Patrick McGorry calls it a “shadow pandemic”. He says the mental health sector was ill-prepared to cope with the demand created by Covid-19 and that a mental health emergency is now under way.

“It was already woefully unable to meet the level of need for care even prior to the pandemic,” says McGorry, executive director of Orygen and professor of youth mental health at the University of Melbourne, “and now we’ve got a 30 per cent increase on top of the normal level among need. So it’s created a mental health emergency where people who are seriously ill, young people who are seriously ill in life-threatening situations, cannot get access to expert help.”

The increase McGorry cites is based on modelling conducted last year by the University of Sydney. It predicted a 25 per cent increase in deaths by suicide, and it is likely that about 30 per cent of those will be among young people. They warned that if the Australian economy deteriorated further, the number may increase.

“We are facing a situation where between an extra 750 and 1500 more suicides may occur annually, in addition to the 3000 plus lives that are lost to suicide already every year,” the research says. “Furthermore, this tragically higher rate is likely to persist for up to five years if the economic downturn lasts more than 12 months.”

According to the latest Australian Bureau of Statistics data, almost one in three Australians aged 18 to 34 years experienced high or very high levels of psychological distress in June 2021, compared with 18 per cent of people aged 35 to 64 years and 10 per cent of people aged 65 years and over.

Interim data from the Victorian Agency for Health Information also points to an increase in the number of young people presenting to hospitals with self-harm and suicidal ideation. The agency reports that for young people aged up to 17 years old, 157 young people a week presented to emergency departments in the six weeks to May 2, a marked increase from 83 in the same period in 2020 and 91 in 2019.

McGorry says the impact of the pandemic on young people has been significant. “If you just look at what’s happened to the lives of young people throughout the pandemic – so much uncertainty about their future; disruption in schooling; if they are employed, they are working casual jobs or insecure employment. Then you look at support systems around young people, whether it’s teachers or parents, universities, all of those institutions and scaffolding around young people has been under tremendous strain and stress as well, and for six lockdowns here in Victoria. The parents are actually exhausted.”

Last week, the federal treasurer, Josh Frydenberg, used McGorry’s assessment of a shadow pandemic to argue for the states to “move ahead with the plan” to reopen. But McGorry says there is evidence to show those living in areas with eased restrictions are also being adversely affected.

“It’s interesting that you’re also seeing these trends in states that haven’t had such severe lockdowns,” he says. “Lockdowns definitely make it much worse in terms of the effect, but you still see these mental health effects in other parts of Australia which haven’t been as heavily exposed.”

Data from the Australian Institute of Health and Welfare does not show a rise in deaths by suicide during the pandemic to date. What is evident, however, is a broader trend showing an increase in the suicide rate of young people. Recent data from the New South Wales Ombudsman shows the rate of suicide among people aged 10 to 17 has increased by 47 per cent over the past 15 years, with Aboriginal and Torres Strait Islander children being disproportionately affected. The ombudsman also found that more males than females die by suicide, and this gender gap has increased in the past five years.

Justin Dwyer, a psychiatrist and the medical director of psychosocial cancer care at St Vincent’s Hospital in Melbourne, led a team of researchers from the Coroners Court of Victoria, Monash University and St Vincent’s and Mercy hospitals, to examine how the pandemic may have influenced suicides. Dwyer says the study was largely driven by commentary in the media about the severity of the impact of Covid-19.

“This view that people were espousing that suicide rates were definitely going to go up, and there was quite a lot of talk about modelling that showed increases in different groups.”

The researchers looked at numbers and frequencies of deaths by suicide, as well as testimony from loved ones and past mental health history. This allowed the researchers to look at how the pandemic affected each individual, looking for mentions of “coronavirus” or “JobKeeper”, and these themes were qualitatively analysed in the lead-up to the individual’s suicide. The study looked at the frequency of suicide in Victoria over the five years preceding the pandemic, and through the pandemic.

“Looking at it month by month we were able to look at what happened during the harshest stage four lockdown last year versus when we exited that,” Dwyer says.

“We ended up finding 60 deaths that mentioned Covid specifically and explicitly as one of the stressors. Covid was only one of many things that were going wrong with these people in their lives. These were people the majority of whom had pre-existing mental health problems.”

The preliminary study did not find an increase in suicide rates but it noted there was an increase in people “coming through the hospital system who clearly were really affected by the pandemic in all sorts of ways”.

Professor Sam Harvey, acting director of the Black Dog Institute, says trying to judge a country’s mental health on suicide rates alone is difficult because suicides are complex phenomena. “It’s only one way to measure,” he says. “On a personal level, these suicides are tragedies; at a national level, to try and see trends, you often need data over long periods of time to see those trends”.

Dwyer agrees. He says suicides are “presented as this thing which is: you’re going along in your life, Covid comes along, it stresses you out and you decide to end your life. It is not like that all. The different ways in which it impacted people is complex.”

Dwyer argues there may have been a number of factors that mitigated the effect of the stress during the first 12 months of the pandemic. “All of a sudden a large number of people were lifted out of poverty by the different schemes that the government put in place,” he says. “There were things like increased access to mental health services, phone services, things that previously may have been a bit more difficult to make contact with.”

Professor Pat Dudgeon, a psychologist and the director of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention at the University of Western Australia, says the early measures introduced by governments may have helped mitigate rates of suicide – especially in Indigenous communities, which already experience higher rates.

“Some of the benefits that came on earlier in the pandemic, like JobSeeker increases, would have been a welcome situation for a lot of Aboriginal people,” she says. “Now that’s diminished, so we go back to poverty.”

Tom Brideson, the chief executive of Gayaa Dhuwi, which promotes collective excellence in Indigenous mental healthcare, says that the mental health of Aboriginal and Torres Strait Islander people must be prioritised. “When you’ve got acute care services, Aboriginal people being overrepresented, the rate being three times what it should be, and then you’ve got mental health issues or presentations within emergency departments being three times what they should be, there’s a real concern.”

In May, the federal government allocated $2.3 billion to mental health and suicide prevention. Making the announcement, Health Minister Greg Hunt said the plan would invest “$1.4 billion in high-quality and person-centred treatment, which includes the development of a national network of mental health treatment centres for adults, youth and children through the Head to Health and headspace programs”.

Sam Harvey welcomes the government’s commitment but says the investment doesn’t go far enough. “Mental health issues are the No. 1 reason people are going to see their GP. Suicide is the leading cause of death among young Australians and yet our system is relatively underfunded – both in terms of the money that goes towards clinical services, the number of people that are employed in the workforce, and the money that goes towards research to find solutions to these problems.”

Patrick McGorry agrees. “The problem is the execution of that new funding is being done in a business-as-usual timescale. In other words, it hasn’t taken account of the fact that we’re now dealing with a very changed set of circumstances with, as I say, a big surge of demand.”

Harvey says that while people are being encouraged to seek help, access to services is not always possible. “The messaging is encouraging people to go and get help, yet we hear countless stories of when they do go and seek help, there’s a six- to nine-month wait to see a psychiatrist or psychologist in their area.”

Both men argue that an emergency workforce needs to be mobilised urgently to deal with the demand.

“We’ve got to do something over the next few weeks and months because otherwise lives will be lost and there will be nowhere for these young people to go,” McGorry says.

“It’s just not acceptable that if you’ve got a life-threatening mental health condition, you can be turned away from the health system in probably about three out of four cases or go onto a waiting list for months…

“It’s just not right that we have this two-tiered system of healthcare; we were supposed to have fixed that when we integrated mental health care in the general health system where it’s not fixed. It’s absolutely a double standard that’s operating here.” 

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