed, in an effort to avoid the need for hospitalisation.

A busy emergency department is never an ideal place for someone experiencing mental distress. But now, to reduce the risk of infection, it is even more important to give people the support they need before they end up in hospital.

The mental health system was “broken” before COVD-19

Victoria’s mental health system was in crisis before COVID-19 hit. In 2018, Victoria had the lowest per person funding for mental health in the country. Premier Daniel Andrews described the mental health system as “broken”, and launched the Royal Commission into Victoria’s Mental Health System.

The royal commission had only released its initial recommendations and interim report when the coronavirus hit, overwhelming an already broken system.




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Accelerated initiatives

The new funding is in addition to the work of the royal commission and the funding announced in Februrary and April.

The government has increased the total number of new mental health inpatient beds to 144, nine more than the royal commission’s recommendation. Some A$30 million has been allocated to fast-tracking the new mental health inpatient beds in Geelong, Epping, Sunshine and Melbourne, and A$4.1 million will go to existing hospital-based services.

A hospital bed
The government has slightly increased the total number of new mental health inpatient beds to 144 from the 135 recommended by the Royal Commission.
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Just over A$4 million has been committed to accelerating the statewide rollout of the Hospital Outreach Post-Suicidal Engagement (HOPE) program to Box Hill, Royal Melbourne, Monash, Heidelberg and Broadmeadows hospitals. But as with the extra inpatient beds, this program was already in the Royal Commission’s recommendations, so it’s not a new initiative, just accelerated.

New initiatives

But there are also some genuinely new initiatives. Some A$11.1 million has been designated to community-based mental health services to be open seven days a week, with extended hours and additional staff. General hospitals and general practitioners will have increased consultancy from psychiatrists to the tune of A$7 million. Headspace, which provides community mental health support to 12-25 year olds, has also received A$1 million across 15 Melbourne sites to reach young people in their homes.

The Victorian Mental Illness Awareness Council, Victoria’s peak body for people who use mental health services, and Tandem, Victoria’s peak body for carers of people who use mental health services, received a combined A$900,000 to continue their work supporting and representing people who use the mental health system.

More than A$1 million has also been allocated to supporting the mental health of police, paramedics, nurses and midwives. This is a valuable investment, but is arguably filling an existing need rather than catering to the effects of the pandemic.

Why now?

Since the same period last year, people going to emergency departments for self-harm has increased by nearly 10%. For young people, this has increased by 33%. With limited access to services and fewer opportunities for self-care, more people are ending up in emergency departments. In fact, compared with last year, the number of people seeking emergency mental health health support has increased by nearly a quarter.




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Increased restrictions have made accessing services even harder. Telehealth services are increasing, but for many people a virtual meeting is no replacement for face-to-face contact. Some people don’t have the devices necessary for virtual meetings, can’t afford the data, or are not proficient in using technology.

Limited access to services is only part of the problem. Normally, people maintain good mental health by being active, working, and staying connected to their families and communities. These activities cannot be replaced by a weekly online counselling session.

Man clasping his hands, looking distressed
Compared with last year, the number of people going to emergency departments for mental health reasons has increased by nearly a quarter.
Shutterstock

Will it make a difference?

The coronavirus and related restrictions have had devastating effects on people’s lives and livelihoods. Those who are most affected by restrictions include Victorians in precarious work, those who are experiencing family violence, or Victorians who live in disadvantaged areas.

This new funding is certainly welcome, and if it prevents the loss of even one life, it will be worth the investment. But the funding ultimately equates to only about A$10 per Victorian, and there will be many people who still can’t get access to services. The royal commission may bring much needed change to the system, but in the meantime many of our most disadvantaged community members will still not receive the support they desperately need.

What is really required is an approach that recognises this is just as much a social issue as it is a health issue – no amount of government support can replace a connected and supportive community.The Conversation

Chris Maylea, Senior Lecturer, Law and Social Work, RMIT University

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

As ‘lockdown fatigue’ sets in, the toll on mental health will require an urgent response



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Ian Hickie, University of Sydney

As Victorians face yet another long period of enforced lockdown, serious concerns are being raised about people’s capacity to comply with the new orders and the mental health impacts of such prolonged social isolation.

The risks of being dispirited, chronically stressed and socially disconnected are real and substantial. While the behavioural consequences of “lockdown fatigue” are becoming more obvious, the questions to be answered from a mental health perspective are:

  • who is most likely to be harmed by a longer, more stringent lockdown?

  • what are the public policy responses that are most likely to deliver real benefits?

Melbourne’s streets have emptied under the latest restrictions.
James Ross/AAP

Job losses and social disconnection

On the first issue, Sydney University’s Brain and Mind Centre has produced both place-based models and a provisional national simulation model to estimate the possible size of the impact of the pandemic on mental health and suicide rates, as well as identifying those who are most likely to be affected.

Prior to the recent spike in cases in Victoria, our most conservative estimates were a 14% increase in overall suicide rates due to COVID-19 restrictions and the subsequent social dislocation and economic fall-out nationally.

We also estimated at least a 25% increase in suicide rates in rural and regional areas with pre-existing high levels of unemployment and educational disadvantage.

The real drivers of these substantive health risks are job losses, social disconnection and, for young people, the availability of support for ongoing education and training.




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Given the return to lockdown in Melbourne, we now expect to see much greater levels of uncertainty about job prospects — particularly in those industries like hospitality, tourism and the arts that were already devastated — as well as a more prolonged period of social disconnection.

For both of these factors, both the duration of the lockdown and the degree of uncertainty it generates really do matter.

What can government do to minimise harm to people?

Given the necessity to “act fast and go hard” to contain the spread of the virus, the harder question to answer is the second one: what can our political and social leaders do to minimise the impact on people’s mental health and well-being?

Top of the list is job certainty. Conceptually, JobKeeper is critical because it ties people to real workplaces, social contacts and their social identity.

However, in its initial application it missed many casual workers, women and young people. Each of these groups were massively affected by COVID-19 restrictions and are now facing even tougher long-term employment prospects.

Our model suggests JobKeeper, in its current or appropriately modified form, now needs to be in place until at least 2022. And our place-based approach suggests policy-makers need to think about how it can best function in Melbourne and surrounding districts.

JobKeeper will continue until March, but payments will fall to $1,200 a fortnight.
David Mariuz/AAP

From a social connection perspective, all governments need to get their public messaging on track. An over-emphasis on top-down, law-and-order directives has limited and short-term utility for achieving the required behaviour changes. Often, it has the reverse effect to that intended.

What is really required are public health messages that engage people to be community-minded and active in their local settings to support and care for each other in really testing times.

The diverse faces and voices of genuine and trusted community leaders, elders, celebrities, sporting identities and young people — not simply politicians — are critical. These have much greater impact on two key outcomes: promoting best public behaviour and providing the necessary person-to-person support we all require.

Importantly, from a public mental health and health services perspective, any substantive actions rely heavily on close cooperation between the federal and Victorian governments. We cannot risk a retreat to the finger-pointing we saw during the Ruby Princess and quarantine hotel failures, and are now starting to see in the COVID-19 aged care crisis.

As indicated by the recent Victorian royal commission and the Productivity Commission report on mental health, both levels of government are responsible for the current deficiencies in our public mental health systems.

How to send the right message

From a public messaging perspective, people experiencing mental distress are being encouraged to use mental health hotlines or seek help from their family doctor or other mental health practitioners.

While these may seem to be straightforward and sensible messages, we have shown that simply increasing awareness without expanding the actual capacity of an already thinly stretched (if not broken) care system can have more negative outcomes.

What is really required are two clear actions. One is public messaging about supporting each other, and those who are distressed, within our families, workplaces, communities and churches throughout this period. The other is rapid action to fix key elements of the mental health system.




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As demonstrated by Health Minister Greg Hunt’s actions in the early phases of the pandemic, it is possible to mobilise simultaneously both our private and public health services to respond to a national emergency.

That is now urgently required for mental health. We need to use our private health capacity to help public hospital emergency departments, and other acute care services, meet the increasing need for mental health services.

For instance, we could immediately make use of private hospital beds and clinics for those who have attempted suicide or are in need of urgent care, but who do not require admission to a public psychiatry unit.




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Predicting the pandemic’s psychological toll: why suicide modelling is so difficult


While this need will soon likely become acutely obvious in Melbourne, we have already seen evidence in national surveys, and other state systems, of the escalating demand for these types of mental health services.

This has been most obvious for young people, who often do not easily connect with general practice doctors and typically present for care in a crisis situation.

Amid the chronic uncertainty that is now emblematic of the COVID-19 pandemic — often confusing government responses and the long-term economic and social impacts of the crisis — it is now time we respond to this looming mental health crisis cohesively, collectively and intelligently.


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

Ian Hickie, Professor of Psychiatry, University of Sydney

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

It’s OK to be OK: how to stop feeling ‘survivor guilt’ during COVID-19



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Erin Smith, Edith Cowan University

Everyone’s pandemic experience is unfolding differently. There’s no denying COVID-19 has been devastating for millions of people around the world. At the worst end of the spectrum are the millions of cases and hundreds of thousands of people who have died, as well as their grieving friends and families.

There are also likely millions suffering financial hardship due to the pandemic, which in many cases will be affecting their mental health.

But at the other end of the spectrum are those who are not only doing well, but in some cases thriving. For some people, this can lead to a kind of “survivor guilt” – believing they’ve done something wrong by surviving and thriving during the pandemic.

A new type of survivor guilt

The term survivor guilt is usually used to describe the emotional distress some people feel after surviving a traumatic event in which others have died, such as a natural disaster or terrorist attack.

It has been identified in military veterans, those who survived the Holocaust, 9/11 survivors, and emergency first responders.

COVID-19 has certainly been a traumatic experience and has had a profound impact on mental health. Around 1,000 people have died by suicide in Australia since it began and modelling from the University of Sydney found suicide deaths could rise by 25% annually for the next five years.

During COVID-19 we have witnessed the conventional type of survivor guilt associated with surviving the coronavirus when hundreds of thousands haven’t.

But not everyone is struggling, and this has resulted in a new type of survivor guilt. This emerging type of guilt is characterised by not feeling “impacted enough” by the pandemic.

This type of survivor guilt can be seen in the workplace. The pandemic has forced many organisations to reduce staffing, causing some remaining employees to feel guilty, according to John Hackston, head of thought leadership at the Myers-Briggs Co.

Survivor guilt can result in a range of emotions, from shame to a sense of unworthiness or even anger. When emotions are not processed properly, they can impact our physical and mental health and cause depression, anxiety and physical illness.

It’s OK to be happy during the pandemic

While mental health advocates and support groups are right to remind people who are struggling that it’s “OK not to be OK” during this pandemic, it’s important to remember it’s “OK to be OK” too.

During a global public health crisis, no one should feel bad for being healthy or able to continue working. And if this pandemic has resulted in opportunities not just to survive but to thrive, we should celebrate those wins.

Cassie Mogilner Holmes, associate professor of behavioural decision-making at UCLA, says it’s not only OK, but essential, to enjoy one’s good fortune.

“It’s actually more important now than ever to focus on our personal emotional health,” says Holmes.

Professor Kim Felmingham from the University of Melbourne says feeling guilty about being “OK” during these challenging times isn’t just a “perfectly normal” reaction — it’s part of our evolutionary programming. That’s because feeling survivor guilt means you are feeling empathy for others who have been less fortunate. In an evolutionary sense, empathy allows us to form close social bonds and connections with others.

“So give yourself a break, don’t beat yourself up if you are feeling guilty,” says Felmingham.

A person enjoying working on their laptop at home
It’s OK to feel OK during the pandemic.
Shutterstock

Unless we tackle survivor guilt, it could ultimately add to the mental health burden of COVID-19 by manifesting as future depression, anxiety or post-traumatic stress disorder.

For anyone struggling with these feelings, it’s important to remember this pandemic is not your fault. You didn’t do anything wrong. You are doing valuable work, either generating much-needed economic activity or helping your fellow citizens. You just happen to be lucky to be healthy, or to live in a place that’s relatively unaffected by the virus, or to work in an occupation that can withstand a recession triggered by a public health crisis.

How to manage the guilt

Guilt can sometimes be turned into a positive thing, as a sort of moral compass to help give back to the world.

If your mind is going down a negative path, perhaps you might like to start a “gratitude journal” to list the things for which you are thankful. It could help you settle into a more positive mindset, and allow you to ask yourself whom you can help right now, perhaps financially, physically with something like childcare, or mentally by letting someone unload some of their own stress on you with a simple chat.The Conversation

Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan University

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

Is psychiatry shrinking what’s considered normal?



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Nick Haslam, University of Melbourne and Fabian Fabiano, University of Melbourne

Psychiatric classifications catalogue the many forms of mental ill-health. They define what counts as a disorder and who counts as disordered, drawing the boundary between psychological normality and abnormality.

In the past century that boundary has shifted radically. Successive classifications have added new disorders and revised old ones. Diagnoses have increased rapidly as new forms of human misery have been identified.

The wider psychiatric classifications cast their net, the more people qualify for diagnoses and the more treatment is considered necessary.

These changes may have mixed blessings. Broadening definitions of mental illness allow us to address mental health problems that were previously neglected. Mental illness may come to seem more commonplace and thereby less stigmatised.

However, inflating definitions may also lead to over-diagnosis, over-medication, and bogus epidemics. Many writers worry broad definitions of mental illness lead ordinary problems of living to be pathologised and medicalised.

But is this “diagnostic inflation” actually occurring?




Read more:
Explainer: what is the DSM and how are mental disorders diagnosed?


Diagnostic inflation

These concerns often target the Diagnostic and Statistical Manual of Mental Disorders. The “DSM” is the American Psychiatric Association’s influential classification manual of mental health problems. Since its revolutionary third edition in 1980, each major DSM revision has been challenged over diagnostic inflation.

Some writers argue the DSM over-diagnoses depression and anxiety disorders, misrepresenting many normal responses to adversity as mental illnesses. Others suggest it has diluted what counts as a traumatic event for the purpose of diagnosing PTSD. Eyebrows have been raised by some researchers over new diagnoses such as internet addiction and mathematics disorder.

These criticisms reached fever pitch when the latest version (DSM-5) was launched in 2013. Leading the charge was distinguished American psychiatrist Allen Frances who led the Task Force that developed the previous edition. Frances criticised the new edition for creating “diagnostic hyperinflation” that would make mental illness ubiquitous.

For example, the latest version removed the rule that a recently bereaved person could not be diagnosed with depression. It listed new disorders representing relatively mild cognitive declines and bodily complaints. It introduced a disorder of binge eating and another for frequent temper outbursts in children.

In response to shifts such as these, Frances led a campaign to “save normality” from psychiatry’s territorial expansion.

Some prominent psychiatrists have claimed the DSM is turning everyday ups and downs into mental illness.
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But is it a myth?

It seems obvious the DSM has steadily inflated psychiatric diagnoses. But we decided to test this assumption in our recently published research — with surprising results.

We scoured the research for studies in which consecutive editions of the manual were used to diagnose the same group of people on a single occasion. These were 1980’s DSM-III, 1987’s DSM-III-R, 1994’s DSM-IV, and 2013’s DSM-5. For instance, a study might use DSM-III and DSM-III-R criteria to diagnose schizophrenia in a sample of inpatients.

We found more than 100 studies comparing rates of diagnosis of at least one mental disorder across a pair of editions. In all, 123 disorders could be compared based on 476 study findings. For each comparison, we evaluated diagnostic inflation by dividing the rate of diagnosis in the later edition by the rate in the earlier one — the “relative rate”.

For example, if 15% of a group of people received a certain diagnosis by DSM-5’s criteria and only 10% received it by DSM-IV’s, the relative rate would be 1.5. This would indicate diagnostic inflation. If the percentages were reversed, the relative rate would be 0.67, indicating deflation. A relative rate of 1.0 would show stability.

We found no consistent evidence of diagnostic inflation. Relative rates for each new edition were 1.11 (DSM-III-R), 0.95 (DSM-IV) and 1.01 (DSM-5). None of these differed reliably from 1.0 or from one another. The average relative rate overall was exactly 1.0, indicating an absence of diagnostic inflation from DSM-III to DSM-5.

Although there was no pattern of inflation across the board, we found a few specific disorders have inflated. Attention-deficit/hyperactivity disorder (ADHD) and autism both inflated significantly from DSM-III to DSM-III-R, as did several eating disorders and Generalised Anxiety Disorder from DSM-IV to DSM-5. However, a similar number of disorders significantly deflated so fewer people could be diagnosed with them, including autism from DSM-IV to DSM-5.

Stressed child with attention deficit hyperactivity disorder (ADHD)
Some disorders, like ADHD, have inflated across editions of the DSM. But overall, concerns about rampant inflation are unfounded.
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Normality may not need saving after all

These findings call into question the widespread view the DSM has created runaway diagnostic inflation. No consistent trend toward diagnostic expansion has occurred, nor has any DSM revision been singularly prone to bloat. Normality may not need saving after all.

Worries about growing over-diagnosis or over-medication should focus on particular disorders for which diagnostic inflation can be demonstrated, rather than seeing these as rampant and systemic.

Our findings restore some confidence that the DSM’s process of diagnostic revision does not necessarily make psychiatric diagnosis more expansive.

Also, they suggest supposed epidemics of depression, anxiety, ADHD or autism must be evaluated sceptically. If steep increases in diagnoses occur for disorders whose criteria have not inflated, there may be cause for alarm. If such increases occur for inflating disorders, they may simply be caused by lowered diagnostic thresholds that create a “new abnormal”.




Read more:
Depression: it’s a word we use a lot, but what exactly is it?


Two kinds of diagnostic expansion

Our finding that rules for diagnosing mental disorders have not consistently become less stringent might seem to encourage complacency about diagnostic expansion. Not so fast! Diagnostic expansion can also occur through the addition of new disorders.

As we have written in relation to “concept creep”, ideas can broaden in two directions: downward to encompass milder phenomena than they did previously, and outward to encompass new kinds of phenomena.

Our study finds little evidence for the “vertical” sort of creep, but the “horizontal” sort has surely occurred. New DSM editions have always identified new ways of being mentally ill, and some of the rhetorical heat generated by DSM-5’s critics was directed at new diagnoses.

The fact that psychiatric classifications continue to evolve should not surprise us, and nor should the fact they sometimes expand. Such changes are not unique to the mental health field either. As Allen Frances has drily observed, “modern medicine is making such rapid advances, soon none of us will be well.”

Our findings suggest that although new ways of being mentally unwell may continue to be discovered, the old ways have tended to stay the same.




Read more:
Is your mental health deteriorating during the coronavirus pandemic? Here’s what to look out for


The Conversation


Nick Haslam, Professor of Psychology, University of Melbourne and Fabian Fabiano, Research Assistant, Brain and Mind, Murdoch Children’s Research Institute, University of Melbourne

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

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




Michelle H Lim, Swinburne University of Technology

Many Victorians are now well into their second round of stage 3 lockdown, under which there are only a handful of reasons one can leave home — and for many who live alone, it’s starting to grate.

Under the rules, partnered people are allowed to visit a boyfriend or girlfriend without risking an infringement notice, which may feel unfair to single people.

That’s understandable. Humans are innately social, we all need human connection and we’re used to routine. When we are deprived of something — even for a short time — the need sometimes becomes stronger. (And while I’m talking mostly about the need for human connection, many who live alone are less able than usual to get help from family or friends with practical essentials, such as getting food, care or medicines).

If you live alone — or with others to whom you are not particularly close — it’s important to find different and creative ways to connect with people while still reducing the immediate COVID-19 risk.

And for all of us, it’s time to redouble our efforts to check up on family, friends, neighbours, and colleagues.




Read more:
Social distancing can make you lonely. Here’s how to stay connected when you’re in lockdown


Lockdown can make us lonely

Victoria Police Deputy Police Commissioner Rick Nugent told reporters that since stage 3 stay at home restrictions resumed for much of Melbourne last Wednesday, many vehicles had been stopped and infringement notices issued, adding:

The most common reason is going to visit family or friends or associates and overnight stays.

We don’t know how many, if any, of those were single people but it shows the risks many people are willing to take to see family and friends.

We are partway through a yet-to-be published study aimed at understanding the impact of the COVID-19 pandemic on relationships, health, and quality of life. We have surveyed 2,666 people at the first wave around the world.

The first wave data found that 1 in 2 Australians report feeling more lonely since COVID-19. Living with family during COVID-19 seems to be most beneficial for protecting against feelings of loneliness, depression, social anxiety and stress. Young adults aged 18-25 also reported the highest levels of loneliness compared with other age groups. We know from previous research that young people have high social needs.

And it’s not just people living alone. People who live with housemates (or those unrelated to them) may also be at greater risk of loneliness. People also have complex social needs. Some have said, “I love my husband and my kids but I’m desperate to see my friends”.

These findings are preliminary and work is ongoing. These early results are from when we first went into lockdown — before many people had lost jobs and networks and before the shine had worn off Zoom social catch-ups.

Data from the second and third round of surveys will tell us more about how things have changed.

Making your interaction count

So, what can we do?

There are many ways to have safe social interactions within the recommended guidelines. It might help to remind yourself often that it’s not forever. There will be lots of time we can have together when the immediate threat has passed. And right now, the immediate risk to public health is huge.

And it doesn’t have to be just about Zoom catch-ups. Try going for a walk while talking on the phone with a friend, making something for a friend, writing a letter to a relative, or exercising with a friend while observing physical distancing.

There are very few benefits to this crisis but it may help us rediscover flexible ways to relate to others. Maybe we can think more clearly about cherishing these moments of interaction. You might think: “now I can’t see my nanna, I feel the need more than ever to connect with her. I can give her more regular phone calls or send a letter to make her feel valued, as opposed to going through the motions of a more routine visit.”

It’s not just having a conversation but rather having meaningful interactions.

Insights from social and behavioural science tell us that comprehensive public health responses work best when leaders, public health experts and policy makers emphasise that cooperating is the right thing to do, that other people are already cooperating and appeal to our shared sense of identity.

Understanding how people perceive the COVID-19 threat, their social context (including cultural norms), the way these messages are communicated to the public, and individual and collective interests are all crucial.

While most people try their best to follow the guidelines, simplistic messaging such as “don’t do this” is often ineffective.

Remind yourself the current restrictions won’t last forever.
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Nuance is hard

I am sympathetic to people who feel disadvantaged by rules that lack the nuance to account for their social needs.

But blanket guidelines are probably the most direct way to get the key clear messages across about what we can do to prevent further spread of COVID-19. Nobody wants lockdown to be toughened further or extended longer.

It’s a real challenge for the government to manage a society made up of different types of communities with varying social needs and expectations. And clearly there isn’t a one-size-fits all guideline that can account for society’s diversity. Allowing many nuanced conditions makes it harder to manage and can also introduce confusion. And it is important to promote a sense of community during this public health crisis, as people who feel socially excluded are less likely to be cooperative.

The top priority is managing this public health crisis and stopping the spread of COVID-19. Social health is extremely important but it can be managed even while social restrictions are in place.

I think if people are feeling a bit lonely, even if they are bunkering down with a housemate or a partner but missing their friends, it’s important to know it’s OK to feel that way.

But humans are astonishingly flexible and resilient through times of crisis. We can find creative ways to connect with people while still reducing the immediate risk.




Read more:
1 in 3 young adults is lonely – and it affects their mental health



Correction: An earlier version of this story attributed a quote to Victoria Police Police Commissioner Shane Patton. It should have been attributed to Victoria Police Deputy Police Commissioner Rick Nugent. The error was made by an editor in the editing process.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.

Melbourne’s second lockdown will take a toll on mental health. We need to look out for the vulnerable



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Louise Stone, Australian National University

Metropolitan Melbourne and Mitchell Shire are beginning another six weeks of lockdown due to a spike in COVID-19 cases.

While this second round of lockdown may bring the case numbers under control, its effects on Victorians’ mental health could be significant.

Australians are already experiencing mental health fallout from COVID-19. A prolonged pandemic, and a second lockdown, might only make things worse.

COVID-19 and our mental health

Our mental health is affected by changes in our social circumstances, and no event in recent history has wrought havoc with our daily lives quite like COVID-19.

Parents of newborns have had reduced access to social support.

Many people have had to grieve alone after the death of a loved one.

People experiencing homelessness have received temporary housing, but may have difficulty readjusting to life without support again.

Nursing home residents have endured months of isolation.

Job losses and the economic consequences will mean the emergence of mental health problems in people who had previously enjoyed a life of privilege.




Read more:
Social distancing can make you lonely. Here’s how to stay connected when you’re in lockdown


While we don’t yet know the full extent of the mental health fallout from COVID-19, we are seeing an increase in mental disorders like depression and anxiety.

As Melbournians return to lockdown, the impact of loneliness, fear, anxiety and hopelessness is likely to increase further.

It could be harder the second time

A review of the literature around quarantine shows the mental health effects worsen with longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma.

The reality is we don’t know what the mental health effects of a second lockdown will be. But this second lockdown in Melbourne has all the features of a difficult quarantine situation, including enforced isolation from friends and relatives.

Another six weeks will likely bring frustration, anger and a sense of hopelessness, compounding the mental health effects we’ve felt up to this point.

Plus, any “novelty” we might have felt the first time has likely worn off.

This second lockdown also shows us COVID-19 is likely to be with us for a long time. Our hope for a quick resolution and return to normal is fading.

It won’t be the same for everyone

The effects of hardship, trauma and loss associated with lockdown and the pandemic more broadly are unlikely to be spread evenly across the population.

People who are socioeconomically disadvantaged, people who are unemployed, Aboriginal and Torres Strait islander people and those from culturally and linguistically diverse backgrounds already have poorer mental health and poorer access to services.

This week’s “hard lockdown” in the North Melbourne tower blocks is a stark reminder of the disproportionate effect this pandemic is having on vulnerable groups.

And unlike natural disasters that bring communities together, epidemics often foster suspicion and division. Sadly, scapegoating is emerging and we’re seeing multicultural groups targeted.

The longer the pandemic endures, the greater the division between those who have resources to access care and those who don’t is likely to become.




Read more:
If Australia really wants to tackle mental health after coronavirus, we must take action on homelessness


For young people, the sense of hopelessness and worry about the future is escalating.

Professor Susan Rossell from Swinburne University has been tracking the mental health of 18-25-year-olds over the past three months, and has noted a serious spike in mental illness. The mental health impacts of COVID-19 also seem to be more severe for women, and those with existing mental illness.

In the past month, this spike was particularly noticeable in Victoria, presumably due to increasing numbers of new cases.

Young people seem to be struggling during the pandemic.
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Mental health will change over time

In many ways, the trajectory of emotional responses to COVID-19 echoes the trajectory of chronic illness.

As a GP, I see people transition from their first episode of illness, where they hope everything will return to normal, to a more chronic course, where they gradually realise they need to adapt to a new and changing idea of what normal will become.




Read more:
Coronavirus is stressful. Here are some ways to cope with the anxiety


This second wave in Victoria shows us we can’t just wait for things to return to normal. The implications COVID-19 has on our lives — and the associated mental health effects — will be ongoing.

Somewhat like a patient with chronic illness, we need to adapt to the idea that change is the “new normal”. This uncertainty makes life profoundly difficult for people beginning to plan for their future, like young people, and people who have few resources to weather change.

More than ever, we need to offer medical and psychosocial care to the vulnerable people in our community if we’re to prevent mental illness becoming more damaging than the virus itself.

On the other hand, there’s always hope the new normal will become more equal, more sustainable and more humane.




Read more:
Feeling hopeless? There are things you can do to create and maintain hope in a post-coronavirus world


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

Louise Stone, General practitioner; Clinical Associate Professor, ANU Medical School, Australian National University

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