Our suicide research is clear: Australia needs more urgent action to address the Covid-19 fallout
The potential mental health and suicide impacts resulting from the massive economic and social dislocation caused by Covid-19 are front and centre internationally. In Australia the prime minister, Scott Morrison, has repeated his personal commitment to minimising these effects, and particularly to preventing youth suicide. In reality, however, his government has been awaiting the final report of the Productivity Commission before considering any serious reform to our highly dysfunctional mental health system.
In the last two weeks, the PM’s preCovid-19 mental health plan (much like his economic agenda) has been blown way off course by the harsh reality of the current crisis. In response to the predicted 25-50% increase in suicides over the next five years (released by the Brain and Mind Centre), the health minister, Greg Hunt, appointed a new deputy chief medical officer for mental health, Dr Ruth Vine, to support the Australian Health Protection Principal Committee (AHPPC). For the first time, Covid-19-precipitated mental ill health was given the same status as physical ill health.
As was the case early in the pandemic, our statistical modelling of mental ill health and suicides is designed to assist the AHPPC to develop the best possible medical advice. The modelling emphasises the extent to which those in rural and regional areas are at high risk, due to higher pre-existing rates of suicide, youth unemployment and lower educational achievement. Unlike other national crises, such as wars (where unemployment and suicide rates go down), economic recessions preferentially hurt those who are already most vulnerable.
Most importantly, the modelling details what economic, social and health measures have the greatest prospects for preventing catastrophic outcomes. Top of the list are the effectiveness of jobkeeper and jobseeker. Do they really connect with those who are most at risk, particularly in rural and regional Australia? Educational and training supports for young people are critical. Preventing further social dislocation, largely by supporting employment, education and welfare recipients over the longer-term, really matters.
Although economic and social interventions have the most benefits, a functional mental health system is an essential safety net. However, not all initiatives are equally useful. Public awareness campaigns, helplines and more entry systems that do not connect with specialised care are of little value. Rather bizarrely, given the commonwealth’s previous investments in 2019 in a national campaign (#YouCanTalk), we are now being cautioned against open discussion of suicide or the scale of the challenge we face. Many have retreated to the discredited approach that open discussion undermines hope or generates a selffulfilling prophecy.
By contrast, the modelling emphasises that the big ticket items that work are more specialised care outside of hospitals, aftercare of those who have self-harmed and informationtechnology based coordination and delivery of care. Urgent reform of the Medicare schedules, public purchasing of specialist services from the private sector and direct financial support for state services are all essential.
So, what has been the Morrison government’s response? Following national cabinet on 15 May, Hunt released a National Mental Health and Wellbeing Pandemic Response Plan, detailing 10 priorities, three enablers, seven principles and 75 actions. The key outcome, as described by Morrison’s suicide prevention adviser, Christine Morgan, (who is also the CEO of the national mental health commission) was simply reaching an agreement with the states and territories. No implementation timetable or scale of investment is described. No urgency to make the key structural decisions or finance the key priorities is evident.
Concurrently, Hunt reported no increase in suicide in three states so far this year – that is, for the period prior to the economic impacts of Covid-19. From a modelling perspective, however, the key number is the number of people who have lost their jobs, now estimated at more than 600,000. All other real-time mental health measures (eg national surveys of mental distress, calls to helplines) are heading up.
While the commonwealth announced $48.1m in additional funding, including $10.4m for another national communications strategy, none of the funded measures have any specific relationship to the big ticket items suggested by the modelling.
On Monday, Hunt announced the outcomes of previous research grants, including $17m in awards to various academic institutions to conduct mental health and suicide prevention research. Another round of $3m in new grant applications was also announced. While investments in mental health research are always welcome, these announcements do not constitute any new investments in the services recommended by the modelling.
In recent public comments, Dr Vine has stated that she is not aware of the details of the modelling. Morgan has emphasised the need to focus on hope and enhanced social connectedness.
The clear questions that need to be answered are: Just what actions are our national cabinet planning to take and with what urgency? Are they committed to taking those economic, social and health services actions that will have the greatest impact? As decisive and timely actions are not yet on the agenda, many are left to ask: if not now, when?
• Professor Ian Hickie AM is codirector health and policy, Brain and Mind Centre, University of Sydney and former national mental health commissioner (2012-18)
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• 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