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



Shutterstock

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).




Read more:
Coronavirus has boosted telehealth care in mental health, so let’s keep it up


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.
Shutterstock

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.




Read more:
5 ways to get mental health help without having to talk on the phone


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.




Read more:
Number of Australia’s vulnerable children is set to double as COVID-19 takes its toll


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.




Read more:
The government will spend $48 million to safeguard mental health. Extending JobKeeper would safeguard it even more


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.
Shutterstock

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.




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


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.

Is psychiatry shrinking what’s considered normal?



Vijay Sadasivuni/Pexels

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.
Shutterstock

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.
Shutterstock

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.

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



Shutterstock

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.
Shutterstock

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.

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



Shutterstock

Vaughan J Carr, UNSW and Anthony Jorm, University of Melbourne

The COVID-19 pandemic has opened fault lines in social, economic and health-care policy in Australia. One area in which all three converge is homelessness.

It’s almost impossible to practise self-isolation and good hygiene if you’re living on the streets or moving from place to place. This puts homeless people at higher risk of both catching the disease and transmitting it to others.

At the beginning of the pandemic, governments recognised this problem and responded by housing homeless people in hotels.

But we need to act now to ensure these people aren’t forced back onto the streets as the pandemic recedes.

This is particularly important given we’re worried about the mental health fallout of the pandemic. Evidence shows homelessness and mental illness are inextricably linked.




Read more:
Homelessness and overcrowding expose us all to coronavirus. Here’s what we can do to stop the spread


Homelessness in Australia

The initiative to house the homeless in hotels has been targeted mostly at “rough sleepers”, of whom there are more than 8,000 in Australia.

But people who sleep on the streets make up only a tiny proportion of the Australians we consider to be homeless. Homeless people also include those living in unstable or substandard accommodation, for example.

In 2018-19 more than 290,000 Australians – roughly 1.2% of the population – accessed specialist homelessness services.

So this is only a temporary solution to a national emergency, and addresses only the tip of the iceberg.

Mental illness and beyond

At least one in three homeless people have a mental illness.

Homelessness is often a consequence of mental illness, especially of the more severe kinds that involve hallucinations, confusion, mood swings, depression and intense anxiety.

It’s also a consequence of family violence, which itself increases the risk of poor mental health in children and adults.

But homelessness can also be a cause of mental illness, through its associations with poverty, unemployment, emotional stress, food insecurity, discrimination, exploitation, loneliness and exposure to violence, crime and drugs.

It’s a vicious cycle. Mental illness can lead to homelessness, and homelessness can lead to mental illness.
Shutterstock

The pandemic has momentarily lifted the cover on homelessness as a widespread and, so far, intractable social, economic and health problem.

It’s not only a reservoir of private suffering for those driven to the social margins through unstable or inadequate accommodation.

Homelessness also has broad social impacts, including lost productivity, adverse effects on young people’s health, education and well-being, and increased consumption of mental health services and criminal justice resources, among others.




Read more:
When it’s easier to get meds than therapy: how poverty makes it hard to escape mental illness


Next steps

What will happen to the homeless people currently housed in hotels as the pandemic subsides?

As catastrophic an event as COVID-19 has been, it has created a unique opportunity to improve the long-neglected and critically poor state of social housing in Australia.

The Community Housing Industry Association recently put forward a strong economic argument under the Social Housing Acceleration and Renovation Program (SHARP) proposal for national investment in building 30,000 social housing units and upgrading existing housing.

Meanwhile, the Productivity Commission draft report on mental illness and the Australian Housing and Urban Research Institute (AHURI) have put forward robust recommendations concerning housing policy for people with mental illness.

The Productivity Commission and AHURI both advocate increased investment in low-cost, secure and good-quality accommodation, linked where necessary with suitable support services.

Many jurisdictions have excellent programs that help people with mental illness to live independently, such as the Housing and Accommodation Support Initiative in NSW. But these need to be scaled up dramatically.




Read more:
The need to house everyone has never been clearer. Here’s a 2-step strategy to get it done


Affordable social housing combined with government transfer payments (such as pensions, Centrelink and disability payments) sufficient to meet basic living costs would be a major boon to mental health in this country.

Both the Productivity Commission and AHURI highlight bridging the gaps in social housing could promote recovery from mental illness, enabling greater social participation and enhancing well-being. It’s likely this approach would also prevent many cases of mental illness before they take hold.

In the long term this would far exceed the benefits flowing from piecemeal handouts for clinical services, which is the present norm in addressing the mental health fallout of the COVID-19 pandemic.

Improving social housing in Australia would have a range of benefits.
Shutterstock

Home improvements or reducing homelessness?

Last week the Australian government announced HomeBuilder grants of A$25,000 for owner-occupiers for certain works on their homes. This funding will be going to people who already have homes and can afford substantial renovations.

There is a strong case for making similar investments in housing the homeless, which would substantially benefit the mental health of our most disadvantaged citizens.

Now is the time for a nationally coordinated effort by federal and state governments to institute economic, social and health policies to address the nexus between homelessness and mental health, and the poverty that feeds into both.




Read more:
Poor housing leaves its mark on our mental health for years to come


The Conversation


Vaughan J Carr, Professor of Psychiatry, University of New South Wales; Adjunct Professor, Monash University, UNSW and Anthony Jorm, Professor emeritus, University of Melbourne

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

Women are drinking more during the pandemic, and it’s probably got a lot to do with their mental health



Shutterstock

Shalini Arunogiri, Monash University; Caroline Gurvich, Monash University, and Jayashri Kulkarni, Monash University

COVID-19 has significantly affected our collective mental health.

For many people, social disconnection, financial strain, increased obligations in the home and ongoing uncertainty have created distress – and with it, a need for new ways of coping.

One way people may choose to cope with stress is through the use of alcohol.

We’re now starting to understand the degree to which alcohol use has increased in Australia during COVID-19. While the data aren’t alarming so far, they suggest women are drinking at higher levels than usual during the pandemic, more so than men.

This trend is likely linked to the levels of stress and anxiety women are feeling at the moment – which, research suggests, are disproportionate to the distress men are experiencing.




Read more:
Worried about your drinking during lockdown? These 8 signs might indicate a problem


Alcohol consumption and COVID-19

Early reports of increased alcohol purchasing raised the alarm that we might see an increase in alcohol use across the population during lockdown.

However, recent data from the Australian Bureau of Statistics suggests overall, alcohol consumption remained relatively stable during April. Only 14% of Australians reported increased use of alcohol in the previous month.

But women are over-represented in this group. Some 18% of women reported increased alcohol use in the previous month, compared with only 10.8% of men.

14% of Australians reported they were drinking more than usual during April.
Shutterstock

Similarly, preliminary results from our COVID-19 mental health survey of 1,200 Australians in April found a significantly higher proportion of women had increased their alcohol intake: 31.8%, versus 22.5% of men.

Why are we seeing this disparity between women and men? The answers may lie in what we know about why women drink, and in the disproportionate burden of stress women are facing as a result of COVID-19.

Women tend to drink for different reasons to men

In Australia in 2016, 14% of men and 7% of women drank alcohol to risky levels.

Although fewer women than men drink alcohol regularly, alcohol consumption among women has increased in the past decade, particularly in middle-aged and older women. This mirrors international trends that suggest women may be catching up to men in terms of their alcohol consumption.




Read more:
Did you look forward to last night’s bottle of wine a bit too much? Ladies, you’re not alone


Overall, Australia has observed a reduction in risky drinking across the population, with increasing numbers of young people choosing not to drink.

In contrast, women in their 50s are the only subset of the Australian population with rising rates of alcohol use. In 2016, data showed for the first time, they were more likely to drink at risky levels than younger women.

Drinking has become more normalised among women in this middle-to-older age group, potentially contributing to the rise in alcohol use. Alcohol has become a commonly accepted coping mechanism for distress, with women feeling comfortable to say “I just had a bad day. I needed to have a drink”.

This highlights a theme that frequently underpins problematic alcohol use in women: what’s termed a “coping motive”. Many studies have found more women drink alcohol to cope – with difficult emotions or stressful circumstances – as compared to men, who more often drink alcohol in social settings or as a reward.




Read more:
Women’s alcohol consumption catching up to men: why this matters


Women seem to be struggling more during the pandemic

With this in mind, it’s unsurprising we’re seeing increased alcohol consumption among women during COVID-19. International data show women have been more likely to experience symptoms of stress, anxiety and depression during the pandemic.

Meanwhile, Australian data show loneliness has been more of a problem for women (28%) than men (16%) during this past month under lockdown.

Caregiver load has also been a source of stress, with women almost three times more likely than men to be looking after children full-time on their own during COVID-19.

Many women have had to work from home while looking after their children.
Shutterstock

While we don’t have enough evidence yet to tell us conclusively whether family violence incidents have increased during the pandemic, this may add to the mental health burden for some women during COVID-19.

Further, younger female workers are disproportionately affected by the economic crisis in the wake of COVID-19. The fact women make up a majority of the casual workforce makes them highly vulnerable at this time.




Read more:
Coronavirus: it’s tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check


Together, it seems COVID-19 is having a different mental health impact on women compared to men. And this is likely to be intertwined with their increased drinking during the coronavirus pandemic.

Whether we’ll see higher rates of problem alcohol use or dependence in women after the pandemic remains unclear. However, we know women who drink at unsafe levels experience complications more quickly, and enter treatment later, with perceived stigma a barrier to help-seeking.

It’s vital we draw our attention to these gender-specific differences in mental health and alcohol consumption as we formulate our mental health pandemic plan.

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

Shalini Arunogiri, Addiction Psychiatrist, Senior Lecturer, Monash University; Caroline Gurvich, Senior Research Fellow and Clinical Neuropsychologist, Monash University, and Jayashri Kulkarni, Professor of Psychiatry, Monash University

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

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


Shutterstock

Jayashri Kulkarni, Monash University

We’ve recently heard experts raise concerns about a looming mental health crisis, warning COVID-19’s psychological toll on Australians could be like a second wave of the pandemic.

Suicide modelling from the University of Sydney’s Brain and Mind Centre has predicted a potential 25-50% increase in the number of people taking their lives in Australia over the next five years. The researchers expect this projected increase to disproportionately affect younger people.

Any suicide is a tragedy and prevention must be a priority.

But the grim predictions from suicide modelling warrant analysis and exploration. They have significant implications for public health policy and funding decisions, as well as community concern.




Read more:
The government will spend $48 million to safeguard mental health. Extending JobKeeper would safeguard it even more


The challenges of modelling in health

Models in health have to begin with questions about the basic assumptions underpinning them. They need to be built on reliable data, be clear on how they’ve dealt with uncertainty, and describe whether they are generalisable or not.

The best models for diseases are mechanistic models, not purely statistical ones. Mechanistic models are based on understanding how a system’s components interact with each other.

For example, the preferred mechanistic model for COVID-19 includes measures of actual viral infections and underlying transmission processes, plus testing how the pandemic may change under various conditions.

The complexities of mental illness mean suicide doesn’t fit neatly into a mathematical model.
Shutterstock

Trying to emulate this in suicide modelling has many problems, starting with the basic assumptions. Mental illness and suicide are multifaceted, complex and fluctuating entities.

There is a spectrum from fleeting thoughts of suicide, through to planning or attempting suicide, to the final tragedy of completing suicide. These subtle but important phases are crucial to identify, intervene in and factor into a model.

But to date, existing suicide prediction tools have not been able to account for these factors, and have largely failed to generate accurate predictions.




Read more:
We need to flatten the ‘other’ coronavirus curve, our looming mental health crisis


The recent modelling takes into account social factors such as homelessness, unemployment, domestic violence and substance use as causal factors for suicide. Importantly, psychological distress, a critical causal factor, can change rapidly and is very difficult to measure.

The lack of clear, objective tests for mental illness together with the many rapidly changing social and personal factors makes it very difficult to develop a reliable mechanistic model for suicide.

Add COVID-19, and it becomes even harder

Mental health during the coronavirus pandemic is impacted by many unique and variable factors which are difficult to model with reliability.

Suddenly Australians have had to be isolated from extended family and friends, contend with disrupted work and home routines, and manage the fear of becoming ill with a virus that has claimed more than 350,000 lives around the world to date.

These factors can create temporary psychological distress of varying severity, which changes with time and is difficult to measure.

All of this is quite different to mechanistic viral disease models, which include actual, stable measures of infection with nonlinear spread. This means one infected person can spread the virus to others who subsequently spread it – an exponential rise.

While viral disease models are not perfect either, we can’t track suicide in the same way.

Some people are at higher risk

International surveys show women of all ages are experiencing significantly higher rates of anxiety and depression than men during the pandemic.

Older citizens, (with a female majority due to their greater longevity), understandably have increased fears about their health and safety if infected, as well as their financial security. So they’re at greater risk of mental ill health too.




Read more:
Is isolation a feeling?


People with pre-existing mental health conditions or physical illness are also likely to be struggling more with COVID-19-related mental health problems.

These disparities create further complexities that are difficult to model.

Some people will be at higher risk of mental ill health during COVID-19.
Shutterstock

We need to act

For many of us, the fear and anxiety we felt during the early stages of COVID-19 will have improved as it’s become apparent Australia has been able to avoid the enormous toll seen elsewhere.

Nonetheless, past experience of financial crises and increased unemployment, such as during the great depression, show us the suicide rate does increase at such times.

Stressors such as rising household debt, increased social isolation and loneliness are key risk factors for suicide.




Read more:
COVID lockdowns have human costs as well as benefits. It’s time to consider both


While we may not be able to predict accurately how significantly deaths from suicide will rise, we do need to take action to prevent or minimise any increase in suicides in the months and years following the pandemic.

Close monitoring of the nation’s mental health through repeated targeted and well-constructed surveys will be vital to inform how we go about this.

We need all sectors of our nation to unite to face this challenge. Governments must invest wisely and in a timely manner to enhance mental health care for the whole community, paying particular attention to groups at higher risk.

Tackling this while avoiding a national panic about suicide is imperative. Raising well-meaning concerns is of course important, but placing the country on “suicide watch” is alarmist and could potentially cause more anxiety.The Conversation

Jayashri Kulkarni, Professor of Psychiatry, Monash University

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

What are the characteristics of strong mental health?



Shutterstock

Simon Rosenbaum, UNSW and Jill Newby, UNSW

Amid the coronavirus pandemic we are being warned of a “second wave” of mental health problems that threatens to overrun an already weakened mental health service.

As we emerge from this crisis, while some people may need specialist help with treating mental illness, everybody can benefit from strategies to improve mental health.

This is because mental health is more than just the absence of mental illness. Positive mental health is a combination of feeling good and functioning well.




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


Mental illness vs mental health: what’s the difference?

Mental health and mental illness are not simply two sides of the same coin. Mental health, just like physical health, exists on a spectrum from poor to optimal.

With physical health, some days we naturally feel stronger and more energetic than others. Similarly, some days our mental health is worse than others, and that too is a natural part of being human. We may feel tired, grumpy, sad, angry, anxious, depressed, stressed, or even happy at any point in time. These are all normal human emotions, and aren’t on their own a sign of mental illness.

Someone living with a mental illness can be experiencing optimal mental health at any point in time, while someone else can feel sad or low even in the absence of a mental illness.

Differentiating between poor mental health and symptoms of a mental illness is not always clear-cut. When poor mental health has a sustained negative impact on someone’s ability to work, have meaningful relationships, and fulfil day-to-day tasks, it could be a sign of mental illness requiring treatment.

Mental health and mental illness are not the same thing. You can have poor mental health in the absence of a mental illness.
Supplied, adapted from Keyes 2002.

What does positive mental health look like?

Mental health is more than just the absence of mental illness.

Positive mental health and well-being is a combination of feeling good and functioning well. Important components include:

  • experiencing positive emotions: happiness, joy, pride, satisfaction, and love

  • having positive relationships: people you care for, and who care for you

  • feeling engaged with life

  • meaning and purpose: feeling your life is valuable and worthwhile

  • a sense of accomplishment: doing things that give you a sense of achievement or competence

  • emotional stability: feeling calm and able to manage emotions

  • resilience: the ability to cope with the stresses of daily life

  • optimism: feeling positive about your life and future

  • self-esteem: feeling positive about yourself

  • vitality: feeling energetic.

How can I cultivate my mental health?

Your mental health is shaped by social, economic, genetic and environmental conditions. To improve mental health within society at large, we need to address the social determinants of poor mental health, including poverty, economic insecurity, unemployment, low education, social disadvantage, homelessness and social isolation.

Positive mental health involves being able to cope with the challenges of daily life.
Shutterstock

On an individual level, there are steps you can take to optimise your mental health. The first step is identifying your existing support networks and the coping strategies that you’ve used in the past.

There are also small things you can do to improve your mental health and help you to cope in tough times, such as:

  • helping others

  • finding a type of exercise or physical activity you enjoy (like yoga)

  • getting good sleep

  • eating healthy food

  • connecting with others, building and maintaining positive relationships

  • learning strategies to manage stress

  • having realistic expectations (no one is happy and positive all the time)

  • learning ways to relax (such as meditation)

  • counteracting negative or overcritical thinking

  • doing things you enjoy and that give you a sense of accomplishment.

How do I know if I need extra support?

Regardless of whether you are experiencing a mental illness, everyone has the right to optimal mental health. The suggestions above can help everyone improve their mental health and well-being, and help is available if you’re not sure how to get started.

However, when distress or poor mental health is interfering with our daily life, work, study or relationships, these suggestions may not be enough by themselves and additional, individualised treatment may be needed.

If the answer to RUOK? is no, or you or your loved ones need help, reaching out to your local GP is an important step. If you are eligible, your GP can refer you for free or low-cost sessions with a psychologist, exercise physiologist, dietitian, or other allied health or medical support services.


This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Simon Rosenbaum, Associate professor & Scientia Fellow, UNSW and Jill Newby, Associate Professor and MRFF Career Development Fellow, UNSW

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

Are you worried someone you care about is thinking of suicide? Here’s how you can support them from afar



Shutterstock

Milena Heinsch, University of Newcastle; Dara Sampson, University of Newcastle, and Frances Kay-Lambkin, University of Newcastle

We’ve now been social distancing for several weeks. While these measures have allowed us to slow the spread of COVID-19, they’ve also upended our day-to-day lives.

If you’ve found yourself experiencing feelings of fear, anxiety, depression, boredom, anger, frustration or irritability, you’re not alone.

Older adults, health-care workers, people with pre-existing mental health conditions and people experiencing financial pressure could be particularly vulnerable to psychological distress at this time.

When feelings of psychological distress increase, suicidal thoughts and behaviours may also increase.

So how do we know when to be worried about someone we love, and how can we support them from afar?




Read more:
Can’t sleep and feeling anxious about coronavirus? You’re not alone


Recognising the signs

During COVID-19, we may all be feeling more stressed than usual. That’s why we need to stay connected with each other online, on the phone and via text messages.

But it’s important we’re attuned to whether this extra stress and uncertainty is developing into something more for any of the people we care about.

Some warning signs for suicide might be easier to recognise when you can see a person’s facial expressions and gestures. But there are cues you can pick up on during text, phone or online communication.

Social withdrawal can indicate a person is at greater risk. Perhaps a friend or relative is increasingly difficult to contact via phone or text, disappears from social media or starts saying they just want to be alone.

A persistent drop in mood might be revealed on the phone by a flat tone of voice, talking less than usual or more slowly, and by shorter text messages or none at all.

You may be able to tell if a friend is becoming socially withdrawn by the tone of their messages.
Shutterstock

Some people might say things like “you’d be better off without me” or “there’s nothing to live for”, which suggest they can’t see a way out of their situation and may be thinking about suicide.

If you’re worried someone you know might be suicidal, reaching out and having a conversation could save their life.

Talking on the phone or online

Choose a time and place where you can talk openly and without getting interrupted. This might be challenging when whole families are at home together for extended periods. But these can be sensitive and confronting conversations and it’s important to protect the person, as well as people in your family or household.

You could start the conversation by asking your friend or loved one how they are. You might also let them know you’ve noticed a change in them: “you don’t seem yourself”.

Starting the conversation may look different if you’re online. Perhaps someone has posted a comment or image on social media that seems unusual for them, or which makes it seem like they’re thinking about suicide. If so, contact them directly by sending a private message. It’s OK to talk online, just not in a public forum.




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


Once you’ve started the conversation, ask directly about suicidal thoughts and intentions (for example, “are you thinking about suicide?”).

And be prepared they may answer “yes”. Then you just have to listen with supportive statements. Say things like “that sounds really tough” rather than “don’t be silly”.

Some people considering suicide might actually find it easier to talk online.
Jonas Leupe/Unsplash

Being at a distance can be an advantage

You might feel worried about having a difficult conversation on the phone or online, but this style of communication actually has some benefits.

People may feel more comfortable revealing suicidal thoughts, without fear of stigma, when communication isn’t face-to-face. And sometimes people find it easier to communicate via emoji, GIFs or images rather than having to find the words to express how they’re feeling.




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


Further, listening on the phone or via messaging gives us time to think about how to best respond, and to let our initial reactions pass.

This is important because negative reactions, like criticising or dismissing someone’s feelings, may make the person less likely to seek help and increase their thoughts of suicide.

Encourage them to get help

If you’re worried about someone and you think they’re at risk of suicide, offering help is important. Our research with people who had previously attempted suicide found although participants wouldn’t necessarily seek help, many said they would accept it if it were offered.

While talking with the person you’re worried about is an important first step, you may be able to guide them towards professional help. For example, they may want help to make an appointment with a GP or counsellor, or to call a crisis line.

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

Lauren Rogers, a research assistant at the University of Newcastle, contributed to this article.The Conversation

Milena Heinsch, Senior Research Fellow, Centre for Brain and Mental Health, University of Newcastle; Dara Sampson, Academic Research Manager, University of Newcastle, and Frances Kay-Lambkin, Professor, University of Newcastle

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

To improve firefighters’ mental health, we can’t wait for them to reach out – we need to ‘reach in’


Erin Smith, Edith Cowan University

Many firefighters will by now be exhausted, having been on the front line of Australia’s bushfire crisis for weeks or months.

This bushfire season has been unrelenting, and the hottest months of summer may still lie ahead.

In part, the toll is physical. The flames are high, they are intense, and they move fast. It’s hard to breathe because the air is so hot.

At the same time, first responders have witnessed widespread devastation. To land and livelihoods, to people and animals. Meanwhile, grief for the death of fellow firefighters feels raw, and the risk to their own lives very real.

We’re right to be concerned about firefighters’ mental health.




Read more:
‘I can still picture the faces’: Black Saturday firefighters want you to listen to them, not call them ‘heroes’


Emergency responders already have poorer mental health

Every 4.3 weeks, a firefighter, paramedic or police officer dies by suicide – and that’s when it’s “business as usual”.

Research shows our first responders are more likely to be diagnosed with a mental health condition than the overall Australian population. They are more than twice as likely to think about suicide, and three times as likely to have a suicide plan.

This paints a grim picture of the well-being of a population who dedicate their professional lives to helping others.




Read more:
As bushfires intensify, we need to acknowledge the strain on our volunteers


It’s likely responding to a disaster on the scale of the current bushfires could increase the risk of mental illness for some.

If firefighters are not coping, they may develop psychological disorders including post-traumatic stress disorder (PTSD), anxiety, depression, and substance abuse.

PTSD

PTSD develops when a person isn’t able to recover after experiencing a traumatic event.

Some firefighters may develop symptoms while they’re still fighting the fires. They may feel on edge, but push down their fears to get on with the job. However, it’s more likely symptoms will only appear weeks, months, even years down the track.

PTSD is associated with significant impairment in day-to-day functioning socially and at work. For firefighters and others with PTSD, typical symptoms or behaviours will include:

  • reliving the traumatic event. People with PTSD describe vivid images and terrifying nightmares of their experience

  • avoiding reminders of what happened. They may become emotionally numb and isolate themselves to avoid any triggers

  • being constantly tense and jumpy, always looking out for signs of danger.

Volunteers in regional communities are particularly susceptible to trauma. They have often joined fire brigades to help protect their own communities, and then face trying to save their own homes or those of neighbours and friends.

We also need to be mindful of retired firefighters for whom these current bushfires will have triggered painful and disturbing memories. They may not currently be on the front lines, but they only need to turn on the television, open the newspaper, or look at social media to be taken straight back to Black Saturday or whatever particular event is distressing for them.




Read more:
Paramedics need more support to deal with daily trauma


The problem with reaching out

The increased prevalence of mental health issues among emergency responders suggests many existing emergency service well-being programs are failing those who need them the most.

In Australia, these programs are largely based on a what’s called a “resilience model” that focuses on people “reaching out” and seeking help when they need it.

First responders may be unlikely to take this initiative in the middle of a mental health crisis, when it’s often a struggle even to pick up the phone to a loved one, friend or colleague.

Some firefighters might not reach out for help when they need it.
Jacob Carracher, Author provided

Instead, we need an approach to well-being that removes the onus on the individual. We need to shift our thinking from a model that requires the individual to “reach out”, to a model that also values others “reaching in” to identify those who may be struggling.

Ambulance Victoria’s Peer Support Dog Program, which allows staff to bring in accredited dogs to create social interactions and conversations, is a good example of how “reaching in” helps with first responder well-being. This kind of approach empowers people through social connections and the appreciation they are also supporting others.

While employers need to do more in to facilitate “reach in” programs, anyone can create informal support networks. Whether friendship groups, community groups, sporting groups, or something else, the underlying thread should be a committment to each other’s well-being.




Read more:
The rise of ‘eco-anxiety’: climate change affects our mental health, too


As we continue to contend with this crisis, ensuring firefighters feel supported can make a difference to their well-being. If you see a responder in the street, say thank you. If you see one in a cafe, shout them a cuppa. If you have kids, get them to write a letter or draw a picture and drop it off to the local emergency services station.

We can’t eliminate the risk firefighters will suffer with mental health problems after what they’ve been through, but these little acts of kindness can make a difference.

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

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.