As Sydney enters its 13th week in its current lockdown, with Victoria not far behind, debate about the effects of Covid-19 has begun to shift, with concerns about a “shadow epidemic” of mental illness overtaking concern about the economic fallout. In part this reflects the federal government’s attempts to deflect attention from its catastrophic mishandling of both quarantine and vaccination, and reposition itself as the advocate of reopening ahead of the election. But it also reflects a genuine sense of exhaustion. “It’s different from last year,” says one Sydney psychotherapist. “Last year people felt insecure and anxious. This time there’s a sense of hopelessness that wasn’t there before.”
Professor Richard Bryant, of UNSW Sydney’s school of psychology, is an expert on post-traumatic stress and anxiety. He believes the effects of continuing lockdowns and uncertainty are cumulative. “We know from previous experience that people are able to manage certain stressors for a time, but after a while they start to erode our resources.”
Yet more than 18 months into the pandemic, it is also possible to see patterns emerging. “In the midst of Covid, rates of anxiety and depression went up a lot,” Bryant says, “so that in many countries you had up to a quarter of people affected, and as many as 10 per cent reporting suicidal thoughts.” These rates fell over time – one British study found that two months into lockdown the number of people reporting symptoms of depression and anxiety had decreased slightly – but even after restrictions began to ease, psychological distress remained widespread, with more than half of those surveyed still feeling anxious about the pandemic, more than a quarter feeling isolated and lonely, and one in 10 still experiencing suicidal thoughts.
This fallout has been felt hardest by already vulnerable groups, such as younger people, the unemployed, single parents and those suffering from pre-existing health conditions. For young people, who are especially reliant on social interaction and leisure, and have experienced major interruptions to their education and careers, the effects have been particularly pronounced. Research from the United States reveals that more than 50 per cent of people aged 18-34 reported moderate mental distress across the course of the pandemic, as opposed to 40 per cent of people aged 35-54, and 24 per cent of people over 55.
The impact on children and teenagers has been even more severe. Professor Helen Christensen is director and chief scientist at Sydney’s Black Dog Institute. She says Covid-19 has led to significant increases in both anxiety and depression and presentations to hospital for self-harm. “We’re seeing more young people saying they feel hopeless, that they’re considering suicide, that they want to die.”
This is starkly illustrated in figures obtained by The Sun-Herald in August, which showed that across the first seven months of 2021, an average of 282 people under the age of 18 presented at New South Wales hospitals for self-harm and suicidal ideation a week, an increase of 31 per cent on the same period last year and 47 per cent on 2019. This compared with a rise of only 13 per cent on 2020 across the general population. In Victoria the situation is even worse, with presentations increasing 88 per cent since 2020.
These increases in psychological distress have not translated into a rise in suicide rates. Christensen says the reasons for this aren’t clear. “It’s possible Covid is acting as a brake on youth suicide in some way. The physical constraints of not being able to get out of the house, or the fact there are more people out and about near cliffs and similar places, might be acting to restrict means. Or it might be that we’re all feeling distressed, so young people don’t feel as alienated because other people are suffering as well. The fact we’ve had the economic safety net of JobKeeper has probably made a huge difference as well, because it’s reduced financial stress by providing economic support to families that may not have been there before.”
Worryingly, though, Christensen says young people seem less able to recover from the mental health impacts of the pandemic than older individuals. “What we’re seeing in adults is sharp increases in anxiety and depression as lockdowns occur, followed by a return to normal once the crisis goes away or the lockdown ends, which shows adults are adaptive. But what happens in kids is different, because they’re not adapting. Instead, they’re maintaining higher and higher levels of distress as time goes on.”
The mental health of Indigenous Australians has also been negatively affected. Professor Pat Dudgeon, a Bardi woman and director of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention at the University of Western Australia, says the pandemic has amplified existing vulnerabilities and inequities, compounding the already extremely high rates of mental illness and psychological distress among Indigenous Australians. She also points to a series of pressures unique to Indigenous people, in particular the psychological effects of being prevented from carrying out cultural practices, concern about the potential loss of Elders due to infection, and of being unable to visit Country due to lockdowns and border closures. “I’ve talked to Perth people who are trapped in Sydney, and they’re very much yearning to come home.”
Recent work by Dr Belinda Liddell of UNSW Sydney’s school of psychology reveals the pandemic has also had a significant impact on the mental health of refugees. At one level this is not surprising – rates of post-traumatic stress disorder (PTSD) and other mental illness are already elevated in refugee communities, and the high incidence of loneliness and isolation among refugees means limitations on social contact can have a particularly severe effect on their mental health. But Liddell also found the terrible memories triggered by social restrictions and increased police and military presence on the streets made refugees especially vulnerable. “The strongest predictor of poor mental health during the pandemic for refugees was the degree to which it reminded them of stressful experiences in the past,” she said.
Despite this, these same experiences often seemed to be connected to greater resilience. “One of the really interesting findings from our clinical work with refugees is that while many said Covid reminded them of their pasts, and that was a problem for them, the fact they’ve experienced uncertainty and the difficulties that go with it in the past has actually helped them cope with the uncertainties of the pandemic more effectively,” Liddell says. “For example, many know how to focus on the things they can control and not on the things they can’t.”
For some, these effects are likely to be felt for months or even years to come. Bryant predicts we will see what he calls “long mental health” in the form of continuing anxiety, depression and PTSD alongside long Covid. These effects are likely to be concentrated in areas of existing disadvantage. “We know there’s always a relationship between economic downturn and subsequent poor mental health, including suicidal risk,” he says.
Christensen agrees. “Research shows that about 80 per cent of kids are resilient. But the long-term impacts for those who get anxious and depressed at a clinical level are likely to be significant: poorer employment prospects, greater likelihood of anxiety and depression later in life.”
Bryant argues that while Australian governments have generally responded well to the mental health challenges of the pandemic so far, there is more to be done. “We need to come up with models of care that can teach people the skills they need to cope,” he says, pointing to the online resilience training being offered through UNSW’s Traumatic Stress Clinic as an example. But he also believes there needs to be a more targeted approach. “There will be a very significant minority who will have longer-term mental health problems after the pandemic. We need to be focusing on them, and thinking about how we plan for looking after them.”
Dudgeon believes increased use of services such as telehealth, to allow people in remote communities to access psychologists, and the development of services such as Lifeline’s new Indigenous anti-suicide program show mainstream services can become more culturally responsive. But she says it is vital Indigenous communities are at the centre of this process. “Our focus has to be ensuring communities have self-determination and are able to decide what the issues are and how to address them in culturally appropriate ways.”
Christensen advocates a similar scale of ambition. “We’ve been very short-sighted about mental health. We don’t invest enough in prevention, or do enough to increase resilience. But in the long term what we need is for our governments to have a future vision and be thinking about what needs to be done for the next 20 years.”
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This article was first published in the print edition of The Saturday Paper on September 18, 2021 as "Long mental health".
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