Stress, isolation, suicide: Australia's new mental health officer on the challenges of Covid-19
Australia’s new deputy chief medical officer for mental health, Dr Ruth Vine, has sounded a cautionary note over a high-profile study predicting massive increases in suicide following the Covid-19 pandemic.
The research by top academics from the University of Sydney predicted a 25% increase in suicide and has been seized upon by advocates in the call for greater mental health funding and real-time suicide data.
Vine, who was appointed to the newly created role earlier this month as the government unveiled a suite of mental health measures, agrees it is important to “keep a very close eye on suicide data” but warns of “the difficulty” of modelling suicide, which she says is “always multifactorial”.
Asked for her view on the research, which predicted suicides could spike by between 750 and 1,500 deaths per year, Vine says: “I’m not aware how they factored in mitigating issues like some of the improved service in reach or consideration of people, particularly high-risk groups, accessing services.
“And the whole emphasis on some of the broader community things like schools and allowing family groups to get back together and allowing some greater movement.
“I’m aware of it, I think it’s interesting, but I just think it’s more complicated than that.”
High-profile mental health advocates Prof Patrick McGorry and Sydney University’s Prof Ian Hickie, who led the suicide research released by the Brain and Mind Centre, were behind the push to create the new role filled by Vine, who is Victoria’s former chief psychiatrist.
Hickie, a former national mental health commissioner, told the Guardian he is “very surprised” by Vine’s comments.
He notes the health minister, Greg Hunt, confirmed he would consider the study as part of the government’s response to the pandemic.
Hickie says the “assumptions built into the model (notably on employment, social disconnection, health services capability) are all in the public domain” and says these services generally have “negligible additional effects” while some “may actually make the situation worse”.
“The models are place-based, detailed and increasingly supported by similar modelling exercises in USA and reviews of past economic impacts on suicide rates.”
‘$40-odd-million isn’t really going to do a lot’
The government last week announced a $48m mental funding package that included extra money for services including Kids Helpline and Lifeline, a new “It’s okay not to be okay” awareness campaign, and other measures.
It also appointed Vine to the powerful Australian Health Protection Principal Committee and released the National Mental Health and Wellbeing Pandemic Response Plan, which was led by the NSW and Victorian governments.
Some, like Hickie and the Monash University researcher Alex Collie, were not blown away by the scale of investment.
“It seems small compared to the scale of what we’re seeing in the community,” Collie says. “Investment of $40-odd-million isn’t really going to do a lot.”
Experts have long warned about gaps in services for people whose mental health had significant impact on their day-to-day lives but who did not need hospital care.
Vine cites this as a concern, as well as the integration of services between the commonwealth and state systems.
“The commonwealth has funded Headspace. Headspace is great,” Vine says.
“But Headspace looks after people with a spectrum of need that doesn’t extend into when they are very acute or very high risk and at that point they need to go to the state system. It’s not always a seamless transition.”
In an interview with the Guardian, Vine, a consultant psychiatrist with more than 25 years’ experience, says the usual punter might face “three different routes of access to what might be providing similar or overlapping services”.
“There is a risk in some duplication,” she says. “Certainly some people get sick of saying, when I go to a new provider I have to give the same story all over again.”
Dr Leanne Beagley, the chief executive of Mental Health Australia, told the Guardian duplication is a real concern but adds “I think the problem of lack of services is more of a problem”.
“The point of having doctors … to lead the decision making around healthcare has not been brought up more powerfully than the chief medical officer Brendan Murphy’s work around the pandemic,” she says.
“What’s exciting in Ruth’s appointment is having that kind of medical leadership around mental health to match what’s been there for health.”
Financial stress a risk factor for mental health
Collie is part of a team of academics tracking the impact of job losses during the pandemic. The team has already garnered some preliminary findings from interviews with around 1,000 people who have lost work hours or their jobs.
“The main findings are really high levels of psychological distress, 31% of people we’ve surveyed so far are telling us on a standardised scale they have severe psychological distress,” Collie told the Guardian. “Over 40% reported moderate psychological distress.”
“We’ve tried to look at why that’s occurring and one of the main causes is financial distress. We’ve got millions of people in Australia who’ve gone from having an income and having money, to having no income or very little almost overnight.
“Happily, we are finding people who are maintaining social connections, which is quite difficult, are less likely to be impacted by this psychological distress.”
But Collie notes that others, about 30%, are drinking more alcohol to cope with their new situation.
Hickie’s research, meanwhile, suggests a link between the increase in the number of suicides and the unemployment rate.
Collie and Beagley both hope Vine will go beyond the usual bounds of advice around service delivery in health care, and advocate on issues such as an adequate rate of the jobseeker payment.
“We do know the things that predict the onset of poor mental health. People’s financial circumstances is one of those,” Collie says. “Unemployment is a risk factor but there is a set of reasons, it’s financial stress.”
Vine is guarded when asked if she has concerns about the withdrawal of income supports such as the boosted rate of the jobseeker payment.
“Those decisions are, of course, complicated ones,” Vine says. “I think it’s simplistic to say that that is, if you like, the only element. My big concern is more about the social connectedness and people’s engagement with their families and communities.
“Of course there will be an impact if people lose financial advantage or if people are unable to sustain their tenancy or their rent or their mortgage repayments.
“Those things have much broader implications and some of those implications are around mental health.”
Asked what she thinks the impact of the pandemic has been on Australians’ mental health so far, Vine suggests it might be too early to say for sure.
“We know there has been increased demand on help lines, but also know a lot of those calls are around loneliness or social connection. Loneliness is not a mental illness, but it is a very unpleasant emotion.
“We can say people are more worried, because there are so many uncertainties. By and large, we love to know stuff, we love to feel we are being fully informed. We don’t like surprises. That’s been a real problem during the pandemic.
“There has been that uncertainty about when things will shift back, what the impact on employment will be in the longer term.
“I think we’re still living with that uncertainty, although probably a bit less.”
In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123.Other international suicide helplines can be found at befrienders.org